1|Page
AHIP Final Exam 2025-2026:
Comprehensive Study Guide with Updated
Questions, Revised Answers, and Key
Concepts for Medicare Advantage and Part
D Plans, Covering Enrollment, Special
Needs Plans, Regulatory Compliance, and
Marketing Guidelines, Graded A+
Richard is a licensed agent who represents Spartan Health Plan and its Medicare
Advantage (MA) plans. Richard has several clients who have recently come to him
for help who are in their initial coverage election period (ICEP) and are interested
in enrolling in one of Spartan Health Plan's MA plans. Alice will soon turn 65 and
retire. Alice has coverage through Spartan Health Plan offered by her employer.
Bob had health coverage through Spartan but dropped the coverage when he
retired early to travel overseas. Bob, who has just turned age 65, is now back in the
United States. Charlotte, who will turn 65 next month, has coverage through
Athena Health plan - a company Richard also represents. Who qualifies for the
opt-in simplified enrollment mechanism?
Answer: Alice and Charlotte because each of them currently have health coverage
and is in their initial coverage election period (ICEP).
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)?
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.
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Ms. Morris will turn 65 on June 10th. She has never previously qualified for
Medicare. She is entitled to Medicare Part A and intends to enroll in Part B. She
wants to know if she is eligible to enroll in a Medicare Advantage plan that
includes prescription drug coverage. What do you tell her?
Answer: Ms. Morris can enroll in an MA-PD plan now since her initial election
period (IEP) for Part D prescription drug coverage and initial coverage period are
occurring together beginning March 1st and ending September 30th.
Mr. Lopez, who is fairly well-off financially, would like to enroll in a Medicare
prescription drug plan you represent and simply give you a check to cover his
premiums for the entire year. What should you tell him?
Answer: Enrollees should pay using automatic withdrawal from a bank account or
credit or debit card, direct monthly billing from the plan, or deductions from their
Social Security check.
Mrs. Albertson has been enrolled in a Medicare Part D plan for several years. She
takes several brand name drugs and is interested in learning about the Medicare
Prescription Payment Plan. What should you tell her?
Answer: Enrollees can opt out of the program at any time. However, they will
continue to be billed for any cost-sharing amounts still owed.
Mr. Wu is eligible for Medicare. He has limited financial resources but failed to
qualify for the Part D low-income subsidy. Where might he turn for help with his
prescription drug costs?
Answer: Mr. Wu may still qualify for help in paying Part D costs through his State
Pharmaceutical Assistance Program.
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Mr. Bauer is 49 years old, but eighteen months ago he was declared disabled by the
Social Security Administration and has been receiving disability payments. He is
wondering whether he can obtain coverage under Medicare. What should you tell
him?
Answer: After receiving such disability payments for 24 months, he will be
automatically enrolled in Medicare, regardless of age.
Mildred Savage enrolled in Allcare Medicare Advantage plan several years ago.
Mildred recently learned that she is suffering from inoperable cancer and has just a
few months to live. She would like to spend these final months in hospice care.
Mildred's family asks you whether hospice benefits will be paid for under the
Allcare Medicare Advantage plan. What should you say?
Answer: Mildred may remain enrolled in Allcare and make a hospice election.
Hospice benefits will be paid for by Original Medicare under Part A and Allcare
will continue to pay for any non-hospice services.
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?
Answer: 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.
Agent John Miller is meeting with Jerry Smith, a new prospect. Jerry is currently
enrolled in Medicare Parts A and B. Jerry has also purchased a Medicare
Supplement (Medigap) plan which he has had for several years. However, the plan
does not provide drug benefits. How would you advise Agent John Miller to
proceed?
Answer: Tell prospect Jerry Smith that he should consider adding a standalone Part
D prescription drug coverage policy to his present coverage.
AHIP Final Exam 2025-2026:
Comprehensive Study Guide with Updated
Questions, Revised Answers, and Key
Concepts for Medicare Advantage and Part
D Plans, Covering Enrollment, Special
Needs Plans, Regulatory Compliance, and
Marketing Guidelines, Graded A+
Richard is a licensed agent who represents Spartan Health Plan and its Medicare
Advantage (MA) plans. Richard has several clients who have recently come to him
for help who are in their initial coverage election period (ICEP) and are interested
in enrolling in one of Spartan Health Plan's MA plans. Alice will soon turn 65 and
retire. Alice has coverage through Spartan Health Plan offered by her employer.
Bob had health coverage through Spartan but dropped the coverage when he
retired early to travel overseas. Bob, who has just turned age 65, is now back in the
United States. Charlotte, who will turn 65 next month, has coverage through
Athena Health plan - a company Richard also represents. Who qualifies for the
opt-in simplified enrollment mechanism?
Answer: Alice and Charlotte because each of them currently have health coverage
and is in their initial coverage election period (ICEP).
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)?
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.
,2|Page
Ms. Morris will turn 65 on June 10th. She has never previously qualified for
Medicare. She is entitled to Medicare Part A and intends to enroll in Part B. She
wants to know if she is eligible to enroll in a Medicare Advantage plan that
includes prescription drug coverage. What do you tell her?
Answer: Ms. Morris can enroll in an MA-PD plan now since her initial election
period (IEP) for Part D prescription drug coverage and initial coverage period are
occurring together beginning March 1st and ending September 30th.
Mr. Lopez, who is fairly well-off financially, would like to enroll in a Medicare
prescription drug plan you represent and simply give you a check to cover his
premiums for the entire year. What should you tell him?
Answer: Enrollees should pay using automatic withdrawal from a bank account or
credit or debit card, direct monthly billing from the plan, or deductions from their
Social Security check.
Mrs. Albertson has been enrolled in a Medicare Part D plan for several years. She
takes several brand name drugs and is interested in learning about the Medicare
Prescription Payment Plan. What should you tell her?
Answer: Enrollees can opt out of the program at any time. However, they will
continue to be billed for any cost-sharing amounts still owed.
Mr. Wu is eligible for Medicare. He has limited financial resources but failed to
qualify for the Part D low-income subsidy. Where might he turn for help with his
prescription drug costs?
Answer: Mr. Wu may still qualify for help in paying Part D costs through his State
Pharmaceutical Assistance Program.
, 3|Page
Mr. Bauer is 49 years old, but eighteen months ago he was declared disabled by the
Social Security Administration and has been receiving disability payments. He is
wondering whether he can obtain coverage under Medicare. What should you tell
him?
Answer: After receiving such disability payments for 24 months, he will be
automatically enrolled in Medicare, regardless of age.
Mildred Savage enrolled in Allcare Medicare Advantage plan several years ago.
Mildred recently learned that she is suffering from inoperable cancer and has just a
few months to live. She would like to spend these final months in hospice care.
Mildred's family asks you whether hospice benefits will be paid for under the
Allcare Medicare Advantage plan. What should you say?
Answer: Mildred may remain enrolled in Allcare and make a hospice election.
Hospice benefits will be paid for by Original Medicare under Part A and Allcare
will continue to pay for any non-hospice services.
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?
Answer: 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.
Agent John Miller is meeting with Jerry Smith, a new prospect. Jerry is currently
enrolled in Medicare Parts A and B. Jerry has also purchased a Medicare
Supplement (Medigap) plan which he has had for several years. However, the plan
does not provide drug benefits. How would you advise Agent John Miller to
proceed?
Answer: Tell prospect Jerry Smith that he should consider adding a standalone Part
D prescription drug coverage policy to his present coverage.
