AHIP 2027 Medicare Certification Exam
Study Guide | Complete Practice Question
Bank with Answers and Rationales | Latest
Updated Edition – Graded A+
Question 1
Peter Miller heads a local association of medical professionals - Better Health. The
association has many members who are retired or approaching retirement age. Peter
comes to you for advice as to whether the association can establish an employer group
waiver plan (EGWP) for these members. What do you say?
A. It is illegal for you to sell Mr. Harvey a Medigap plan if he is enrolled in an MA plan,
and besides, Medigap only works with Original Medicare.
B. No, Better Health is a professional association whose membership is based on their
profession, not an individual employer or former employer.
C. No, when an individual enrolls in a Medicare Advantage (MA) plan after starting a
course of treatment, there is a minimum 90-day transition period during which the MA
organization may not disrupt or require authorization for the active course of treatment.
D. Yes, there is no cost-sharing for the shingles vaccine, even in the deductible phase of
her prescription drug plan, because it is an adult vaccine recommended by the Advisory
Committee on Immunization Practices (ACIP).
Answer: B
Rationale: An employer group waiver plan (EGWP) must be established by an
employer or former employer, not a professional association based on membership in a
profession.
Question 2
Mrs. Stark is enrolled in her state's Medicaid program in addition to Medicare. What
should she be aware of when considering enrollment in a Medicare Advantage (MA)
plan?
A. She cannot enroll in an MA Medical Savings Account (MSA) plan.
B. She will automatically be enrolled in a Medicare Advantage plan if she does nothing.
C. She cannot enroll in a Medicare Advantage plan because she is under 65.
D. She must drop her Medicaid coverage to enroll in any Medicare Advantage plan.
Answer: A
pg. 1
,Rationale: Medicare beneficiaries with Medicaid cannot enroll in MA MSA plans. They
can enroll in other MA plan types and remain eligible for Medicaid benefits.
Question 3
Mrs. Huang is a retired federal worker with coverage under a Federal Employee Health
Benefits (FEHB) plan that includes creditable drug coverage. She will soon turn 65 and
become Medicare-eligible for the first time. What issues might she consider concerning
whether to enroll in a Medicare prescription drug plan?
A. She could compare the coverage to see if the Medicare Part D plan offers better
benefits and coverage than the FEHB plan for the specific medications she needs and
whether any additional benefits are worth the Part D premium costs on top of her FEHB
contribution.
B. Conrad is 64, retiring soon, and considering enrollment in his employer-sponsored
MA retiree group health plan that includes drug coverage with nominal copays. He
heard about a neighbor's MA-PD plan that you represent and because he takes
numerous prescription drugs, he is considering signing up for it. What should you tell
him?
C. Mr. Solomon has drug coverage through his former employer's retiree plan. He is
concerned about the Part D premium penalty if he does not enroll in a Medicare
prescription drug plan but does not want to purchase extra coverage that he will not
need. What should you tell him?
D. Mr. Hardin is interested in the Medicare Advantage (MA) PPO plan that you
represent. It is one of three plans operated by the same organization in Mr. Hardin's
area. The MA PPO plan does not include drug coverage, but the other two plans do. Mr.
Hardin likes the PPO plan that does not include drug coverage and intends to obtain his
drug coverage through a stand-alone Medicare prescription drug plan. What should you
tell him about this situation?
Answer: A
Rationale: Individuals with FEHB coverage should compare costs and benefits
between their FEHB plan and Part D options, considering premiums, formularies, and
coverage.
Question 4
Mary Alice is covered by Original Medicare Parts A and B. During her initial enrollment
period she purchased a standard Medigap Plan A policy from you because of its
relatively low cost. After speaking to her friend Stan, she asks whether any of the
following are "core benefits" covered in her plan?
A. All Medicare Advantage (MA) plans must have a "maximum out-of-pocket" limit
(known as "MOOP") for Part A and Part B benefits. Once the MA plan member pays a
pg. 2
,specified amount of cost-sharing that health plan pays 100 percent of the medical
services covered.
