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AHIP 2024/ 247 Updated Questions with Definitive Solutions

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AHIP 2024/ 247 Updated Questions with Definitive Solutions. Terms like: A client wants to give you an enrollment application on October 1 before the beginning of the Annual Election Period because he is leaving on vacation for two weeks and does not want to forget about turning it in. What shou...

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  • July 6, 2024
  • 69
  • 2023/2024
  • Exam (elaborations)
  • Questions & answers

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  • AHIP 2024 ex
  • AHIP 2024 ex

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AHIP 2024/ 247 Updated Questions
with Definitive Solutions.
A client wants to give you an enrollment application on October 1 before the
beginning of the Annual Election Period because he is leaving on vacation for two
weeks and does not want to forget about turning it in. What should you tell him? -
Answer: You must tell him you are not permitted to take the form. If he sends the
form directly to the plan, the plan will process the enrollment on the day the
Annual Election Period begins.


A Medicare beneficiary has walked into your office and requested that you sit
down with her and discuss her options under the Medicare Advantage program.
Before engaging in such a discussion, what should you do? - Answer: You must



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,have her sign a scope of appointment form, indicating which products she wishes
to discuss. You may then proceed with the discussion.


A person drops off a prescription for a beneficiary who is a "regular" customer.
The prescription is for a controlled substance with a quantity of 160. This
beneficiary normally receives a quantity of 60, not 160. You review the
prescription and have concerns about possible forgery. What is your next step? -
Answer: Call the prescriber to verify the quantity


A sales agent, employed by the Sponsor's first-tier, downstream, or related entity
(FDR), submitted an application for processing and requested two things: 1) to
back-date the enrollment date by one month, and 2) to waive all monthly
premiums for the beneficiary. What should you do? - Answer: Process the
application properly (without the requested revisions)—inform your supervisor
and the compliance officer about the sales agent's request


ABC is a Medicare Advantage (MA) plan sponsor. It would like to use its enrollees'
information to market non-health related products such as life insurance and
annuities. Which statement best describes ABC's obligation to its enrollees
regarding marketing such products? - Answer: It must obtain a HIPAA compliant
authorization from an enrollee that indicates the plan or plan sponsor may use
their information for marketing purposes.


Able, Baker, and Charles are engaged in the marketing to and enrollment of
beneficiaries into Medicare health plans. Mr. Able is an independent agent paid

2|Page

,directly by a health plan. Ms. Baker is an independent agent paid through a field
marketing organization (FMO). Mr. Charles is an independent agent paid for his
work by a third-party marketing organization (TMO). How do the CMS
compensation rules apply to these three agents? - Answer: Baker and Charles are
subject to CMS compensation rules because they are paid by third parties. Able is
not because he is paid directly by a health plan.


Abuse involves payment for items or services when there is no legal entitlement
to that payment and the provider has not knowingly or intentionally
misrepresented facts to obtain payment. - Answer: True


ACA Section 1557 rules for disability concern - Answer: policies and procedures,
physical access, and communication.


Agent Daniel Webber has properly set up a sales appointment to meet with client
Edward Young at Agent Webber's office. At the agreed upon appointment time,
Mr. Young arrives with his elderly neighbor - Clara Burton, who wants to learn
about her Medicare Advantage options. What should Agent Daniel Webber do? -
Answer: After executing a scope of appointment (SOA) with Clara Burton, meet
with Edward Young and Clara Burton to discuss their Medicare Advantage options.


Agent Harriet Walker has recently begun marketing Medicare Advantage and
related products aimed at meeting the needs of senior citizens. Client Mildred
Jones has expressed interest in a Medicare Advantage plan. It is now the
beginning of September. If you were in Agent Walker's position, what would you

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, do? - Answer: Inquire whether the client qualifies for a special enrollment period,
and if not, solicit an enrollment application once the annual open enrollment
election period begins on October 15th.


Agent Jennings makes a presentation on Medicare advertised as an educational
event. Agent Jennings distributes materials that are solely educational. However,
she gives a brief presentation that mentions plan-specific premiums. Is this a
prohibited activity at an event that has been advertised as educational? - Answer:
Yes. When an event has been advertised as "educational," discussing plan-specific
premiums is impermissible.


Agent John Miller is meeting with Jerry Smith, a new prospect. Jerry is currently
enrolled in Medicare Parts A and B. Jerry has also purchased a Medicare
Supplement (Medigap) plan which he has had for several years. However, the plan
does not provide drug benefits. How would you advise Agent John Miller to
proceed? - Answer: Tell prospect Jerry Smith that he should consider adding a
standalone Part D prescription drug coverage policy to his present coverage.


Agent Martinez wishes to solicit Medicare Advantage prospects through e-mail
and asks you for advice as to whether this is possible. What should you tell her? -
Answer: Marketing representatives may initiate electronic contact through e-mail
but an opt-out process must be provided.




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