2025 AHIP Module 4 - Communications and Marketing Rules for Medicare Advantage and Part D Plans

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 do? a. 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. b. Tell the client that she should also consider non-health products (such as cash value life insurance) to meet some of her health needs and offer to submit a life insurance application to see if client Jones is insurable. c. Solicit and complete the enrollment application in September and wait until the open enrollment date to submit it so that the client does not purchase a plan through another agent. d. Tell the client

a

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? a. Yes. When an event has been advertised as "educational," discussing plan-specific premiums is impermissible. b. Yes. Whether or not an event has been advertised as "educational" or a "sales presentation," discussing plan-specific information is impermissible. c. This action is permissible. Handing out enrollment forms, on the other hand, would not be permissible. d. Attendees expect some "puffery" at any event on a product in which they may be potentially interested.

a

Winthrop Brokerage wishes to place an advertisement in the local newspaper that says: "We offer Medicare Advantage plans offered by AB Health and Top Choice Health. Contact us if you would like to learn more." Which of the following best describes the obligation(s) of Winthrop Brokerage regarding the advertisement? a. Winthrop Brokerage does not need to submit the advertisement to CMS for prior approval because it does not include information about the plans' benefits structures, cost-sharing, or information about measures or ranking standards. b. Winthrop Brokerage must submit the advertisement to CMS for prior approval because it is considered general audience marketing. c. Winthrop Brokerage must submit the advertisement to CMS for prior approval because it meets the definition of marketing material. d. Winthrop Brokerage does not need to submit the advertisement to CMS for prior approval and may also include

a

If you are to comply with Medicare's guidance regarding educational events, which of the following would be acceptable activities? a. You may discuss plan-specific premiums and benefits. b. You may have a stack of enrollment forms on the table in your booth but may only pass them out to individuals who request one. c. You may ask passers-by to provide you with their names, addresses, and phone numbers so that you can contact them later with information about the plan(s) you represent. d. You may distribute business cards to individuals who request information on how to contact you for further details on the plan(s) you represent.

d

You market many different types of insurance and ordinarily you spend time each evening calling potential clients. To comply with requirements for marketing Medicare Advantage and Part D plans, what must you do about contacting potential clients to market those plans? a. You will have to avoid calling any potential client unless he or she initiates contact with you and specifically asks that you give him or her a call. b. As long as you market only health-related products, you can make an initial call to any beneficiary but then must honor "do not call again" requests. c. You only need to comply with the requirements of federal and state "Do Not Call" registries. d. Because the Medicare health plans are important federal programs for beneficiaries, federal law regarding the "Do Not Call" registry is waived so you will be able to call and enroll beneficiaries over the telephone.

a

You plan to participate in an educational event sponsored by a large regional health care system. One of your colleagues suggests that you do a presentation on one of the Medicare Health plans you market and modify it to include information about preventive screening tests showcased at the event. How should you respond to your colleague's suggestion? a. You should tell your colleague no because participation in an educational event may not include a sales presentation. b. Whether a sales presentation is allowed at this educational event is entirely up to the sponsor of the event. c. As long as your sales presentation includes information that is about healthy living or clinically effective screening exams, you could talk about the Medicare plans in your presentation. d. You should tell your colleague no, because marketing representatives are not permitted to participate, in any way, in an educational event.

a

One of your colleagues argues that it is better to focus your time and energy exclusively on neighborhoods with single-family homes. He further argues that their older owners are more likely to have higher incomes and purchase the Medicare Advantage products you represent compared to those living in apartment complexes. How should you respond? a. This is not a discriminatory activity since this is merely a widely recommended sales practice. b. This could be considered discriminatory activity and a prohibited practice. c. This could be considered discriminatory activity, but it is not a prohibited practice. d. This is not a discriminatory activity since it is based on the incomes of likely prospects and not based on race or gender.

b

You will be holding a sales event soon, at which you would like to offer door prizes to attendees. Under guidelines from the Medicare agency, what types of gifts or prizes would not be allowed in this situation a. A gift card to Starbucks worth $5. b. Gift cards or gift certificates of $15 or less that can be readily converted to cash. c. Two or more gifts whose combined value does not exceed $15 d. Gifts of nominal retail value ($15 or less)

b

By contacting plans available in your area, you have learned that the plan you represent has a significantly lower monthly premium than the others. Furthermore, you see that the plan you represent has a unique benefits package. What should you do to make sure your clients know about these pieces of information? a. You have anecdotal evidence that your plan is the best and can say so to your clients. b. You may create a chart based on anecdotal hearsay that lists each plan in the beneficiary's service area along with the benefits of the plan you represent, compared to those of the other available plans. c. You may make comparisons between plans if you can support them with studies or statistical data and such comparisons are factually based and referenced. d. To obtain information about another plan's benefits, you must refer clients to those other plans, because you may not provide comparative information, regard

c

During a sales presentation to Ms. Daley for a Medicare Advantage plan that has a 5-star rating in customer service and care coordination, and received an overall plan performance rating of a 4-star, which of the following would be the best statement to say to her? a. The Medicare Advantage plan received the best star rating in customer service and care coordination. b. This Medicare Advantage plan is a 5-star rated plan due to its high rating in customer service. c. The Medicare Advantage plan received a 5-star rating in customer service and care coordination with an overall performance rating of 4 stars. d. The Medicare Advantage plan is a top-rated plan.

