AHIP MCQ 4 — Questions and Answers
Question 1: An agent sells a Medicare Advantage plan to a beneficiary who was not eligible because they were not enrolled in Medicare Parts A and B. What should happen?
- The plan enrollment is automatically corrected by CMS
- The plan can waive the requirement for long-standing customers
- The enrollment is invalid and must be voided; the beneficiary cannot be enrolled (Correct answer)
- The agent may enroll the beneficiary in Part B retroactively
Correct answer: The enrollment is invalid and must be voided; the beneficiary cannot be enrolled
Enrollment in a Medicare Advantage plan requires the beneficiary to have both Medicare Parts A and B; ineligible enrollments are voided.
Question 2: What is the Medicare Annual Enrollment Period (AEP) for Medicare Advantage and Part D plans?
- January 1 – March 31
- October 15 – December 7 (Correct answer)
- November 1 – January 31
- July 1 – September 30
Correct answer: October 15 – December 7
The AEP runs October 15 through December 7 each year; plan changes made during this period take effect January 1.
Question 3: Under CMS marketing guidelines, which activity is PROHIBITED for Medicare Advantage plan agents?
- Hosting an educational seminar at a library
- Conducting sales presentations at a healthcare provider's office during patient care hours (Correct answer)
- Distributing CMS-approved plan materials at a community center
- Making outbound calls to existing enrolled members about plan renewals
Correct answer: Conducting sales presentations at a healthcare provider's office during patient care hours
CMS prohibits sales activities in healthcare provider settings during patient care hours to prevent inappropriate influence on beneficiaries.
Question 4: Which of the following is a characteristic of a Preferred Provider Organization (PPO) health plan?
- Members must use only in-network providers
- Members need a referral to see any specialist
- Members can see out-of-network providers at higher cost-sharing (Correct answer)
- The plan has no deductible for any services
Correct answer: Members can see out-of-network providers at higher cost-sharing
PPO plans allow members to use out-of-network providers, but cost-sharing is higher than for in-network care.
Question 5: A dual-eligible beneficiary (enrolled in both Medicare and Medicaid) is automatically eligible for which Part D program?
- PACE
- Extra Help (Low Income Subsidy) (Correct answer)
- Medicare Savings Program
- CHIP
Correct answer: Extra Help (Low Income Subsidy)
Full dual-eligible beneficiaries automatically qualify for Extra Help (Low Income Subsidy), which reduces Part D premiums, deductibles, and cost-sharing.
Question 6: How long must Medicare Advantage organizations retain marketing materials and records of agent/broker activities under CMS requirements?
- 1 year
- 3 years
- 5 years
- 10 years (Correct answer)
Correct answer: 10 years
CMS requires Medicare Advantage organizations to retain marketing materials and agent activity records for a minimum of 10 years.
Question 7: Which of the following best describes 'guaranteed issue' rights in the context of Medigap plans?
- The right to purchase any Medigap plan at any time without medical underwriting
- The right to enroll in a Medigap plan without medical underwriting during specific qualifying events (Correct answer)
- The right to receive guaranteed lower premiums when enrolling during open enrollment
- The right to switch Medigap plans twice per year without underwriting
Correct answer: The right to enroll in a Medigap plan without medical underwriting during specific qualifying events
Guaranteed issue rights allow beneficiaries to buy certain Medigap plans without medical underwriting only during specific qualifying events such as losing employer coverage.
AHIP MCQ 4
An agent sells a Medicare Advantage plan to a beneficiary who was not eligible because they were not enrolled in Medicare Parts A and B.
What should happen?