AHIP PRACTICE EXAM QUESTIONS
WITH COMPLETE SOLUTION
Mr. Carlini has heard that Medicare prescription drug plans are only offered through private companies
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under a program known as Medicare Advantage (MA), not by the government. He likes Original
Medicare and does not want to sign up for an MA product, but he also wants prescription drug coverage.
What should you tell him? - Mr. Carlini can stay with Original Medicare and also enroll in a Medicare
prescription drug plan through a private company that has contracted with the government to provide
only such drug coverage to eligible Medicare beneficiaries.
During a sales presentation to Ms Daley for a Medicare Advantage plan that has a 5-star rating in
customer service and care coordination, and received an overall plan performance of a 4-star, which of
the following would be the correct statement to say to her? - The Medicare Advantage plan received a 5-
star rating in customer service and care coordination with an overall performance rating of 4-stars
Mrs. Pena is 66 years old, has coverage under an employer plan and will retire next year. She heard she
must enroll in Part B at the beginning of the year to ensure no gap in coverage. What can you tell her? -
She may enroll at any time while she is covered under her employer plan, but she will have a special
eight-month enrollment period that differs from the standard general enrollment period, during which
she may enroll in Medicare Part B
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? - He 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.
Alice is a marketing representative employed by a health plan. Betty is a captive agent of a health plan
who markets to multiple plans and sponsors. Carl is a captive agent who markets to only one
plan/sponsor. Denise is an independent agent who markets to different types of groups. Edward is an
independent agent who markets only to employer and union groups. CMS marketing representative
compensation rules generally apply to: - Betty and Denise, but not Alice (the employee) or Carl or
Edward (to whom exceptions apply).
Mrs. Valentino is currently enrolled in a Medicare Cost plan. This plan is no longer meeting her needs,
but it is now mid-year and past the annual election period (AEP). What would you say to Mrs. Valentino
regarding her options? - Mrs. Valentino can submit a written request to Medicare to be disenrolled from
the Cost plan and enroll in Original 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? - She 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.
, Mrs. Tanner is enrolled in a Medicare Advantage HMO that offers a point of service options. This allows
Mrs. Tanner to do which of the following? - Mrs. Tanner can go to non-plan doctors for certain services
without receiving prior approval
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? - 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.
Mrs. Chen will be 65 soon, has been a citizen for twelve years, has been employed full time, and paid
taxes during that entire period. She is concerned that she will not qualify for coverage under part A
because she was not born in the United States. What should you tell her? - Most individuals who are
citizens and over age 65 are covered under Part A by virtue of having paid Medicare taxes while working,
though some may be covered as a result of paying monthly premiums.
Mr. Katz reached the Part D coverage gap in August last year. His prescriptions have not been changed,
he is keeping the same Part D plan and the benefits, cost-sharing, and coverage of his drugs are all the
same as last year. He asked what to expect for this year about his out-of-pocket costs. What could you
tell him? - Because he reached the coverage gap last year, he will probably reah it again this year close to
the same time.
ABC is a Medicare Advantage (MA) plan sponsor. It would like to use its enrollees' protected health
information to market non-health related products such as life insurance and annuities. To do so it must
obtain authorization from the enrollees. Which statement best describes the authorization process? -
Authorization may be obtained by directing a beneficiary to a website to provide consent
Mrs. Henderson believes that she will qualify for Medicare coverage when she turns 65, without paying
any premiums, because she has been working for 40 years and paying Medicare taxes. What should you
tell her? - In order to obtain Part B coverage, she must pay a standard monthly premium, though it is
higher for individuals with higher incomes.
Mr. Buck has several family members who died from different cancers. He wants to know if Medicare
covers cancer screening. What should you tell him? - Medicare covers periodic performance of a range of
screening tests that are meant to provide early detection of disease. Mr. Buck will need to check specific
tests before obtaining them to see if they will be covered.
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 oculd you tell her to address her concern. - Medicare is a program for
people age 65 or older and those under age 65 with certain disabilities, end-stage renal disease, and Lou
Gehrig's disease so she will be eligible for Medicare.
Mr. Wells is trying to understand the difference between Original Medicare and Medicare Advantage.
What would be a correct description? - Medicare Advantage is a way of covering all the Original
Medicare benefits through private health insurance companies.
