AHIP Complete Final Questions And
Answers A+ (Latest Update 2025/2026)
Mrs. Willis has a rare condition for which two different brand name drugs are the only available
treatment. She is concerned that since no generic prescription drugs are available and these drugs are
very high cost, she will not be able to find a Medicare Part D prescription drug plan that covers either
one of them. What should you tell her? correct answers
Medicare prescription drug plans are required to cover drugs in each therapeutic category. She should
be able to enroll in a Medicare prescription drug plan that covers the medications she needs.
Mrs. McFarren is enrolled in her state's Medicaid plan and has just become eligible for Medicare as well.
What can she expect will happen to her drug coverage? correct answers
Unless she chooses a Medicare Part D prescription drug plan on her own, she will be automatically
enrolled in one available in her area.
Mrs. Wood, age 65, is concerned that she may not qualify for enrollment in a Medicare prescription
drug plan because, although she is entitled to Part A, she is not enrolled under Medicare Part B. What
should you tell her? correct answers
An individual 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. Wood is entitled to Part A, she does not need to enroll under Part
B before enrolling in a prescription drug plan.
Mr. Sutton has a small savings account. He would like to pay for his monthly Part D premiums with an
automatic monthly withdrawal from his savings account until it is exhausted, and then have his
premiums withheld from his Social Security check. What should you tell him? correct answers
In general, he must select a single Part D premium payment mechanism that will be used throughout the
year.
,.
Mr. and Mrs. Cole both take a specialized multivitamin prescription each day. Mr. Cole takes a
prescription to help regrow his hair. They are anxious to have their Medicare prescription drug plan
cover these drug needs. What should you tell them? correct answers
Medicare prescription drug plans are not permitted to cover the prescription medications the Coles are
interested in under Part D coverage, however, plans may cover them as supplemental benefits and the
Coles could look into that possibility.
Ms. Ramos is enrolled in a Medicare Advantage plan that includes prescription drug plan (PDP)
coverage. She is traveling and wishes to fill two of the prescriptions that she has lost. How would you
advise her? correct answers
She may fill prescriptions for covered drugs at non-network pharmacies, but likely at a higher cost than
paid at an in-network pharmacy.
Mr. Chen was still working when he first qualified for Medicare. At that time, he had employer group
coverage that was creditable. During his initial Part D eligibility period, he decided not to enroll because
he was satisfied with his drug coverage. It is now a year later and Mr. Chen has lost his employer group
coverage within the last two weeks. How would you advise him? correct answers
Mr. Chen should enroll in a Part D plan before he has a 63-day break in coverage in order to avoid a
premium penalty.
Mrs. Kelly wants to enroll in a Medicare Advantage plan that does not include drug coverage and also
enroll in a stand-alone Medicare prescription drug plan. Under what circumstances can she do this?
correct answers
If the Medicare Advantage plan is a Private Fee-for-Service (PFFS) plan that does not offer drug coverage
or a Medical Savings Account plan, Mrs. Kelly can do this.
John Cohen is a Medicare beneficiary who suffers from diabetes. Mr. Cohen is considering enrollment in
an MA-PD plan that you represent. He asks you whether his insulin costs will be covered. What should
you say? correct answers
,Mr. Cohen's insulin costs for a one-month supply cannot be more than $35 in any coverage phase.
Mrs. Strickland is a new Medicare beneficiary who has just retired from retail work. She is interested in
selecting a Medicare Part D prescription drug plan. She takes several medications and is concerned that
she has not been able to identify a plan that covers all of her medications. She does not want to make
an abrupt change to new drugs that would be covered and asks what she should do. What should you
tell her? correct answers
Every Part D drug plan is required to cover a single one-month fill of her existing medications sometime
during a 90-day transition period.
What types of tools can Medicare Part D prescription drug plans use that affect the way their enrollees
can access medications? correct answers
Part D plans do not have to cover all medications. As a result, their formularies, or lists of covered drugs,
will vary from plan to plan. In addition, they can use cost containment techniques such as tiered co-
payments and step therapy.