B. I. Coverage for Part A hospital coinsurance amount
II. Coverage for 365 additional days during an insured's lifetime after Medicare benefits
end
III. Coverage for 3 pints of blood
C. Gary Summers is enrolled in Ajax Medicare Advantage plan. Gary has recently faced a
series of health issues leading to substantial out-of-pocket expenses. Gary understands
that in Original Medicare (Parts A and B) there is no annual out-of-pocket maximum.
He asks you if the same is true of his Medicare Advantage plan? How do you respond?
D. Mrs. McCarty is in good health, uses a single prescription, and lives independently in
her own home. She is attracted by the idea of maintaining control over a Medical
Savings Account (MSA) but is not sure if the plan associated with the account will fit her
needs. What specific piece of information about a Medicare MSA plan would it be
important for her to know, before enrolling in such a plan?
Answer: B
Rationale: Core benefits of Medigap Plan A include coverage for Part A hospital
coinsurance, 365 additional lifetime hospital days after Medicare benefits are exhausted,
and coverage for the first 3 pints of blood.
Question 5
Mr. Peters understands that there is a standard Medicare Part D prescription drug
benefit, but when he looks at information on various plans available in his area, he sees
a wide range in what they charge for deductibles, premiums, and cost-sharing. How can
you explain this to him?
A. Part D covers prescription drugs and she should look at her premiums, formulary,
and cost-sharing among other factors to see if they have changed.
B. No, he cannot execute the enrollment for her. He must have a legal authorization,
under state law that explicitly allows him to make health care decisions for his mother.
C. She cannot enroll in an MA Medical Savings Account (MSA) plan.
D. Medicare Part D drug plans may have different benefit structures, but on average,
they must all be at least as good as the standard model established by the government.
Answer: D
Rationale: While all Part D plans must offer at least the standard Medicare benefit,
they can vary in premiums, deductibles, cost-sharing, and formularies, as long as the
overall value is actuarially equivalent to or better than the standard model.
Question 6
You are doing a sales presentation for Ms. Yu and her son. Ms. Yu has some cognitive
pg. 3
, impairment and her son informs you that he has power of attorney to only make
financial not health care decisions for her. Can he execute the enrollment for her?
A. She should remain in Original Medicare until the annual election period running
from October 15 to December 7, during which she can select an MA plan.
B. Part D covers prescription drugs and she should look at her premiums, formulary,
and cost-sharing among other factors to see if they have changed.
C. No, he cannot execute the enrollment for her. He must have a legal authorization,
under state law that explicitly allows him to make health care decisions for his mother.
D. She cannot enroll in an MA Medical Savings Account (MSA) plan.
Answer: C
Rationale: A financial power of attorney does not grant authority to make health care
decisions. The son would need a health care power of attorney or legal guardianship to
enroll his mother.
Question 7
Mrs. Waller is a retiree with substantial income. She is enrolled in an MA-PD plan and
was disappointed with the service she received from her primary care physician because
she was told she would have to wait five weeks to get an appointment when she was
feeling ill. She called you to ask what she could do so she would not have to put up with
such poor access to care. What could you tell her?
A. She should call the doctor's office to complain since the plan cannot do anything
about the doctor's schedule.
B. She should not expect to get in to see her doctor any more quickly since she is a
Medicare patient.
C. She could file a grievance with her plan to complain about the lack of timeliness in
getting an appointment.
D. She should call the doctor's office to complain since the plan cannot do anything
about the doctor's schedule.
Answer: C
Rationale: Grievances are used to address complaints about quality of care, including
access issues such as long wait times for appointments.
Question 8
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. Pens, pencils, and notepads with the agent's name and company logo.
