AHIP FINAL EXAM TEST QUESTION AND LATEST ANSWERS
VERSION 2023-2024 RATED A GRADE.
Question (Scope of Appointment and Enrollment Timing)
Mrs. Lu is turning 65 in November and schedules an appointment with you on
October 15 after signing a Scope of Appointment form. During this appointment,
what activities are you permitted to perform?
• Answer: You may provide her with the required enrollment materials and
take her completed enrollment application.
Rationale: Since Mrs. Lu is in her Initial Enrollment Period (IEP) for Medicare
(which begins three months before her 65th birthday month), she is eligible
to enroll. The Scope of Appointment form authorizes the discussion of
specific products. As long as it is within her valid enrollment period, you
may accept and submit the application.
Question (Agent Compliance with Medicare Marketing Rules)
A colleague claims that because he is not employed by the Medicare Advantage
plans he represents, he is not subject to the same marketing requirements as the
plans themselves. How should you respond?
• Answer: Your coworker is not correct. Marketing on behalf of a plan is
considered marketing by the plan, and all contracted and employed agents
must comply with all Medicare marketing rules.
Rationale: CMS Marketing Guidelines explicitly state that agents, brokers,
and third-party marketing organizations (TMOs) are extensions of the plans
they represent. Therefore, they are held to the exact same compliance
standards regarding solicitation, presentations, and material approvals.
Question (Special Election Period – Permanent Move)
Ms. Lee is enrolled in an MA-PD plan but is moving out of the plan's service area
next month. When can she enroll in a new plan available in her new residence?
, • Answer: She is eligible for a Special Election Period (SEP) that begins either
the month before her permanent move (if she notifies the plan in advance)
or the month she provides notice of the move, and this period typically lasts
an additional two months after the move.
Rationale: A permanent move outside the service area is a qualifying SEP
trigger. CMS permits enrollment into a plan available in the new residence
beginning the month before the move (if known) and continuing for two full
months after the move month, allowing a smooth transition without a
coverage gap.
Question (Inpatient Hospital Costs under Original Medicare)
Mr. Patel is preparing a retirement budget. In general terms, what are his cost
responsibilities for inpatient hospital services under Original Medicare?
• Answer: Under Original Medicare, there is a single deductible amount due
for the first 60 days of any inpatient hospital stay, after which it converts
into a per-day coinsurance amount through day 90. After day 90, he would
pay a daily amount up to 60 days over his lifetime (lifetime reserve days),
after which he would be responsible for all costs.
Rationale: Medicare Part A uses a "benefit period" structure. The
beneficiary pays one deductible for the first 60 days, a daily coinsurance for
days 61-90, and uses lifetime reserve days (up to 60 total) for days 91-150,
with high daily coinsurance. After these are exhausted, the patient pays
100% of the costs.
Question (Agents and Unsolicited Phone Calls)
You market many types of insurance and ordinarily call potential clients in the
evenings. What must you do to remain compliant with CMS requirements for
marketing Medicare Advantage and Part D plans?
• Answer: You will have to avoid calling any potential client unless he or she
initiates contact with you and specifically asks that you give him or her a call
(this excludes cold calling).
, Rationale: CMS strictly prohibits unsolicited, proactive telemarketing. "Cold
calling" for Medicare plans is illegal. Agents may only call beneficiaries who
have provided express written or verbal permission (e.g., calling a provided
number on an inbound inquiry).
Question (Submitting Applications Before the AEP)
Agent Adams is considering submitting Mrs. Young's MA application in mid-
September, before the Annual Election Period (AEP) begins, because she is going
on vacation. What would you advise him?
• Answer: This is a bad idea. Agents are generally prohibited from soliciting
or accepting an enrollment form prior to the start of the AEP.
Rationale: The Annual Election Period (AEP) begins on October 15th.
Accepting an enrollment form before this date for an AEP effective date is a
violation of CMS marketing guidelines. The agent must wait until the official
start of the election period to process the enrollment.
Question (Special Election Period – Loss of Employer Creditable Coverage)
Mr. Rockwell (age 67) is enrolled in Part A but delayed Part B and Part D due to
employer coverage. He receives notice on June 1 that his employer will cut
creditable drug coverage effective July 1. When can he enroll in a Part D plan?
• Answer: Mr. Rockwell is eligible for a SEP due to his involuntary loss of
creditable drug coverage; the SEP begins in June (the month he is notified)
and ends September 1 (two months after the loss of creditable coverage).
Rationale: The loss of creditable coverage triggers a SEP. The enrollment
period begins the month the beneficiary is notified of the impending loss
and generally lasts for 63 days (approximately two months) after the
coverage ends. This allows ample time to select a new Part D plan without a
coverage gap or late enrollment penalty.
