AHIP EXAM 2026 ACTUAL PAPER FULL KEY
PASSED
◉ Mrs. Shields is covered by Original Medicare. She sustained a hip
fracture and is being successfully treated for that condition. However,
she and her physicians feel that after her lengthy hospital stay she will
need a month or two of nursing and rehabilitative care. What should you
tell them about Original Medicare's coverage of care in a skilled nursing
facility? Answer: Medicare will cover Mrs. Shield's skilled nursing
services provided during the first 20 days of her stay, after which she
would have a copay until she has been in the facility for 100 days.
◉ Mr. Robinson was quite ill recently and forgot to pay his monthly
premium for his MA-PD plan. He is worried that he will lose his
coverage now when he needs it the most. He is certain his plan will
disenroll him because that is what happened to a friend of his in a
similar type of plan. What can you tell Mr. Robinson about his situation?
Answer: Plan sponsors have the option to do nothing when a plan
member does not pay their premiums or disenroll the member after a
grace period and notice.
◉ Mr. Sinclair has diabetes and heart trouble and is generally satisfied
with the care he has received under Original Medicare, but he would like
to know more about Medicare Advantage Special Needs Plans (SNPs).
What could you tell him? Answer: SNPs have special programs for
enrollees with chronic conditions, like Mr. Sinclair, and they provide
prescription drug coverage that could be very helpful as well.
, ◉ Willard works as a representative focused on the senior marketplace.
What would be considered prohibited activity by Willard? Answer:
Implying that only seniors can enroll in a Medicare Advantage plan
when meeting with Mr. Hernandez, who is 58 but qualifies for Medicare
because he is disabled.
◉ 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? 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.
◉ Mr. Landry is approaching his 65th birthday. He has signed up for
Medicare Part A, but he did not enroll in Part B because he has
employer-sponsored coverage and intends to keep working for several
more years. But he is considering enrolling in Part D prescription drug
coverage because he believes it is superior to his employer plan. How
would you advise him? Answer: Mr. Landry is eligible for Part D since
he has Part A, and his initial enrollment period (IEP) for Part D will
continue for three months after his 65th birthday.
◉ Agent Marvin Millner wants to reach out to his current clients for
referrals. What advice would you give to Marvin? Answer: Marvin
should consult with the health plans he represents to determine whether
those plans impose requirements around beneficiary referrals.
PASSED
◉ Mrs. Shields is covered by Original Medicare. She sustained a hip
fracture and is being successfully treated for that condition. However,
she and her physicians feel that after her lengthy hospital stay she will
need a month or two of nursing and rehabilitative care. What should you
tell them about Original Medicare's coverage of care in a skilled nursing
facility? Answer: Medicare will cover Mrs. Shield's skilled nursing
services provided during the first 20 days of her stay, after which she
would have a copay until she has been in the facility for 100 days.
◉ Mr. Robinson was quite ill recently and forgot to pay his monthly
premium for his MA-PD plan. He is worried that he will lose his
coverage now when he needs it the most. He is certain his plan will
disenroll him because that is what happened to a friend of his in a
similar type of plan. What can you tell Mr. Robinson about his situation?
Answer: Plan sponsors have the option to do nothing when a plan
member does not pay their premiums or disenroll the member after a
grace period and notice.
◉ Mr. Sinclair has diabetes and heart trouble and is generally satisfied
with the care he has received under Original Medicare, but he would like
to know more about Medicare Advantage Special Needs Plans (SNPs).
What could you tell him? Answer: SNPs have special programs for
enrollees with chronic conditions, like Mr. Sinclair, and they provide
prescription drug coverage that could be very helpful as well.
, ◉ Willard works as a representative focused on the senior marketplace.
What would be considered prohibited activity by Willard? Answer:
Implying that only seniors can enroll in a Medicare Advantage plan
when meeting with Mr. Hernandez, who is 58 but qualifies for Medicare
because he is disabled.
◉ 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? 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.
◉ Mr. Landry is approaching his 65th birthday. He has signed up for
Medicare Part A, but he did not enroll in Part B because he has
employer-sponsored coverage and intends to keep working for several
more years. But he is considering enrolling in Part D prescription drug
coverage because he believes it is superior to his employer plan. How
would you advise him? Answer: Mr. Landry is eligible for Part D since
he has Part A, and his initial enrollment period (IEP) for Part D will
continue for three months after his 65th birthday.
◉ Agent Marvin Millner wants to reach out to his current clients for
referrals. What advice would you give to Marvin? Answer: Marvin
should consult with the health plans he represents to determine whether
those plans impose requirements around beneficiary referrals.
