AHIP Final Exam Test Questions and Answers- Latest
2024-2025 (Verified Answers)
Mrs. Mulcahy is concerned that she may not qualify for enrollment in a Medicare prescription
drug plan because, although she is entitled to Part A, she is not enrolled under Medicare Part
B. What should you tell her? - ansEveryone who is entitled to Part A or enrolled under Part B is
eligible to enroll in a Medicare prescription drug plan. As long as Mrs. Mulcahy is entitled to
Part A, she does not need to enroll under Part B before enrolling in a prescription drug plan.
Mrs. Quinn has just turned 65, is in excellent health, and has a relatively high income. She
uses no medications and sees no reason to spend money on a Medicare prescription drug plan
if she does not need the coverage. What could you tell her about the implications of such a
decision? - ansIf she does not sign up for a Medicare prescription drug plan as soon as she is
eligible to do so, if she does sign up at a later date, her premium will be permanently
increased by 1% of the national average premium for every month that she was not covered.
Mrs. Radford asks whether there are any special eligibility requirements for Medicare
Advantage. What should you tell her? - ansMrs. Radford must be entitled to Part A and enrolled
in Part B to enroll in Medicare Advantage.
Mrs. Ramos is considering a Medicare Advantage PPO and has questions about which
providers she can go to for her health care. What should you tell her? - ansMrs. Ramos can
obtain care from any provider who participates in Original Medicare, but generally will have a
higher cost-sharing amount if she sees a provider who/that is not part of the PPO network.
Mrs. Reeves is newly eligible to enroll in a Medicare Advantage plan and her MA Initial
Coverage Election Period (ICEP) has just begun. Which of the following can she not do during
the ICEP? - ansShe can enroll in a Medigap plan to supplement the benefits of the MA plan that
she's also enrolling in.
Mrs. Schmidt is moving and a friend told her she might qualify for a "Special Election Period"
to enroll in a new Medicare Advantage plan. She contacted you to ask what a Special Election
Period is. What could you tell her? - ansIt is a time period, outside of the Annual Election
Period, when a Medicare beneficiary can select a new or different Medicare Advantage and/or
Part D prescription drug plan. Typically the Special Election Period is beneficiary specific and
results from events, such as when the beneficiary moves outside of the service area.
Mrs. West wears glasses and dentures and has enjoyed considerable pain relief from arthritis
through acupuncture. She is concerned about whether or not Medicare will cover these items
and services. What should you tell her? - ansMedicare does not cover acupuncture, or, in
general, glasses or dentures.
Mrs. Young is currently enrolled in Original Medicare (Parts A and B), but she has been
working with Agent Neil Adams in the selection of a Medicare Advantage (MA) plan. It is mid-
September, and Mrs. Young is going on vacation. Agent Adams is considering suggesting that
he and Mrs. Young complete the application together before she leaves. He will then submit
the paper application prior the start of the annual enrollment period (AEP). What would you
say If you were advising Agent Adams? - ansThis is a bad idea. Agents are generally prohibited
from soliciting or accepting an enrollment form prior to the start of the AEP.
,AHIP Final Exam Test Questions and Answers- Latest
2024-2025 (Verified Answers)
Ms. Edwards is enrolled in a Medicare Advantage plan that includes prescription drug plan
(PDP) coverage. She is traveling and wishes to fill two of her prescriptions that she has lost.
How would you advise her? - ansShe may fill prescriptions for covered drugs at non-network
pharmacies, but likely at a higher cost than paid at an in-network pharmacy.
Ms. Lewis understands that Medicare prescription drug plans may use various methods to
control the use of specific drugs. She has heard about a technique called "step therapy" and is
wondering if you can explain what that is. What should you tell her? - ansStep therapy involves
using one or more lower priced drugs before trying a more expensive drug when all are used to
treat the same condition.
Ms. Moore plans to retire when she turns 65 in a few months. She is in excellent health and
will have considerable income when she retires. She is concerned that her income will make it
impossible for her to qualify for Medicare. What could you tell her to address her concern? -
ansMedicare is a program for people age 65 or older and those under age 65 with certain
disabilities, end stage renal disease or Lou Gehrig's disease, so she will be eligible for
Medicare.