VERSION 2023-2024 RATED A GRADE.
Question (Scope of Appointment and Enrollment Timing)
Mrs. Lu is turning 65 in November and schedules an appointment with you on
October 15 after signing a Scope of Appointment form. During this appointment,
what activities are you permitted to perform?
• Answer: You may provide her with the required enrollment materials and
take her completed enrollment application.
Rationale: Since Mrs. Lu is in her Initial Enrollment Period (IEP) for Medicare
(which begins three months before her 65th birthday month), she is eligible
to enroll. The Scope of Appointment form authorizes the discussion of
specific products. As long as it is within her valid enrollment period, you
may accept and submit the application.
Question (Agent Compliance with Medicare Marketing Rules)
A colleague claims that because he is not employed by the Medicare Advantage
plans he represents, he is not subject to the same marketing requirements as the
plans themselves. How should you respond?
• Answer: Your coworker is not correct. Marketing on behalf of a plan is
considered marketing by the plan, and all contracted and employed agents
must comply with all Medicare marketing rules.
Rationale: CMS Marketing Guidelines explicitly state that agents, brokers,
and third-party marketing organizations (TMOs) are extensions of the plans
they represent. Therefore, they are held to the exact same compliance
standards regarding solicitation, presentations, and material approvals.
Question (Special Election Period – Permanent Move)
Ms. Lee is enrolled in an MA-PD plan but is moving out of the plan's service area
next month. When can she enroll in a new plan available in her new residence?
, • Answer: She is eligible for a Special Election Period (SEP) that begins either
the month before her permanent move (if she notifies the plan in advance)
or the month she provides notice of the move, and this period typically lasts
an additional two months after the move.
Rationale: A permanent move outside the service area is a qualifying SEP
trigger. CMS permits enrollment into a plan available in the new residence
beginning the month before the move (if known) and continuing for two full
months after the move month, allowing a smooth transition without a
coverage gap.
Question (Inpatient Hospital Costs under Original Medicare)
Mr. Patel is preparing a retirement budget. In general terms, what are his cost
responsibilities for inpatient hospital services under Original Medicare?
• Answer: Under Original Medicare, there is a single deductible amount due
for the first 60 days of any inpatient hospital stay, after which it converts
into a per-day coinsurance amount through day 90. After day 90, he would
pay a daily amount up to 60 days over his lifetime (lifetime reserve days),
after which he would be responsible for all costs.
Rationale: Medicare Part A uses a "benefit period" structure. The
beneficiary pays one deductible for the first 60 days, a daily coinsurance for
days 61-90, and uses lifetime reserve days (up to 60 total) for days 91-150,
with high daily coinsurance. After these are exhausted, the patient pays
100% of the costs.
Question (Agents and Unsolicited Phone Calls)
You market many types of insurance and ordinarily call potential clients in the
evenings. What must you do to remain compliant with CMS requirements for
marketing Medicare Advantage and Part D plans?
• Answer: You will have to avoid calling any potential client unless he or she
initiates contact with you and specifically asks that you give him or her a call
(this excludes cold calling).
, Rationale: CMS strictly prohibits unsolicited, proactive telemarketing. "Cold
calling" for Medicare plans is illegal. Agents may only call beneficiaries who
have provided express written or verbal permission (e.g., calling a provided
number on an inbound inquiry).
Question (Submitting Applications Before the AEP)
Agent Adams is considering submitting Mrs. Young's MA application in mid-
September, before the Annual Election Period (AEP) begins, because she is going
on vacation. What would you advise him?
• Answer: This is a bad idea. Agents are generally prohibited from soliciting
or accepting an enrollment form prior to the start of the AEP.
Rationale: The Annual Election Period (AEP) begins on October 15th.
Accepting an enrollment form before this date for an AEP effective date is a
violation of CMS marketing guidelines. The agent must wait until the official
start of the election period to process the enrollment.
Question (Special Election Period – Loss of Employer Creditable Coverage)
Mr. Rockwell (age 67) is enrolled in Part A but delayed Part B and Part D due to
employer coverage. He receives notice on June 1 that his employer will cut
creditable drug coverage effective July 1. When can he enroll in a Part D plan?
• Answer: Mr. Rockwell is eligible for a SEP due to his involuntary loss of
creditable drug coverage; the SEP begins in June (the month he is notified)
and ends September 1 (two months after the loss of creditable coverage).
Rationale: The loss of creditable coverage triggers a SEP. The enrollment
period begins the month the beneficiary is notified of the impending loss
and generally lasts for 63 days (approximately two months) after the
coverage ends. This allows ample time to select a new Part D plan without a
coverage gap or late enrollment penalty.