B. Door prizes worth $10 or less that are not convertible to cash.
C. Gift cards or gift certificates of $15 or less that can be readily converted to cash.
pg. 4
Study Guide | Complete Practice Question
Bank with Answers and Rationales | Latest
Updated Edition – Graded A+
Question 1
Peter Miller heads a local association of medical professionals - Better Health. The
association has many members who are retired or approaching retirement age. Peter
comes to you for advice as to whether the association can establish an employer group
waiver plan (EGWP) for these members. What do you say?
A. It is illegal for you to sell Mr. Harvey a Medigap plan if he is enrolled in an MA plan,
and besides, Medigap only works with Original Medicare.
B. No, Better Health is a professional association whose membership is based on their
profession, not an individual employer or former employer.
C. No, when an individual enrolls in a Medicare Advantage (MA) plan after starting a
course of treatment, there is a minimum 90-day transition period during which the MA
organization may not disrupt or require authorization for the active course of treatment.
D. Yes, there is no cost-sharing for the shingles vaccine, even in the deductible phase of
her prescription drug plan, because it is an adult vaccine recommended by the Advisory
Committee on Immunization Practices (ACIP).
Answer: B
Rationale: An employer group waiver plan (EGWP) must be established by an
employer or former employer, not a professional association based on membership in a
profession.
Question 2
Mrs. Stark is enrolled in her state's Medicaid program in addition to Medicare. What
should she be aware of when considering enrollment in a Medicare Advantage (MA)
plan?
A. She cannot enroll in an MA Medical Savings Account (MSA) plan.
B. She will automatically be enrolled in a Medicare Advantage plan if she does nothing.
C. She cannot enroll in a Medicare Advantage plan because she is under 65.
D. She must drop her Medicaid coverage to enroll in any Medicare Advantage plan.
Answer: A
pg. 1
,Rationale: Medicare beneficiaries with Medicaid cannot enroll in MA MSA plans. They
can enroll in other MA plan types and remain eligible for Medicaid benefits.
Question 3
Mrs. Huang is a retired federal worker with coverage under a Federal Employee Health
Benefits (FEHB) plan that includes creditable drug coverage. She will soon turn 65 and
become Medicare-eligible for the first time. What issues might she consider concerning
whether to enroll in a Medicare prescription drug plan?
A. She could compare the coverage to see if the Medicare Part D plan offers better
benefits and coverage than the FEHB plan for the specific medications she needs and
whether any additional benefits are worth the Part D premium costs on top of her FEHB
contribution.
B. Conrad is 64, retiring soon, and considering enrollment in his employer-sponsored
MA retiree group health plan that includes drug coverage with nominal copays. He
heard about a neighbor's MA-PD plan that you represent and because he takes
numerous prescription drugs, he is considering signing up for it. What should you tell
him?
C. Mr. Solomon has drug coverage through his former employer's retiree plan. He is
concerned about the Part D premium penalty if he does not enroll in a Medicare
prescription drug plan but does not want to purchase extra coverage that he will not
need. What should you tell him?
D. Mr. Hardin is interested in the Medicare Advantage (MA) PPO plan that you
represent. It is one of three plans operated by the same organization in Mr. Hardin's
area. The MA PPO plan does not include drug coverage, but the other two plans do. Mr.
Hardin likes the PPO plan that does not include drug coverage and intends to obtain his
drug coverage through a stand-alone Medicare prescription drug plan. What should you
tell him about this situation?
Answer: A
Rationale: Individuals with FEHB coverage should compare costs and benefits
between their FEHB plan and Part D options, considering premiums, formularies, and
coverage.
Question 4
Mary Alice is covered by Original Medicare Parts A and B. During her initial enrollment
period she purchased a standard Medigap Plan A policy from you because of its
relatively low cost. After speaking to her friend Stan, she asks whether any of the
following are "core benefits" covered in her plan?
A. All Medicare Advantage (MA) plans must have a "maximum out-of-pocket" limit
(known as "MOOP") for Part A and Part B benefits. Once the MA plan member pays a
pg. 2
,specified amount of cost-sharing that health plan pays 100 percent of the medical
services covered.
