AHIP FINAL EXAM TEST QUESTIONS & ACTUAL
ANSWERS UPDATED 2024 -25
Mrs.,West,wears,glasses,and,dentures,and,has,enjoyed,considerable,pain,relief,from,arthritis,through,ac
upuncture.,She,is,concerned,about,whether,or,not,Medicare,will,cover,these,items,and,services.,What,sh
ould,you,tell,her?,,,ANS,-Medicare,does,not,cover,acupuncture,,or,,in,general,,glasses,or,dentures.
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?,,,ANS,-
He,could,check,with,the,manufacturers,of,his,medications,to,see,if,they,offer,an,assistance,program,to,he
lp,people,with,limited,means,obtain,the,medications,they,need.,Alternatively,,he,could,check,to,see,whe
ther,his,state,has,a,pharmacy,assistance,program,to,help,him,with,his,expenses.
Mr.,Lombardi,is,interested,in,a,Medicare,Advantage,(MA),PPO,plan,that,you,represent.,It,is,one,of,three,
plans,operated,by,the,same,organization,in,Mr.,Lombardi's,area.,The,MA,PPO,plan,does,not,include,drug,
coverage,,but,the,other,two,plans,do.,Mr.,Lombardi,likes,the,PPO,plan,that,does,not,include,drug,covera
ge,and,intends,to,obtain,his,drug,coverage,through,a,stand-
alone,Medicare,prescription,drug,plan.,What,should,you,tell,him,about,this,situation?,,,ANS,-
He,could,enroll,in,one,of,the,MA,plans,that,include,prescription,drug,coverage,or,a,Medigap,plan,and,a,st
and-alone,prescription,drug,plan,,but,he,cannot,enroll,in,the,MA-only,PPO,plan,and,a,stand-
alone,prescription,drug,plan.
Mr.,Torres,has,a,small,savings,account.,He,would,like,to,pay,for,his,monthly,Part,D,premiums,with,an,aut
omatic,monthly,withdrawal,from,his,savings,account,until,it,is,exhausted,,and,then,have,his,premiums,wi
thheld,from,his,Social,Security,check.,What,should,you,tell,him?,,,ANS,-
In,general,,he,must,select,a,single,Part,D,premium,payment,mechanism,that,will,be,used,throughout,the,
year.
Agent,Jennings,makes,a,presentation,on,Medicare,advertised,as,an,educational,event.,Agent,Jennings,dis
tributes,materials,that,are,solely,educational,in,nature.,However,,she,gives,a,brief,presentation,that,men
tions,plan-
specific,premiums.,Is,this,a,prohibited,activity,at,an,event,that,has,been,advertised,as,educational?,,,ANS,
-Yes.,When,an,event,has,been,advertised,as,"educational,",discussing,plan-
specific,premiums,is,impermissible.
, Mrs.,Mulcahy,is,concerned,that,she,may,not,qualify,for,enrollment,in,a,Medicare,prescription,drug,plan,b
ecause,,although,she,is,entitled,to,Part,A,,she,is,not,enrolled,under,Medicare,Part,B.,What,should,you,tell
,her?,,,ANS,-
Everyone,who,is,entitled,to,Part,A,or,enrolled,under,Part,B,is,eligible,to,enroll,in,a,Medicare,prescription,
drug,plan.,As,long,as,Mrs.,Mulcahy,is,entitled,to,Part,A,,she,does,not,need,to,enroll,under,Part,B,before,e
nrolling,in,a,prescription,drug,plan.
Mr.,Jacob,understands,that,there,is,a,standard,Medicare,Part,D,prescription,drug,benefit,,but,when,he,lo
oks,at,information,on,various,plans,available,in,his,area,,he,sees,a,wide,range,in,what,they,charge,for,ded
uctibles,,premiums,and,cost,sharing.,How,can,you,explain,this,to,him?,,,ANS,-
Medicare,Part,D,drug,plans,may,have,different,benefit,structures,,but,on,average,,they,must,all,be,at,leas
t,as,good,as,the,standard,model,established,by,the,government.
Ms.,Moore,plans,to,retire,when,she,turns,65,in,a,few,months.,She,is,in,excellent,health,and,will,have,con
siderable,income,when,she,retires.,She,is,concerned,that,her,income,will,make,it,impossible,for,her,to,qu
alify,for,Medicare.,What,could,you,tell,her,to,address,her,concern?,,,ANS,-
Medicare,is,a,program,for,people,age,65,or,older,and,those,under,age,65,with,certain,disabilities,,end,sta
ge,renal,disease,or,Lou,Gehrig's,disease,,so,she,will,be,eligible,for,Medicare.
