AHIP CORRECT EXAMS QUESTIONS AND
ANSWERS SET A+
✔✔Mr. Chen was still working when he first qualified for Medicare. At that time, he had
employer group coverage that was creditable. During his initial Part D eligibility period,
he decided not to enroll because he was satisfied with his drug coverage. It is now a
year later and Mr. Chen has lost his employer group coverage within the last two weeks.
How would you advise him? - ✔✔Mr. Chen should enroll in a Part D plan before he has
a 63-day break in coverage in order to avoid a premium penalty.
✔✔Mrs. Kelly wants to enroll in a Medicare Advantage plan that does not include drug
coverage and also enroll in a stand-alone Medicare prescription drug plan. Under what
circumstances can she do this? - ✔✔If the Medicare Advantage plan is a Private Fee-
for-Service (PFFS) plan that does not offer drug coverage or a Medical Savings Account
plan, Mrs. Kelly can do this.
✔✔John Cohen is a Medicare beneficiary who suffers from diabetes. Mr. Cohen is
considering enrollment in an MA-PD plan that you represent. He asks you whether his
insulin costs will be covered. What should you say? - ✔✔Mr. Cohen's insulin costs for a
one-month supply cannot be more than $35 in any coverage phase.
✔✔Mrs. Strickland is a new Medicare beneficiary who has just retired from retail work.
She is interested in selecting a Medicare Part D prescription drug plan. She takes
several medications and is concerned that she has not been able to identify a plan that
covers all of her medications. She does not want to make an abrupt change to new
drugs that would be covered and asks what she should do. What should you tell her? -
✔✔Every Part D drug plan is required to cover a single one-month fill of her existing
medications sometime during a 90-day transition period.
✔✔What types of tools can Medicare Part D prescription drug plans use that affect the
way their enrollees can access medications? - ✔✔Part D plans do not have to cover all
medications. As a result, their formularies, or lists of covered drugs, will vary from plan
, to plan. In addition, they can use cost containment techniques such as tiered co-
payments and step therapy.
✔✔Which of the following statements about Medicare Part D is/are correct?
I. Part D plans must enroll any eligible beneficiary who applies, regardless of health
status, except in limited circumstances.
II. Private fee-for-service (PFFS) plans are not required to use a pharmacy network but
may choose to have one.
III. Beneficiaries enrolled in an MA-Medical Savings Account (MSA) plan may only
obtain Part D benefits through a standalone PDP.
IV. Beneficiaries enrolled in an MA-PPO may obtain Part D benefits through a
standalone PDP or through their plan. - ✔✔I, II, and III only
✔✔Mrs. Sharma has Original Medicare and would like to enroll in a Private Fee-for-
Service (PFFS) plan. All types of PFFS plans are available in her area. Which options
could Mrs. Sharma consider before selecting a PFFS plan? - ✔✔A Medicare Advantage
Prescription Drug (MA-PD) PFFS plan that combines medical benefits and Part D
prescription drug coverage, a PFFS plan offering only medical benefits, or a PFFS plan
in combination with a stand-alone prescription drug plan.
✔✔Mr. Aguilar is a newly enrolled Medicare Part D beneficiary and one of your clients.
In addition to drugs on his plan's formulary, he takes several other medications. These
include a prescription drug not on his plan's formulary, over-the-counter medications for
colds and allergies, vitamins, and drugs from an Internet-based Canadian pharmacy to
promote hair growth and reduce joint swelling. His neighbor recently told him about a
concept called TrOOP and he asks you if any of his other medications could count
toward TrOOP should he ever reach the Part D catastrophic limit. What should you say?
- ✔✔None of the costs of Mr. Aguilar's other medications would currently count toward
TrOOP but he may wish to ask his plan for an exception to cover the prescription, not
on its formulary.
✔✔Steban Marsh is a newly appointed agent. Steban intends to conduct an educational
session on Medicare at a senior citizens center near his home. He has advertised the
session as an educational event. Steban asks you what is permissible at such an event.
What should you say? - ✔✔Steban may provide a meal as long as its value is $15 or
less per attendee and he may make available business reply cards (BRCs).
✔✔Maria Valesquez is a marketing representative with RitzCo, a third-party marketing
organization (TPMO). Maria meets with Henry Smythe, who has a website that provides
information about different ways to get Medicare. The website allows beneficiaries to
put in their name and contact information in order to receive additional information.
