AHIP Final Final Test A+ Questions and
Answers Verified Solutions Latest Update
2026/2027
Answer:
a. Cost plan enrollees can choose to receive Medicare covered
services under the plan's benefits by going to plan network providers and paying plan cost sharing,
or may receive services from non-network providers and pay cost-sharing due under Original
Medicare.
■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.
■Mrs. West wears glasses and dentures and has enjoyed considerable pain relief from arthritis
through massage therapy. She is concerned about whether or not Medicare will cover these items
and services. What should you tell her?.
Answer:
Medicare does not cover massage therapy, or, in general, glasses or dentures.
■b. Ms. Lopez is considered a marketing representative of BestCare and thus is obligated to
comply with CMS marketing requirements, including those
regarding using only approved call scripts..
Answer:
Ms. Lopez is an independent agent under contract with MarketCo, a third-party marketing
organization. MarketCo has a contract with BestCare health plan, a Medicare Advantage (MA)
organization, to offer marketing services through its contracted agents and agencies. Ms. Lopez
returns calls to individuals who contact MarketCo in response to its mailers promoting BestCare
health plan. Which of the following best describes the responsibilities of Ms. Lopez?a. Ms. Lopez
is considered a marketing representative of BestCare but is exempt from the marketing rules
,regarding approved call scripts because she works directly for MarketCo. b. Ms. Lopez is
considered a marketing representative of BestCare and thus is obligated to comply with CMS
marketing requirements, including those regarding using only approved call scripts.c. Ms. Lopez no
longer needs to be concerned about state licensure since she is marketing an MA product subject to
federal rules. d. Ms. Lopez needs to maintain state licensure, but because she is working for a
third-party marketing organization she is exempt from CMS training requirements that apply to
BestCare captive agents.
■Mr. Edwards, a marketing representative of the ACME Insurance Company, scheduled a
marketing event and expects about 40 people to attend. He has hired a magician at a cost of $200 to
entertain attendees. Can he do this in a way that complies with guidance from the Medicare
agency?.
Answer:
a. He can do this because the estimated number of attendees is
based on the venue size and response rate and the value of the gift does not exceed $15.
■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?.
Answer:
b. Mrs. 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 a part of the PPO network.
■Julia Harris is turning 66 in July, at which time she will retire. She has contacted your office and
requested a meeting so that she can learn about Medicare and the products you represent. How
should you respond?.
Answer:
c. Tell Julia that you will meet with her to explain Medicare and
should she be interested you can accept and submit an enrollment request, since this is an initial
enrollment qualifying her for a special enrollment period.
■Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What could you tell Mrs. Park
that might be of assistance?.
Answer:
She should contact her state Medicaid agency to see if she qualifies for one of several programs
that can help with Medicare costs for which she is responsible.
■Mr. Rivera has Qualified Medicare Beneficiary (QMB) eligibility and is thus covered by both
, Medicare and Medicaid. He decides to enroll in a Medicare Advantage (MA) PPO plan. Later he
sees an out-of-network doctor to receive a Medicare covered service. How much The doctor may
only collect from Mr. Rivera the cost sharing allowable under the state's Medicaid program.may the
doctor collect from Mr. Rivera?.
Answer:
The doctor may only collect from Mr. Rivera the cost sharing allowable under the state's Medicaid
program.
■Mr. Alonso receives some help paying for his two generic prescription drugs from his employer's
retiree coverage, but he wants to compare it to a Part D prescription drug plan. He asks you what
costs he would generally expect to encounter when enrolling into a standard Medicare Part D
prescription drug plan. What should you tell him?.
Answer:
He generally would pay a monthly premium, annual deductible, and per-prescription cost-sharing.
■Mrs. Gonzalez is enrolled in Original Medicare and has a Medigap policy as well, but it provides
no drug coverage. She would like to keep the coverage she has but replace her existing Medigap
plan with one that provides drug coverage. What should you tell her?.
Answer:
Mrs. Gonzalez cannot purchase a Medigap plan that covers drugs, but she could keep her Medigap
policy and enroll in a Part D prescription drug plan.
■Mr. Davis is 52 years old and has recently been diagnosed with end-stage renal disease (ESRD)
and will soon begin dialysis. He is wondering if he can obtain coverage under Medicare. What
should you tell him?.
Answer:
He may sign-up for Medicare at any time however coverage usually begins on the fourth month
after dialysis treatments start.
■Mrs. Duarte is enrolled in Original Medicare Parts A and
B. She has recently reviewed her Medicare Summary Notice (MSN) and
disagrees with a determination that partially denied one of her claims for services. What advice
would you give her?.