Agent,Armstrong,is,employed,by,XYZ,Agency,,which,is,under,contract,with,ABC,Health,Plan,,a,Medicare,A
dvantage,(MA),plan,that,offers,plans,in,multiple,states.,XYZ,Agency,maintains,a,website,marketing,the,M
A,plans,with,which,it,has,contracts.,Agent,Armstrong,follows,up,with,individuals,who,request,more,infor
mation,about,ABC,MA,plans,via,the,website,and,tries,to,persuade,them,to,enroll,in,ABC,plans.,What,stat
ement,best,describes,the,marketing,and,compliance,rules,that,apply,to,Agent,Armstrong?,,,ANS,-
Agent,Armstrong,needs,to,be,licensed,and,appointed,in,every,state,in,which,beneficiaries,to,whom,he,m
arkets,ABC,MA,plans,are,located.
Mr.,Schmidt,would,like,to,plan,for,retirement,and,has,asked,you,what,is,covered,under,Original,Fee-for-
Service,(FFS),Medicare?,What,could,you,tell,him?,,,ANS,-
Part,A,,which,covers,hospital,,skilled,nursing,facility,,hospice,and,home,health,services,and,Part,B,,which,
covers,professional,services,such,as,those,provided,by,a,doctor,are,covered,under,Original,Medicare.
You,are,seeking,to,represent,an,individual,Medicare,Advantage,plan,and,an,individual,Part,D,plan,in,your,
state.,You,have,completed,the,required,training,for,each,plan,,but,you,did,not,achieve,a,passing,score,on,
the,tests,that,came,after,the,training.,What,can,you,do,in,this,situation?,,,ANS,-
You,will,not,be,able,to,represent,any,Medicare,Advantage,or,Part,D,plan,until,you,complete,the,training,a
nd,achieve,an,adequate,score,,although,you,will,not,have,to,take,a,test,if,you,exclusively,market,employe
r/union,group,plans,and,the,companies,do,not,require,testing.
ANSWERS UPDATED 2024 -25
Mrs.,West,wears,glasses,and,dentures,and,has,enjoyed,considerable,pain,relief,from,arthritis,through,ac
upuncture.,She,is,concerned,about,whether,or,not,Medicare,will,cover,these,items,and,services.,What,sh
ould,you,tell,her?,,,ANS,-Medicare,does,not,cover,acupuncture,,or,,in,general,,glasses,or,dentures.
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?,,,ANS,-
He,could,check,with,the,manufacturers,of,his,medications,to,see,if,they,offer,an,assistance,program,to,he
lp,people,with,limited,means,obtain,the,medications,they,need.,Alternatively,,he,could,check,to,see,whe
ther,his,state,has,a,pharmacy,assistance,program,to,help,him,with,his,expenses.
Mr.,Lombardi,is,interested,in,a,Medicare,Advantage,(MA),PPO,plan,that,you,represent.,It,is,one,of,three,
plans,operated,by,the,same,organization,in,Mr.,Lombardi's,area.,The,MA,PPO,plan,does,not,include,drug,
coverage,,but,the,other,two,plans,do.,Mr.,Lombardi,likes,the,PPO,plan,that,does,not,include,drug,covera
ge,and,intends,to,obtain,his,drug,coverage,through,a,stand-
alone,Medicare,prescription,drug,plan.,What,should,you,tell,him,about,this,situation?,,,ANS,-
He,could,enroll,in,one,of,the,MA,plans,that,include,prescription,drug,coverage,or,a,Medigap,plan,and,a,st
and-alone,prescription,drug,plan,,but,he,cannot,enroll,in,the,MA-only,PPO,plan,and,a,stand-
alone,prescription,drug,plan.
Mr.,Torres,has,a,small,savings,account.,He,would,like,to,pay,for,his,monthly,Part,D,premiums,with,an,aut
omatic,monthly,withdrawal,from,his,savings,account,until,it,is,exhausted,,and,then,have,his,premiums,wi
thheld,from,his,Social,Security,check.,What,should,you,tell,him?,,,ANS,-
In,general,,he,must,select,a,single,Part,D,premium,payment,mechanism,that,will,be,used,throughout,the,
year.