Which of the following statements about Medicare Part D is/are correct? correct answers
I. Part D plans must enroll any eligible beneficiary who applies, regardless of health status, except in
limited circumstances.
II. Private fee-for-service (PFFS) plans are not required to use a pharmacy network but may choose to
have one.
III. Beneficiaries enrolled in an MA-Medical Savings Account (MSA) plan may only obtain Part D benefits
through a standalone PDP.
IV. Beneficiaries enrolled in an MA-PPO may obtain Part D benefits through a standalone PDP or through
their plan.
I, II, and III only
Mrs. Sharma has Original Medicare and would like to enroll in a Private Fee-for-Service (PFFS) plan. All
types of PFFS plans are available in her area. Which options could Mrs. Sharma consider before selecting
a PFFS plan? correct answers
, A Medicare Advantage Prescription Drug (MA-PD) PFFS plan that combines medical benefits and Part D
prescription drug coverage, a PFFS plan offering only medical benefits, or a PFFS plan in combination
with a stand-alone prescription drug plan.
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? correct answers
Tell prospect Jerry Smith that he should consider adding a standalone Part D prescription drug coverage
policy to his present coverage.
.
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? correct answers
Mr. Wu may still qualify for help in paying Part D costs through his State Pharmaceutical Assistance
Program (SPAP).
Mr. Vasquez is in good health and is preparing a budget in anticipation of his retirement when he turns
66. He wants to understand the health care costs he might be exposed to under Medicare if he were to
require hospitalization because of an illness. In general terms, what could you tell him about his costs
for inpatient hospital services under Original Medicare? correct answers
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, after which he would be responsible for all
costs.
Mr. Moy will soon turn age 65. He is slightly younger than his wife. Mr. Moy's wife has a Medicare
Advantage plan, but he wants to understand what coverage Medicare Supplemental Insurance provides
since his health care needs are different from his wife's needs. What could you tell Mr. Moy? correct
answers
Answers A+ (Latest Update 2025/2026)
Mrs. Willis has a rare condition for which two different brand name drugs are the only available
treatment. She is concerned that since no generic prescription drugs are available and these drugs are
very high cost, she will not be able to find a Medicare Part D prescription drug plan that covers either
one of them. What should you tell her? correct answers
Medicare prescription drug plans are required to cover drugs in each therapeutic category. She should
be able to enroll in a Medicare prescription drug plan that covers the medications she needs.
Mrs. McFarren is enrolled in her state's Medicaid plan and has just become eligible for Medicare as well.
What can she expect will happen to her drug coverage? correct answers
Unless she chooses a Medicare Part D prescription drug plan on her own, she will be automatically
enrolled in one available in her area.
Mrs. Wood, age 65, is concerned that she may not qualify for enrollment in a Medicare prescription
drug plan because, although she is entitled to Part A, she is not enrolled under Medicare Part B. What
should you tell her? correct answers
An individual 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. Wood is entitled to Part A, she does not need to enroll under Part
B before enrolling in a prescription drug plan.
Mr. Sutton has a small savings account. He would like to pay for his monthly Part D premiums with an
automatic monthly withdrawal from his savings account until it is exhausted, and then have his
premiums withheld from his Social Security check. What should you tell him? correct answers
In general, he must select a single Part D premium payment mechanism that will be used throughout the
year.
,.
Mr. and Mrs. Cole both take a specialized multivitamin prescription each day. Mr. Cole takes a
prescription to help regrow his hair. They are anxious to have their Medicare prescription drug plan
cover these drug needs. What should you tell them? correct answers
Medicare prescription drug plans are not permitted to cover the prescription medications the Coles are
interested in under Part D coverage, however, plans may cover them as supplemental benefits and the
Coles could look into that possibility.