When Myra first became eligible for Medicare, she enrolled in Original Medicare (Parts A and
B). She is now 67 and will turn 68 on July 1. She would now like to enroll in a Medicare
Advantage (MA) plan and approaches you about her options. What advice would you give her? -
ansShe 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.
Which of the following individuals is most likely to be eligible to enroll in a part d plan? -
ansJose, a grandfather who was granted asylum and has worked in the United States for many
years.
You are seeking to represent an individual Medicare Advantage plan and an individual Part D
plan in your state. You have completed the required training for each plan, but you did not
achieve a passing score on the tests that came after the training. What can you do in this
situation? - ansYou will not be able to represent any Medicare Advantage or Part D plan until
you complete the training and achieve an adequate score, although you will not have to take a
test if you exclusively market employer/union group plans and the companies do not require
testing.
You have approached a hospital administrator about marketing in her facility. The
administrator is uncomfortable with the suggestion. How could you address her concerns? -
ansTell her that Medicare guidelines allow you to conduct marketing activities in common
areas of a provider's facility.
You have come to Mrs. Midler's home for a sales presentation. At the beginning of the
presentation, Mrs. Midler tells you that she has a copy of her medical record available
because she thinks this will help you understand her needs. She suggests that you will know
which questions to ask her about her health status in order to best assist her in selecting a
plan. What should you do? - ansYou can only ask Mrs. Midler questions about conditions that
affect eligibility, specifically, whether she has end stage renal disease or one of the
conditions that would qualify her for a special needs plan.
,AHIP Final Exam Test Questions and Answers- Latest
2024-2025 (Verified Answers)
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? - ansGift cards or gift certificates of $15 or less that can be
readily converted to cash.
Your friend's mother just moved to an assisted living facility and he asked if you could present
a program for the residents about the MA-PD plans you market. What could you tell him? -
ansYou appreciate the opportunity and would be happy to schedule an appointment with
anyone at their request.
Agent Armstrong is employed by XYZ Agency, which is under contract with ABC Health Plan, a
Medicare Advantage (MA) plan that offers plans in multiple states. XYZ Agency maintains a
website marketing the MA plans with which it has contracts. Agent Armstrong follows up with
individuals who request more information about ABC MA plans via the website and tries to
persuade them to enroll in ABC plans. What statement best describes the marketing and
compliance rules that apply to Agent Armstrong? - ansAgent Armstrong needs to be licensed
and appointed in every state in which beneficiaries to whom he markets ABC MA plans are
located.
Agent Jennings makes a presentation on Medicare advertised as an educational event. Agent
Jennings distributes materials that are solely educational in nature. 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? - ansYes. When an event has been advertised
as "educational," discussing plan-specific premiums is impermissible.
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? - ansMarketing
representatives may initiate electronic contact through e-mail but the subject line must say
"marketing" and an opt-out process must be provided.
Alice is enrolled in a MA-PD plan. She makes a permanent move across the country and
wonders what her options are for continuing MA-PD coverage. What would you say to her in
regard to a special enrollment period (SEP)? - ansShe is likely to qualify for a SEP. She can
choose an effective date of up to three months after the month in which the enrollment form is
received by the new plan, but the effective date may not be earlier than the date of her
permanent move.
Another agent working for your agency claims that because you are not employed by the
Medicare Advantage plans that you represent, you are not subject to the same requirements
as the plans themselves. How should you respond to such a statement? - ansYour coworker is
not correct. Marketing on behalf of a plan is considered marketing by the plan and requires
that all contracted and employed agents comply with all Medicare marketing rules.
During a sales presentation, your client asks you whether the Medicare agency recommends
that she sign up for your plan or stay in Original Medicare. What should you tell her? - ansTell
her that the Medicare agency does not endorse or recommend any plan.
, AHIP Final Exam Test Questions and Answers- Latest
2024-2025 (Verified Answers)
Mr. and Mrs. Nunez attended one of your sales presentations. They've asked you to come to
their home to clear up a few questions. During the presentation, Mrs. Nunez feels tired and
tells you that her husband can finish things up. She goes to bed. At the end of your discussion,
Mr. Nunez says that he wants to enroll both himself and his wife. What should you do? - ansAs
long as she is able to do so, only Mrs. Nunez can sign her enrollment form. Mrs. Nunez will
have to wake up to sign her form or do so at another time.
