2025-2026 AHIP FINAL EXAM (FULLY SOLVED)
A Medicare beneficiary has walked into your office and requested that you sit
down with her and discuss her options under the Medicare Advantage program.
Before engaging in such a discussion, what should you do? - CORRECT ANSWER -
You must have her sign a scope of appointment form, indicating which products
she wishes to discuss. You may then proceed with the discussion.
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? -
CORRECT ANSWER - 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.
Agent Jennings makes a presentation on Medicare advertised as an educational
event. Agent Jennings distributes materials that are solely educational. However,
she gives a brief presentation that mentions plan-specific premiums. Is this a
prohibited activity at an event that has been advertised as educational? -
CORRECT ANSWER - Yes. When an event has been advertised as "educational,"
discussing plan-specific premiums is impermissible.
Alice is enrolled in a MA-PD plan. She makes a permanent move across the country
and wonders what her options are for continuing MA-PD coverage. What would
you say to her in regard to a special enrollment period (SEP)? - CORRECT ANSWER
- She is likely to qualify for a SEP. She can choose an effective date of up to three
months after the month in which the enrollment form is received by the new plan,
but the effective date may not be earlier than the date of her permanent move.
,Anita Magri will turn age 65 in August 2023. Anita intends to enroll in Original
Medicare Part A and Part B. She would also like to enroll in a Medicare Supplement
(Medigap) plan. Anita's older neighbor Mel has told her about the Medigap Plan F
in which he is enrolled. It not only provides foreign travel emergency benefits but
also covers his Medicare Part B deductible. Anita comes to you for advice. What
should you tell her? - CORRECT ANSWER - You are sorry to disappoint Anita, but
a Medigap F plan is no longer available to those who turn age 65 after January 1,
2020. Anita might instead consider other Medigap plans that offer foreign travel
benefits but do not cover the Part B deductible.
By contacting plans available in your area, you have learned that the plan you
represent has a significantly lower monthly premium than the others. Furthermore,
you see that the plan you represent has a unique benefits package. What should
you do to make sure your clients know about these pieces of information? -
CORRECT ANSWER - You may make comparisons between plans if you can support
them with studies or statistical data and such comparisons are factually based and
referenced.
Dr. Elizabeth Brennan does not contract with the ABC PFFS plan but accepts the
plan's terms and conditions for payment. Mary Rodgers sees Dr. Brennan for
treatment. How much may Dr. Brennan charge? - CORRECT ANSWER - Dr.
Brennan can charge Mary Rogers no more than the cost sharing specified in the
PFFS plan's terms and condition of payment which may include balance billing up
to 15%of the Medicare rate.
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 rating of a 4-star, which of the following would be the best
statement to say to her? - CORRECT ANSWER - The Medicare Advantage plan
received a 5-star rating in customer service and care coordination with an overall
performance rating of 4 stars.
, Hank's Fish Store, Inc. is a small company with just 15 employees located in Florida.
Hank, the store owner, has provided excellent health benefits to the store's
workforce. William, one of the store's long-time employees, will soon be reaching
age 65 and eligible for Medicare. William is in good health. He intends to remain an
active full-time employee, working several years after becoming eligible for
Medicare. What type(s) of retiree health benefit will Hank's Fish Store be able to
offer William? - CORRECT ANSWER - Hank's can continue to offer William the
same employee health benefit plan, or, if William enrolls in Medicare Part B, it can
enroll him in a Medicare Advantage plan that is offered to the public.
If you are to comply with Medicare's guidance regarding educational events, which
of the following would be acceptable activities? - CORRECT ANSWER - You may
distribute business cards to individuals who request information on how to contact
you for further details on the plan(s) you represent.
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? - CORRECT ANSWER - He generally would pay a monthly premium,
annual deductible, and per-prescription cost-sharing.
Mr. and Mrs. Nunez attended one of your sales presentations. They've asked you
to come to their home to clear up a few questions. During the presentation, Mrs.
Nunez feels tired and tells you that her husband can finish things up. She goes to
bed. At the end of your discussion, Mr. Nunez says that he wants to enroll both
himself and his wife. What should you do? - CORRECT ANSWER - As long as she
can do so, only Mrs. Nunez can sign her enrollment form. Mrs. Nunez will have to
wake up to sign her form or do so at another time.