WITH COMPLETE SOLUTION
Mr. Carlini has heard that Medicare prescription drug plans are only offered through private companies
\ g
under a program known as Medicare Advantage (MA), not by the government. He likes Original
Medicare and does not want to sign up for an MA product, but he also wants prescription drug coverage.
What should you tell him? - Mr. Carlini can stay with Original Medicare and also enroll in a Medicare
prescription drug plan through a private company that has contracted with the government to provide
only such drug coverage to eligible Medicare beneficiaries.
During a sales presentation to Ms Daley for a Medicare Advantage plan that has a 5-star rating in
customer service and care coordination, and received an overall plan performance of a 4-star, which of
the following would be the correct statement to say to her? - The Medicare Advantage plan received a 5-
star rating in customer service and care coordination with an overall performance rating of 4-stars
Mrs. Pena is 66 years old, has coverage under an employer plan and will retire next year. She heard she
must enroll in Part B at the beginning of the year to ensure no gap in coverage. What can you tell her? -
She may enroll at any time while she is covered under her employer plan, but she will have a special
eight-month enrollment period that differs from the standard general enrollment period, during which
she may enroll in Medicare Part B
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? - He 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.
Alice is a marketing representative employed by a health plan. Betty is a captive agent of a health plan
who markets to multiple plans and sponsors. Carl is a captive agent who markets to only one
plan/sponsor. Denise is an independent agent who markets to different types of groups. Edward is an
independent agent who markets only to employer and union groups. CMS marketing representative
compensation rules generally apply to: - Betty and Denise, but not Alice (the employee) or Carl or
Edward (to whom exceptions apply).
Mrs. Valentino is currently enrolled in a Medicare Cost plan. This plan is no longer meeting her needs,
but it is now mid-year and past the annual election period (AEP). What would you say to Mrs. Valentino
regarding her options? - Mrs. Valentino can submit a written request to Medicare to be disenrolled from
the Cost plan and enroll in Original 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? - She 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.
, Mrs. Tanner is enrolled in a Medicare Advantage HMO that offers a point of service options. This allows
Mrs. Tanner to do which of the following? - Mrs. Tanner can go to non-plan doctors for certain services
without receiving prior approval
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? - 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.
Mrs. Chen will be 65 soon, has been a citizen for twelve years, has been employed full time, and paid
taxes during that entire period. She is concerned that she will not qualify for coverage under part A
because she was not born in the United States. What should you tell her? - Most individuals who are
citizens and over age 65 are covered under Part A by virtue of having paid Medicare taxes while working,
though some may be covered as a result of paying monthly premiums.
Mr. Katz reached the Part D coverage gap in August last year. His prescriptions have not been changed,
he is keeping the same Part D plan and the benefits, cost-sharing, and coverage of his drugs are all the
same as last year. He asked what to expect for this year about his out-of-pocket costs. What could you
tell him? - Because he reached the coverage gap last year, he will probably reah it again this year close to
the same time.
ABC is a Medicare Advantage (MA) plan sponsor. It would like to use its enrollees' protected health
information to market non-health related products such as life insurance and annuities. To do so it must
obtain authorization from the enrollees. Which statement best describes the authorization process? -
Authorization may be obtained by directing a beneficiary to a website to provide consent
Mrs. Henderson believes that she will qualify for Medicare coverage when she turns 65, without paying
any premiums, because she has been working for 40 years and paying Medicare taxes. What should you
tell her? - In order to obtain Part B coverage, she must pay a standard monthly premium, though it is
higher for individuals with higher incomes.
Mr. Buck has several family members who died from different cancers. He wants to know if Medicare
covers cancer screening. What should you tell him? - Medicare covers periodic performance of a range of
screening tests that are meant to provide early detection of disease. Mr. Buck will need to check specific
tests before obtaining them to see if they will be covered.
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 oculd you tell her to address her concern. - Medicare is a program for
people age 65 or older and those under age 65 with certain disabilities, end-stage renal disease, and Lou
Gehrig's disease so she will be eligible for Medicare.
Mr. Wells is trying to understand the difference between Original Medicare and Medicare Advantage.
What would be a correct description? - Medicare Advantage is a way of covering all the Original
Medicare benefits through private health insurance companies.