Mr. Barker enjoys a comfortable retirement income. He recently had surgery and expected
that he would have certain services and items covered by the plan with minimal out-of-pocket
costs because his MA-PD coverage has been very good. However, when he received the bill,
he was surprised to see large charges in excess of his maximum out-of-pocket limit that
included a number of services and items he thought would be fully covered. He called you to
ask what he could do? What could you tell him? - ansYou can offer to review the plans appeal
process to help him ask the plan to review the coverage decision.
Mr. Bickford did not quite qualify for the extra help low-income subsidy under the Medicare
Part D Prescription Drug program and he is wondering if there is any other option he has for
obtaining help with his considerable drug costs. What should you tell him? - ansHe could
check with the manufacturers of his medications to see if they offer an assistance program to
help people with limited means obtain the medications they need. Alternatively, he could
check to see whether his state has a pharmacy assistance program to help him with his
expenses.
Mr. Castillo, a naturalized citizen, previously enrolled in Medicare Part B but has recently
stopped paying his Part B premium. Mr. Castillo is still covered by Part A. He would like to
enroll in a Medicare Advantage (MA) plan and is still covered by Part A. What should you tell
him? - ansHe is not eligible to enroll in a Medicare Advantage plan until he re-enrolls in
Medicare Part B.
Mr. Chen has heard about Medical Savings Account (MSA), but wants to know if it is just about
saving money, or if he will get insurance coverage for his health care expenditures as well.
What should you tell him? - ansUnder the Medicare Advantage program. an MSA plan involves
the combination of high deductible health plan and savings account for health expenses.
Medicare will make contributions to this savings account to help him pay his health care
expenses while in the deductible.
Mr. Chen is enrolled in his employer's group health plan and will be retiring soon. He would
like to know his options since he has decided to drop his retiree coverage and is eligible for
Medicare. What should you tell him? - ansMr. Chen can disenroll from his employer-sponsored
coverage to elect a Medicare Advantage or Part D plan within 2 months of his disenrollment,
but he should revaluate if he really wants to drop his employer coverage.
Mr. Cole has been a Medicaid beneficiary for some time, and recently qualified for Medicare as
well. He is concerned about changes in his cost-sharing. What should you tell him? - ansHe
should know that Medicaid will pay cost sharing only for services provided by Medicaid
participating providers.
2024-2025 (Verified Answers)
Mrs. Mulcahy is concerned that she may not qualify for enrollment in a Medicare prescription
drug plan because, although she is entitled to Part A, she is not enrolled under Medicare Part
B. What should you tell her? - ansEveryone who is entitled to Part A or enrolled under Part B is
eligible to enroll in a Medicare prescription drug plan. As long as Mrs. Mulcahy is entitled to
Part A, she does not need to enroll under Part B before enrolling in a prescription drug plan.
Mrs. Quinn has just turned 65, is in excellent health, and has a relatively high income. She
uses no medications and sees no reason to spend money on a Medicare prescription drug plan
if she does not need the coverage. What could you tell her about the implications of such a
decision? - ansIf she does not sign up for a Medicare prescription drug plan as soon as she is
eligible to do so, if she does sign up at a later date, her premium will be permanently
increased by 1% of the national average premium for every month that she was not covered.
Mrs. Radford asks whether there are any special eligibility requirements for Medicare
Advantage. What should you tell her? - ansMrs. Radford must be entitled to Part A and enrolled
in Part B to enroll in Medicare Advantage.
Mrs. Ramos is considering a Medicare Advantage PPO and has questions about which
providers she can go to for her health care. What should you tell her? - ansMrs. Ramos can
obtain care from any provider who participates in Original Medicare, but generally will have a
higher cost-sharing amount if she sees a provider who/that is not part of the PPO network.
Mrs. Reeves is newly eligible to enroll in a Medicare Advantage plan and her MA Initial
Coverage Election Period (ICEP) has just begun. Which of the following can she not do during
the ICEP? - ansShe can enroll in a Medigap plan to supplement the benefits of the MA plan that
she's also enrolling in.
Mrs. Schmidt is moving and a friend told her she might qualify for a "Special Election Period"
to enroll in a new Medicare Advantage plan. She contacted you to ask what a Special Election
Period is. What could you tell her? - ansIt is a time period, outside of the Annual Election
Period, when a Medicare beneficiary can select a new or different Medicare Advantage and/or
Part D prescription drug plan. Typically the Special Election Period is beneficiary specific and
results from events, such as when the beneficiary moves outside of the service area.