B. I. Coverage for Part A hospital coinsurance amount
II. Coverage for 365 additional days during an insured's lifetime after Medicare benefits
end
III. Coverage for 3 pints of blood
C. Gary Summers is enrolled in Ajax Medicare Advantage plan. Gary has recently faced a
series of health issues leading to substantial out-of-pocket expenses. Gary understands
that in Original Medicare (Parts A and B) there is no annual out-of-pocket maximum.
He asks you if the same is true of his Medicare Advantage plan? How do you respond?
D. Mrs. McCarty is in good health, uses a single prescription, and lives independently in
her own home. She is attracted by the idea of maintaining control over a Medical
Savings Account (MSA) but is not sure if the plan associated with the account will fit her
needs. What specific piece of information about a Medicare MSA plan would it be
important for her to know, before enrolling in such a plan?
Answer: B
Rationale: Core benefits of Medigap Plan A include coverage for Part A hospital
coinsurance, 365 additional lifetime hospital days after Medicare benefits are exhausted,
and coverage for the first 3 pints of blood.
Question 5
Mr. Peters understands that there is a standard Medicare Part D prescription drug
benefit, but when he looks at information on various plans available in his area, he sees
a wide range in what they charge for deductibles, premiums, and cost-sharing. How can
you explain this to him?
A. Part D covers prescription drugs and she should look at her premiums, formulary,
and cost-sharing among other factors to see if they have changed.
B. No, he cannot execute the enrollment for her. He must have a legal authorization,
under state law that explicitly allows him to make health care decisions for his mother.
C. She cannot enroll in an MA Medical Savings Account (MSA) plan.
D. Medicare Part D drug plans may have different benefit structures, but on average,
they must all be at least as good as the standard model established by the government.
Answer: D
Rationale: While all Part D plans must offer at least the standard Medicare benefit,
they can vary in premiums, deductibles, cost-sharing, and formularies, as long as the
overall value is actuarially equivalent to or better than the standard model.
Question 6
You are doing a sales presentation for Ms. Yu and her son. Ms. Yu has some cognitive
pg. 3
, impairment and her son informs you that he has power of attorney to only make
financial not health care decisions for her. Can he execute the enrollment for her?
A. She should remain in Original Medicare until the annual election period running
from October 15 to December 7, during which she can select an MA plan.
B. Part D covers prescription drugs and she should look at her premiums, formulary,
and cost-sharing among other factors to see if they have changed.
C. No, he cannot execute the enrollment for her. He must have a legal authorization,
under state law that explicitly allows him to make health care decisions for his mother.
D. She cannot enroll in an MA Medical Savings Account (MSA) plan.
Answer: C
Rationale: A financial power of attorney does not grant authority to make health care
decisions. The son would need a health care power of attorney or legal guardianship to
enroll his mother.
Question 7
Mrs. Waller is a retiree with substantial income. She is enrolled in an MA-PD plan and
was disappointed with the service she received from her primary care physician because
she was told she would have to wait five weeks to get an appointment when she was
feeling ill. She called you to ask what she could do so she would not have to put up with
such poor access to care. What could you tell her?
A. She should call the doctor's office to complain since the plan cannot do anything
about the doctor's schedule.
B. She should not expect to get in to see her doctor any more quickly since she is a
Medicare patient.
C. She could file a grievance with her plan to complain about the lack of timeliness in
getting an appointment.
D. She should call the doctor's office to complain since the plan cannot do anything
about the doctor's schedule.
Answer: C
Rationale: Grievances are used to address complaints about quality of care, including
access issues such as long wait times for appointments.
Question 8
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. Pens, pencils, and notepads with the agent's name and company logo.
B. Door prizes worth $10 or less that are not convertible to cash.
C. Gift cards or gift certificates of $15 or less that can be readily converted to cash.
pg. 4