A Medicare beneficiary has walked into your office and requested that you sit
down with her and discuss her options under the Medicare Advantage program.
Before engaging in such a discussion, what should you do? - CORRECT ANSWER -
You must have her sign a scope of appointment form, indicating which products
she wishes to discuss. You may then proceed with the discussion.
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? -
CORRECT ANSWER - 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.
Agent Jennings makes a presentation on Medicare advertised as an educational
event. Agent Jennings distributes materials that are solely educational. However,
she gives a brief presentation that mentions plan-specific premiums. Is this a
prohibited activity at an event that has been advertised as educational? -
CORRECT ANSWER - Yes. When an event has been advertised as "educational,"
discussing plan-specific premiums is impermissible.
Alice is enrolled in a MA-PD plan. She makes a permanent move across the country
and wonders what her options are for continuing MA-PD coverage. What would
you say to her in regard to a special enrollment period (SEP)? - CORRECT ANSWER
- She is likely to qualify for a SEP. She can choose an effective date of up to three
months after the month in which the enrollment form is received by the new plan,
but the effective date may not be earlier than the date of her permanent move.
,Anita Magri will turn age 65 in August 2023. Anita intends to enroll in Original
Medicare Part A and Part B. She would also like to enroll in a Medicare Supplement
(Medigap) plan. Anita's older neighbor Mel has told her about the Medigap Plan F
in which he is enrolled. It not only provides foreign travel emergency benefits but
also covers his Medicare Part B deductible. Anita comes to you for advice. What
should you tell her? - CORRECT ANSWER - You are sorry to disappoint Anita, but
a Medigap F plan is no longer available to those who turn age 65 after January 1,
2020. Anita might instead consider other Medigap plans that offer foreign travel
benefits but do not cover the Part B deductible.
By contacting plans available in your area, you have learned that the plan you
represent has a significantly lower monthly premium than the others. Furthermore,
you see that the plan you represent has a unique benefits package. What should
you do to make sure your clients know about these pieces of information? -
CORRECT ANSWER - You may make comparisons between plans if you can support
them with studies or statistical data and such comparisons are factually based and
referenced.
Dr. Elizabeth Brennan does not contract with the ABC PFFS plan but accepts the
plan's terms and conditions for payment. Mary Rodgers sees Dr. Brennan for
treatment. How much may Dr. Brennan charge? - CORRECT ANSWER - Dr.
Brennan can charge Mary Rogers no more than the cost sharing specified in the
PFFS plan's terms and condition of payment which may include balance billing up
to 15%of the Medicare rate.
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 rating of a 4-star, which of the following would be the best
statement to say to her? - CORRECT ANSWER - The Medicare Advantage plan
received a 5-star rating in customer service and care coordination with an overall
performance rating of 4 stars.
, Hank's Fish Store, Inc. is a small company with just 15 employees located in Florida.
Hank, the store owner, has provided excellent health benefits to the store's
workforce. William, one of the store's long-time employees, will soon be reaching
age 65 and eligible for Medicare. William is in good health. He intends to remain an
active full-time employee, working several years after becoming eligible for
Medicare. What type(s) of retiree health benefit will Hank's Fish Store be able to
offer William? - CORRECT ANSWER - Hank's can continue to offer William the
same employee health benefit plan, or, if William enrolls in Medicare Part B, it can
enroll him in a Medicare Advantage plan that is offered to the public.
If you are to comply with Medicare's guidance regarding educational events, which
of the following would be acceptable activities? - CORRECT ANSWER - You may
distribute business cards to individuals who request information on how to contact
you for further details on the plan(s) you represent.
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? - CORRECT ANSWER - He generally would pay a monthly premium,
annual deductible, and per-prescription cost-sharing.
Mr. and Mrs. Nunez attended one of your sales presentations. They've asked you
to come to their home to clear up a few questions. During the presentation, Mrs.
Nunez feels tired and tells you that her husband can finish things up. She goes to
bed. At the end of your discussion, Mr. Nunez says that he wants to enroll both
himself and his wife. What should you do? - CORRECT ANSWER - As long as she
can do so, only Mrs. Nunez can sign her enrollment form. Mrs. Nunez will have to
wake up to sign her form or do so at another time.