Mrs. West wears glasses and dentures and has enjoyed considerable pain relief from arthritis
through acupuncture. She is concerned about whether or not Medicare will cover these items
and services. What should you tell her? - ansMedicare does not cover acupuncture, or, in
general, glasses or dentures.
Mrs. Young is currently enrolled in Original Medicare (Parts A and B), but she has been
working with Agent Neil Adams in the selection of a Medicare Advantage (MA) plan. It is mid-
September, and Mrs. Young is going on vacation. Agent Adams is considering suggesting that
he and Mrs. Young complete the application together before she leaves. He will then submit
the paper application prior the start of the annual enrollment period (AEP). What would you
say If you were advising Agent Adams? - ansThis is a bad idea. Agents are generally prohibited
from soliciting or accepting an enrollment form prior to the start of the AEP.
,AHIP Final Exam Test Questions and Answers- Latest
2024-2025 (Verified Answers)
Ms. Edwards is enrolled in a Medicare Advantage plan that includes prescription drug plan
(PDP) coverage. She is traveling and wishes to fill two of her prescriptions that she has lost.
How would you advise her? - ansShe may fill prescriptions for covered drugs at non-network
pharmacies, but likely at a higher cost than paid at an in-network pharmacy.
Ms. Lewis understands that Medicare prescription drug plans may use various methods to
control the use of specific drugs. She has heard about a technique called "step therapy" and is
wondering if you can explain what that is. What should you tell her? - ansStep therapy involves
using one or more lower priced drugs before trying a more expensive drug when all are used to
treat the same condition.
Ms. Moore plans to retire when she turns 65 in a few months. She is in excellent health and
will have considerable income when she retires. She is concerned that her income will make it
impossible for her to qualify for Medicare. What could you tell her to address her concern? -
ansMedicare is a program for people age 65 or older and those under age 65 with certain
disabilities, end stage renal disease or Lou Gehrig's disease, so she will be eligible for
Medicare.
When Myra first became eligible for Medicare, she enrolled in Original Medicare (Parts A and
B). She is now 67 and will turn 68 on July 1. She would now like to enroll in a Medicare
Advantage (MA) plan and approaches you about her options. What advice would you give her? -
ansShe 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.
Which of the following individuals is most likely to be eligible to enroll in a part d plan? -
ansJose, a grandfather who was granted asylum and has worked in the United States for many
years.
You are seeking to represent an individual Medicare Advantage plan and an individual Part D
plan in your state. You have completed the required training for each plan, but you did not
achieve a passing score on the tests that came after the training. What can you do in this
situation? - ansYou will not be able to represent any Medicare Advantage or Part D plan until
you complete the training and achieve an adequate score, although you will not have to take a
test if you exclusively market employer/union group plans and the companies do not require
testing.
You have approached a hospital administrator about marketing in her facility. The
administrator is uncomfortable with the suggestion. How could you address her concerns? -
ansTell her that Medicare guidelines allow you to conduct marketing activities in common
areas of a provider's facility.
You have come to Mrs. Midler's home for a sales presentation. At the beginning of the
presentation, Mrs. Midler tells you that she has a copy of her medical record available
because she thinks this will help you understand her needs. She suggests that you will know
which questions to ask her about her health status in order to best assist her in selecting a
plan. What should you do? - ansYou can only ask Mrs. Midler questions about conditions that
affect eligibility, specifically, whether she has end stage renal disease or one of the
conditions that would qualify her for a special needs plan.
,AHIP Final Exam Test Questions and Answers- Latest
2024-2025 (Verified Answers)
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? - ansGift cards or gift certificates of $15 or less that can be
readily converted to cash.
Your friend's mother just moved to an assisted living facility and he asked if you could present
a program for the residents about the MA-PD plans you market. What could you tell him? -
ansYou appreciate the opportunity and would be happy to schedule an appointment with
anyone at their request.
Agent Armstrong is employed by XYZ Agency, which is under contract with ABC Health Plan, a
Medicare Advantage (MA) plan that offers plans in multiple states. XYZ Agency maintains a
website marketing the MA plans with which it has contracts. Agent Armstrong follows up with
individuals who request more information about ABC MA plans via the website and tries to
persuade them to enroll in ABC plans. What statement best describes the marketing and
compliance rules that apply to Agent Armstrong? - ansAgent Armstrong needs to be licensed
and appointed in every state in which beneficiaries to whom he markets ABC MA plans are
located.