Henry offers to sell Maria leads obtained through the website. What should Maria do? -
✔✔Maria should pass on Henry's offer. Henry's website is a TPMO, and for a TPMO to
provide contact information to another TPMO (including an agent/broker or FMO), it has
ANSWERS SET A+
✔✔Mr. Chen was still working when he first qualified for Medicare. At that time, he had
employer group coverage that was creditable. During his initial Part D eligibility period,
he decided not to enroll because he was satisfied with his drug coverage. It is now a
year later and Mr. Chen has lost his employer group coverage within the last two weeks.
How would you advise him? - ✔✔Mr. Chen should enroll in a Part D plan before he has
a 63-day break in coverage in order to avoid a premium penalty.
✔✔Mrs. Kelly wants to enroll in a Medicare Advantage plan that does not include drug
coverage and also enroll in a stand-alone Medicare prescription drug plan. Under what
circumstances can she do this? - ✔✔If the Medicare Advantage plan is a Private Fee-
for-Service (PFFS) plan that does not offer drug coverage or a Medical Savings Account
plan, Mrs. Kelly can do this.
✔✔John Cohen is a Medicare beneficiary who suffers from diabetes. Mr. Cohen is
considering enrollment in an MA-PD plan that you represent. He asks you whether his
insulin costs will be covered. What should you say? - ✔✔Mr. Cohen's insulin costs for a
one-month supply cannot be more than $35 in any coverage phase.
✔✔Mrs. Strickland is a new Medicare beneficiary who has just retired from retail work.
She is interested in selecting a Medicare Part D prescription drug plan. She takes
several medications and is concerned that she has not been able to identify a plan that
covers all of her medications. She does not want to make an abrupt change to new
drugs that would be covered and asks what she should do. What should you tell her? -
✔✔Every Part D drug plan is required to cover a single one-month fill of her existing
medications sometime during a 90-day transition period.
✔✔What types of tools can Medicare Part D prescription drug plans use that affect the
way their enrollees can access medications? - ✔✔Part D plans do not have to cover all
medications. As a result, their formularies, or lists of covered drugs, will vary from plan
, to plan. In addition, they can use cost containment techniques such as tiered co-
payments and step therapy.
✔✔Which of the following statements about Medicare Part D is/are correct?
I. Part D plans must enroll any eligible beneficiary who applies, regardless of health
status, except in limited circumstances.
II. Private fee-for-service (PFFS) plans are not required to use a pharmacy network but
may choose to have one.
III. Beneficiaries enrolled in an MA-Medical Savings Account (MSA) plan may only
obtain Part D benefits through a standalone PDP.
IV. Beneficiaries enrolled in an MA-PPO may obtain Part D benefits through a
standalone PDP or through their plan. - ✔✔I, II, and III only
✔✔Mrs. Sharma has Original Medicare and would like to enroll in a Private Fee-for-
Service (PFFS) plan. All types of PFFS plans are available in her area. Which options
could Mrs. Sharma consider before selecting a PFFS plan? - ✔✔A Medicare Advantage
Prescription Drug (MA-PD) PFFS plan that combines medical benefits and Part D
prescription drug coverage, a PFFS plan offering only medical benefits, or a PFFS plan
in combination with a stand-alone prescription drug plan.
✔✔Mr. Aguilar is a newly enrolled Medicare Part D beneficiary and one of your clients.
In addition to drugs on his plan's formulary, he takes several other medications. These
include a prescription drug not on his plan's formulary, over-the-counter medications for
colds and allergies, vitamins, and drugs from an Internet-based Canadian pharmacy to
promote hair growth and reduce joint swelling. His neighbor recently told him about a
concept called TrOOP and he asks you if any of his other medications could count
toward TrOOP should he ever reach the Part D catastrophic limit. What should you say?
- ✔✔None of the costs of Mr. Aguilar's other medications would currently count toward
TrOOP but he may wish to ask his plan for an exception to cover the prescription, not
on its formulary.
✔✔Steban Marsh is a newly appointed agent. Steban intends to conduct an educational
session on Medicare at a senior citizens center near his home. He has advertised the
session as an educational event. Steban asks you what is permissible at such an event.
What should you say? - ✔✔Steban may provide a meal as long as its value is $15 or
less per attendee and he may make available business reply cards (BRCs).
✔✔Maria Valesquez is a marketing representative with RitzCo, a third-party marketing
organization (TPMO). Maria meets with Henry Smythe, who has a website that provides
information about different ways to get Medicare. The website allows beneficiaries to
put in their name and contact information in order to receive additional information.
Henry offers to sell Maria leads obtained through the website. What should Maria do? -
✔✔Maria should pass on Henry's offer. Henry's website is a TPMO, and for a TPMO to
provide contact information to another TPMO (including an agent/broker or FMO), it has