Agent,Jennings,makes,a,presentation,on,Medicare,advertised,as,an,educational,event.,Agent,Jennings,dis
tributes,materials,that,are,solely,educational,in,nature.,However,,she,gives,a,brief,presentation,that,men
tions,plan-
specific,premiums.,Is,this,a,prohibited,activity,at,an,event,that,has,been,advertised,as,educational?,,,ANS,
-Yes.,When,an,event,has,been,advertised,as,"educational,",discussing,plan-
specific,premiums,is,impermissible.
, Mrs.,Mulcahy,is,concerned,that,she,may,not,qualify,for,enrollment,in,a,Medicare,prescription,drug,plan,b
ecause,,although,she,is,entitled,to,Part,A,,she,is,not,enrolled,under,Medicare,Part,B.,What,should,you,tell
,her?,,,ANS,-
Everyone,who,is,entitled,to,Part,A,or,enrolled,under,Part,B,is,eligible,to,enroll,in,a,Medicare,prescription,
drug,plan.,As,long,as,Mrs.,Mulcahy,is,entitled,to,Part,A,,she,does,not,need,to,enroll,under,Part,B,before,e
nrolling,in,a,prescription,drug,plan.
Mr.,Jacob,understands,that,there,is,a,standard,Medicare,Part,D,prescription,drug,benefit,,but,when,he,lo
oks,at,information,on,various,plans,available,in,his,area,,he,sees,a,wide,range,in,what,they,charge,for,ded
uctibles,,premiums,and,cost,sharing.,How,can,you,explain,this,to,him?,,,ANS,-
Medicare,Part,D,drug,plans,may,have,different,benefit,structures,,but,on,average,,they,must,all,be,at,leas
t,as,good,as,the,standard,model,established,by,the,government.
Ms.,Moore,plans,to,retire,when,she,turns,65,in,a,few,months.,She,is,in,excellent,health,and,will,have,con
siderable,income,when,she,retires.,She,is,concerned,that,her,income,will,make,it,impossible,for,her,to,qu
alify,for,Medicare.,What,could,you,tell,her,to,address,her,concern?,,,ANS,-
Medicare,is,a,program,for,people,age,65,or,older,and,those,under,age,65,with,certain,disabilities,,end,sta
ge,renal,disease,or,Lou,Gehrig's,disease,,so,she,will,be,eligible,for,Medicare.
Agent,Armstrong,is,employed,by,XYZ,Agency,,which,is,under,contract,with,ABC,Health,Plan,,a,Medicare,A
dvantage,(MA),plan,that,offers,plans,in,multiple,states.,XYZ,Agency,maintains,a,website,marketing,the,M
A,plans,with,which,it,has,contracts.,Agent,Armstrong,follows,up,with,individuals,who,request,more,infor
mation,about,ABC,MA,plans,via,the,website,and,tries,to,persuade,them,to,enroll,in,ABC,plans.,What,stat
ement,best,describes,the,marketing,and,compliance,rules,that,apply,to,Agent,Armstrong?,,,ANS,-
Agent,Armstrong,needs,to,be,licensed,and,appointed,in,every,state,in,which,beneficiaries,to,whom,he,m
arkets,ABC,MA,plans,are,located.
Mr.,Schmidt,would,like,to,plan,for,retirement,and,has,asked,you,what,is,covered,under,Original,Fee-for-
Service,(FFS),Medicare?,What,could,you,tell,him?,,,ANS,-
Part,A,,which,covers,hospital,,skilled,nursing,facility,,hospice,and,home,health,services,and,Part,B,,which,
covers,professional,services,such,as,those,provided,by,a,doctor,are,covered,under,Original,Medicare.
You,are,seeking,to,represent,an,individual,Medicare,Advantage,plan,and,an,individual,Part,D,plan,in,your,
state.,You,have,completed,the,required,training,for,each,plan,,but,you,did,not,achieve,a,passing,score,on,
the,tests,that,came,after,the,training.,What,can,you,do,in,this,situation?,,,ANS,-
You,will,not,be,able,to,represent,any,Medicare,Advantage,or,Part,D,plan,until,you,complete,the,training,a
nd,achieve,an,adequate,score,,although,you,will,not,have,to,take,a,test,if,you,exclusively,market,employe
r/union,group,plans,and,the,companies,do,not,require,testing.