Agent Jennings makes a presentation on Medicare advertised as an educational event. Agent
Jennings distributes materials that are solely educational in nature. 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? - ansYes. When an event has been advertised
as "educational," discussing plan-specific premiums is impermissible.
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? - ansMarketing
representatives may initiate electronic contact through e-mail but the subject line must say
"marketing" and an opt-out process must be provided.
Alice is enrolled in a MA-PD plan. She makes a permanent move across the country and
wonders what her options are for continuing MA-PD coverage. What would you say to her in
regard to a special enrollment period (SEP)? - ansShe is likely to qualify for a SEP. She can
choose an effective date of up to three months after the month in which the enrollment form is
received by the new plan, but the effective date may not be earlier than the date of her
permanent move.
Another agent working for your agency claims that because you are not employed by the
Medicare Advantage plans that you represent, you are not subject to the same requirements
as the plans themselves. How should you respond to such a statement? - ansYour coworker is
not correct. Marketing on behalf of a plan is considered marketing by the plan and requires
that all contracted and employed agents comply with all Medicare marketing rules.
During a sales presentation, your client asks you whether the Medicare agency recommends
that she sign up for your plan or stay in Original Medicare. What should you tell her? - ansTell
her that the Medicare agency does not endorse or recommend any plan.
, AHIP Final Exam Test Questions and Answers- Latest
2024-2025 (Verified Answers)
Mr. and Mrs. Nunez attended one of your sales presentations. They've asked you to come to
their home to clear up a few questions. During the presentation, Mrs. Nunez feels tired and
tells you that her husband can finish things up. She goes to bed. At the end of your discussion,
Mr. Nunez says that he wants to enroll both himself and his wife. What should you do? - ansAs
long as she is able to do so, only Mrs. Nunez can sign her enrollment form. Mrs. Nunez will
have to wake up to sign her form or do so at another time.
Mr. Barker enjoys a comfortable retirement income. He recently had surgery and expected
that he would have certain services and items covered by the plan with minimal out-of-pocket
costs because his MA-PD coverage has been very good. However, when he received the bill,
he was surprised to see large charges in excess of his maximum out-of-pocket limit that
included a number of services and items he thought would be fully covered. He called you to
ask what he could do? What could you tell him? - ansYou can offer to review the plans appeal
process to help him ask the plan to review the coverage decision.
Mr. Bickford did not quite qualify for the extra help low-income subsidy under the Medicare
Part D Prescription Drug program and he is wondering if there is any other option he has for
obtaining help with his considerable drug costs. What should you tell him? - ansHe could
check with the manufacturers of his medications to see if they offer an assistance program to
help people with limited means obtain the medications they need. Alternatively, he could
check to see whether his state has a pharmacy assistance program to help him with his
expenses.
Mr. Castillo, a naturalized citizen, previously enrolled in Medicare Part B but has recently
stopped paying his Part B premium. Mr. Castillo is still covered by Part A. He would like to
enroll in a Medicare Advantage (MA) plan and is still covered by Part A. What should you tell
him? - ansHe is not eligible to enroll in a Medicare Advantage plan until he re-enrolls in
Medicare Part B.
Mr. Chen has heard about Medical Savings Account (MSA), but wants to know if it is just about
saving money, or if he will get insurance coverage for his health care expenditures as well.
What should you tell him? - ansUnder the Medicare Advantage program. an MSA plan involves
the combination of high deductible health plan and savings account for health expenses.
Medicare will make contributions to this savings account to help him pay his health care
expenses while in the deductible.
Mr. Chen is enrolled in his employer's group health plan and will be retiring soon. He would
like to know his options since he has decided to drop his retiree coverage and is eligible for
Medicare. What should you tell him? - ansMr. Chen can disenroll from his employer-sponsored
coverage to elect a Medicare Advantage or Part D plan within 2 months of his disenrollment,
but he should revaluate if he really wants to drop his employer coverage.
Mr. Cole has been a Medicaid beneficiary for some time, and recently qualified for Medicare as
well. He is concerned about changes in his cost-sharing. What should you tell him? - ansHe
should know that Medicaid will pay cost sharing only for services provided by Medicaid
participating providers.