c

Mr. Prentice has many clients who are Medicare beneficiaries. He should review the Centers for Medicare & Medicaid Services (CMS) Communication and Marketing Guidelines to ensure he is compliant with which type of products. a. Section 1332 waiver plans. b. Private long-term care policies for Medicare beneficiaries. c. Medicare Advantage (MA) and Prescription Drug (PDP) plans. d. Medigap plans.

c

Next week you will be participating in your first "educational event" for prospective enrollees. To be sure that you do not violate any of the applicable guidelines, in what activities should you plan to engage? a. You should plan to conduct sales presentations but must not accept enrollment forms. b. You should plan to conduct sales presentations and accept enrollment forms. c. You should plan to ensure that the educational event is informative and must not conduct a sales presentation or distribute or accept enrollment forms at the event. d. You should plan to answer questions and accept enrollment forms.

c

You would like to market a MA plan at a neighborhood pharmacy. What should you keep in mind to comply with the marketing requirements for MA plans? a. You may not market in a pharmacy if you are not a pharmacist. b. You must set up your table and make marketing presentations only in common areas, but you may accept enrollment applications anywhere in the pharmacy. c. You must set up your table, make marketing presentations, and accept enrollment applications only in common areas outside of where the patient waits for services from the pharmacist. d. You must set up your table, make marketing presentations, and accept enrollment applications near the pharmacy counter where people wait for their prescriptions.

c

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? a. You must set an appointment for another time, at least 48 hours from the point when she walked into your office. b. Before speaking with the individual, you must inquire as to her eligibility for MA and Part D plans and then complete a scope of appointment form for the plans for which she is eligible. c. You do not have to do anything. You may proceed with the discussion and enroll the individual if she so desires. d. You must have her sign a scope of appointment form, indicating which products she wishes to discuss. You may then proceed with the discussion.

d

When you market Medicare Advantage and Part D plans, what may you offer as a gift to induce enrollment in a plan? a. You may give enrollees post-enrollment gifts to compensate them for their time. b. You may provide any gift to induce enrollment if its retail value does not exceed $25 in value. c. You may provide cash promotions or giveaways as long they are offered to everyone, whether they are Medicare beneficiaries or the general public. d. You may provide gifts or prizes to all potential enrollees during an event that does not exceed $15 in retail value.

d

While making an appointment to discuss Medicare Advantage (MA) and Part D plans with a potential enrollee, you are asked to describe other types of insurance products that your client might wish to purchase. What additional types of insurance can you present during the MA and Part D marketing appointments? a. You can only present the end of life and life insurance lines of business. b. You can present any line of business you represent as long as you obtain the beneficiary's permission first. c. You cannot present any line of business other than MA or Part D during such a presentation, regardless of whether it is health care related. d. You can present only health care related lines of business but must obtain the beneficiary's permission to do so before the presentation occurs and document that you have obtained that permission.

d

You are mailing invitations to new Medicare beneficiaries for a marketing event. You want an idea of how many people to expect, so you would like to request RSVPs. What should you keep in mind? a. You may not require RSVPs, but when people arrive, you may require the completion of contact information on a sign-up sheet. b. You are not permitted to request RSVPs, so you will need to find a different way to estimate how many people are coming. c. You may require RSVPs and an e-mail address so you can follow up in the event of a cancellation. d. You may request RSVPs, but you are not permitted to require contact information.

d

You are meeting with Mrs. Hall in her home. On her scope of appointment form, she asked to discuss Medicare Advantage plans. During the meeting, she asked to discuss a stand-alone prescription drug plan. She is leaving the next day to visit her family for a week in another state, so she needs to decide before she leaves. What must happen before that additional discussion can take place? a. You must make a telephone call from a location outside Mrs. Hall's home to ensure that the discussion of the prescription drug plan can take place. b. Since Mrs. Hall is leaving the state, you can immediately present her with information on the prescription drug plan, so she can decide before it is too late. c. You must refer Mrs. Hall to another agent for her to be able to engage in such a discussion. d. Since Mrs. Hall specifically asked that you discuss the stand-alone Part D plan, you may do so, as long as she signs a new s

d

You have set up an appointment for an in-home sales presentation with Mrs. Fernandez, who expressed interest in the Medicare plans you represent. In preparation for the sales presentation, what must you do? a. Before arriving at her home, request approval from CMS to use special materials that you developed to explain the plan benefits instead of the plan's materials, which you think are confusing. b. At the time you arrive for the appointment, let her know which products you will be going over. c. Seven days before the appointment, you must notify the company(ies) you represent regarding which products you will be presenting, so they can report the nature of your meeting to the Medicare agency. d. Before conducting the presentation, obtain and document having obtained her permission to visit, along with her interest in the specific products you will present.

d

Your colleague works at a third-party marketing organization (TMO) and she said she did not need to take the Medicare training for brokers and agents or pass a test to market Medicare plans since her contract is with the TMO, not the plans that have the products she sells. What could you say to her? a. You could tell her she was right, but new rules require her to take the training and pass the test at least every other year. b. You could tell her she is right and ask if you could get a contract with the TMO too. c. You could tell her she is wrong and that only agents employed by the plans are exempt from training and testing requirements. d. You could tell her she is wrong, and that only agents selling employer/union group plans are permitted an exemption from testing, but some employer/union group plans may require testing to promote agent compliance with CMS marketing requirements.

d