Ms. Ramos is enrolled in a Medicare Advantage plan that includes prescription drug plan (PDP)
coverage. She is traveling and wishes to fill two of the prescriptions that she has lost. How would you
advise her? correct answers
She may fill prescriptions for covered drugs at non-network pharmacies, but likely at a higher cost than
paid at an in-network pharmacy.
Mr. Chen was still working when he first qualified for Medicare. At that time, he had employer group
coverage that was creditable. During his initial Part D eligibility period, he decided not to enroll because
he was satisfied with his drug coverage. It is now a year later and Mr. Chen has lost his employer group
coverage within the last two weeks. How would you advise him? correct answers
Mr. Chen should enroll in a Part D plan before he has a 63-day break in coverage in order to avoid a
premium penalty.
Mrs. Kelly wants to enroll in a Medicare Advantage plan that does not include drug coverage and also
enroll in a stand-alone Medicare prescription drug plan. Under what circumstances can she do this?
correct answers
If the Medicare Advantage plan is a Private Fee-for-Service (PFFS) plan that does not offer drug coverage
or a Medical Savings Account plan, Mrs. Kelly can do this.
John Cohen is a Medicare beneficiary who suffers from diabetes. Mr. Cohen is considering enrollment in
an MA-PD plan that you represent. He asks you whether his insulin costs will be covered. What should
you say? correct answers
,Mr. Cohen's insulin costs for a one-month supply cannot be more than $35 in any coverage phase.
Mrs. Strickland is a new Medicare beneficiary who has just retired from retail work. She is interested in
selecting a Medicare Part D prescription drug plan. She takes several medications and is concerned that
she has not been able to identify a plan that covers all of her medications. She does not want to make
an abrupt change to new drugs that would be covered and asks what she should do. What should you
tell her? correct answers
Every Part D drug plan is required to cover a single one-month fill of her existing medications sometime
during a 90-day transition period.
What types of tools can Medicare Part D prescription drug plans use that affect the way their enrollees
can access medications? correct answers
Part D plans do not have to cover all medications. As a result, their formularies, or lists of covered drugs,
will vary from plan to plan. In addition, they can use cost containment techniques such as tiered co-
payments and step therapy.
Which of the following statements about Medicare Part D is/are correct? correct answers
I. Part D plans must enroll any eligible beneficiary who applies, regardless of health status, except in
limited circumstances.
II. Private fee-for-service (PFFS) plans are not required to use a pharmacy network but may choose to
have one.
III. Beneficiaries enrolled in an MA-Medical Savings Account (MSA) plan may only obtain Part D benefits
through a standalone PDP.
IV. Beneficiaries enrolled in an MA-PPO may obtain Part D benefits through a standalone PDP or through
their plan.
I, II, and III only
Mrs. Sharma has Original Medicare and would like to enroll in a Private Fee-for-Service (PFFS) plan. All
types of PFFS plans are available in her area. Which options could Mrs. Sharma consider before selecting
a PFFS plan? correct answers
, A Medicare Advantage Prescription Drug (MA-PD) PFFS plan that combines medical benefits and Part D
prescription drug coverage, a PFFS plan offering only medical benefits, or a PFFS plan in combination
with a stand-alone prescription drug plan.
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? correct answers
Tell prospect Jerry Smith that he should consider adding a standalone Part D prescription drug coverage
policy to his present coverage.
.
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? correct answers
Mr. Wu may still qualify for help in paying Part D costs through his State Pharmaceutical Assistance
Program (SPAP).
Mr. Vasquez is in good health and is preparing a budget in anticipation of his retirement when he turns
66. He wants to understand the health care costs he might be exposed to under Medicare if he were to
require hospitalization because of an illness. In general terms, what could you tell him about his costs
for inpatient hospital services under Original Medicare? correct answers
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, after which he would be responsible for all
costs.
Mr. Moy will soon turn age 65. He is slightly younger than his wife. Mr. Moy's wife has a Medicare
Advantage plan, but he wants to understand what coverage Medicare Supplemental Insurance provides
since his health care needs are different from his wife's needs. What could you tell Mr. Moy? correct
answers