Answer:
Answers Verified Solutions Latest Update
2026/2027
Answer:
a. Cost plan enrollees can choose to receive Medicare covered
services under the plan's benefits by going to plan network providers and paying plan cost sharing,
or may receive services from non-network providers and pay cost-sharing due under Original
Medicare.
■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.
■Mrs. West wears glasses and dentures and has enjoyed considerable pain relief from arthritis
through massage therapy. She is concerned about whether or not Medicare will cover these items
and services. What should you tell her?.
Answer:
Medicare does not cover massage therapy, or, in general, glasses or dentures.
■b. Ms. Lopez is considered a marketing representative of BestCare and thus is obligated to
comply with CMS marketing requirements, including those
regarding using only approved call scripts..
Answer:
Ms. Lopez is an independent agent under contract with MarketCo, a third-party marketing
organization. MarketCo has a contract with BestCare health plan, a Medicare Advantage (MA)
organization, to offer marketing services through its contracted agents and agencies. Ms. Lopez
returns calls to individuals who contact MarketCo in response to its mailers promoting BestCare
health plan. Which of the following best describes the responsibilities of Ms. Lopez?a. Ms. Lopez
is considered a marketing representative of BestCare but is exempt from the marketing rules
,regarding approved call scripts because she works directly for MarketCo. b. Ms. Lopez is
considered a marketing representative of BestCare and thus is obligated to comply with CMS
marketing requirements, including those regarding using only approved call scripts.c. Ms. Lopez no
longer needs to be concerned about state licensure since she is marketing an MA product subject to
federal rules. d. Ms. Lopez needs to maintain state licensure, but because she is working for a
third-party marketing organization she is exempt from CMS training requirements that apply to
BestCare captive agents.
■Mr. Edwards, a marketing representative of the ACME Insurance Company, scheduled a
marketing event and expects about 40 people to attend. He has hired a magician at a cost of $200 to
entertain attendees. Can he do this in a way that complies with guidance from the Medicare
agency?.
Answer:
a. He can do this because the estimated number of attendees is
based on the venue size and response rate and the value of the gift does not exceed $15.
■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?.
Answer:
b. Mrs. 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 a part of the PPO network.
■Julia Harris is turning 66 in July, at which time she will retire. She has contacted your office and
requested a meeting so that she can learn about Medicare and the products you represent. How
should you respond?.
Answer:
c. Tell Julia that you will meet with her to explain Medicare and
should she be interested you can accept and submit an enrollment request, since this is an initial
enrollment qualifying her for a special enrollment period.
■Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What could you tell Mrs. Park
that might be of assistance?.
Answer:
She should contact her state Medicaid agency to see if she qualifies for one of several programs
that can help with Medicare costs for which she is responsible.
■Mr. Rivera has Qualified Medicare Beneficiary (QMB) eligibility and is thus covered by both
, Medicare and Medicaid. He decides to enroll in a Medicare Advantage (MA) PPO plan. Later he
sees an out-of-network doctor to receive a Medicare covered service. How much The doctor may
only collect from Mr. Rivera the cost sharing allowable under the state's Medicaid program.may the
doctor collect from Mr. Rivera?.
Answer:
The doctor may only collect from Mr. Rivera the cost sharing allowable under the state's Medicaid
program.
■Mr. Alonso receives some help paying for his two generic prescription drugs from his employer's
retiree coverage, but he wants to compare it to a Part D prescription drug plan. He asks you what
costs he would generally expect to encounter when enrolling into a standard Medicare Part D
prescription drug plan. What should you tell him?.
Answer:
He generally would pay a monthly premium, annual deductible, and per-prescription cost-sharing.
■Mrs. Gonzalez is enrolled in Original Medicare and has a Medigap policy as well, but it provides
no drug coverage. She would like to keep the coverage she has but replace her existing Medigap
plan with one that provides drug coverage. What should you tell her?.
Answer:
Mrs. Gonzalez cannot purchase a Medigap plan that covers drugs, but she could keep her Medigap
policy and enroll in a Part D prescription drug plan.
■Mr. Davis is 52 years old and has recently been diagnosed with end-stage renal disease (ESRD)
and will soon begin dialysis. He is wondering if he can obtain coverage under Medicare. What
should you tell him?.
Answer:
He may sign-up for Medicare at any time however coverage usually begins on the fourth month
after dialysis treatments start.
■Mrs. Duarte is enrolled in Original Medicare Parts A and
B. She has recently reviewed her Medicare Summary Notice (MSN) and
disagrees with a determination that partially denied one of her claims for services. What advice
would you give her?.
Answer:
