AHIP FINAL EXAM, PRACTICE EXAM AND STUDY GUIDE LATEST 2025/202
AHIP FINAL EXAM, PRACTICE EXAM AND STUDY GUIDE LATEST
ACTUAL EXAM
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1. Mr. Davies is turning 65 next a. Cost plan enrollees can choose to receive Medicare
month. He would like to enroll in covered services under the plan's benefits by going to
a Medicare health plan, but does plan network providers and paying plan cost sharing,
not want to be limited in terms of or may receive services from non-network providers
where he obtains his care. What and pay cost-sharing due under Original Medicare.
should you tell him about how a
Medicare Cost Plan might fit his
needs?
2. b. Ms. Lopez is considered a mar- Ms. Lopez is an independent agent under contract
keting representative of BestCare with MarketCo, a third-party marketing organization.
and thus is obligated to comply MarketCo has a contract with BestCare health plan,
with CMS marketing requirements, a Medicare Advantage (MA) organization, to offer
including those regarding using marketing services through its contracted agents and
only approved call scripts. agencies. Ms. Lopez returns calls to individuals who
contact MarketCo in response to its mailers promoting
BestCare health plan. Which of the following best de-
scribes the responsibilities of Ms. Lopez?
a. Ms. Lopez is considered a marketing representative
of BestCare but is exempt from the marketing rules
regarding approved call scripts because she works di-
rectly for MarketCo.
b. Ms. Lopez is considered a marketing representa-
tive of BestCare and thus is obligated to comply with
CMS marketing requirements, including those regard-
ing using only approved call scripts.
c. Ms. Lopez no longer needs to be concerned about
state licensure since she is marketing an MA product
, AHIP FINAL EXAM, PRACTICE EXAM AND STUDY GUIDE LATEST 2025/202
AHIP FINAL EXAM, PRACTICE EXAM AND STUDY GUIDE LATEST
ACTUAL EXAM
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subject to federal rules.
d. Ms. Lopez needs to maintain state licensure, but be-
cause she is working for a third-party marketing orga-
nization she is exempt from CMS training requirements
that apply to BestCare captive agents.
3. Mr. Edwards, a marketing repre- a. He can do this because the estimated number of
sentative of the ACME Insurance attendees is based on the venue size and response rate
Company, scheduled a marketing and the value of the gift does not exceed $15.
event and expects about 40 people
to attend. He has hired a magician
at a cost of $200 to entertain at-
tendees. Can he do this in a way
that complies with guidance from
the Medicare agency?
4. Mrs. Ramos is considering a b. Mrs. Ramos can obtain care from any provider
Medicare Advantage PPO and has who participates in Original Medicare, but generally
questions about which providers will have a higher cost-sharing amount if she sees a
she can go to for her health care. provider who/that is not a part of the PPO network.
What should you tell her?
5. Julia Harris is turning 66 in July, at c. Tell Julia that you will meet with her to explain
which time she will retire. She has Medicare and should she be interested you can accept
contacted your office and request- and submit an enrollment request, since this is an ini-
ed a meeting so that she can learn tial enrollment qualifying her for a special enrollment
about Medicare and the products period.
you represent. How should you re-
spond?
6.
, AHIP FINAL EXAM, PRACTICE EXAM AND STUDY GUIDE LATEST 2025/202
AHIP FINAL EXAM, PRACTICE EXAM AND STUDY GUIDE LATEST
ACTUAL EXAM
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Mr. Rivera has Qualified Medicare The doctor may only collect from Mr. Rivera the cost
Beneficiary (QMB) eligibility and is sharing allowable under the state's Medicaid program.
thus covered by both Medicare and
Medicaid. He decides to enroll in
a Medicare Advantage (MA) PPO
plan. Later he sees an out-of-net-
work doctor to receive a Medicare
covered service. How much The
doctor may only collect from Mr.
Rivera the cost sharing allowable
under the state's Medicaid pro-
gram.may the doctor collect from
Mr. Rivera?
7. During a sales presentation in Ms.
Sullivan's home, she tells you that
she has heard about a type of
Medicare health plan known as
Private Fee-for-Service (PFFS). She
wants to know if this would be
available to her. What should you
tell her about PFFS plans?
8. Choose one answer.
9. a. A PFFS plan is a type of Medicare Supplement plan
and she may enroll in one if it is available in her area.
10. b. A PFFS plan is exactly the same as Original Medicare,
only offered by a private entity and she may enroll in
one if it is available in her area.
, AHIP FINAL EXAM, PRACTICE EXAM AND STUDY GUIDE LATEST 2025/202
AHIP FINAL EXAM, PRACTICE EXAM AND STUDY GUIDE LATEST
ACTUAL EXAM
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11. c. PFFS plans are designed to cover only prescription
drugs and if that is the type of coverage she wants, she
may enroll in one if it is available in her area.
12. d. A PFFS plan is one of the various types of Medicare
Advantage plans offered by private entities and she
may enroll in one if it is available in her area.
13. Question8
14. Marks: 1
15. During an appointment scheduled
to discuss a Medicare Advantage
Prescription Drug plan (MA-PD),
Mr. Peters asked his agent to de-
scribe a stand-alone prescription
drug plan (Part D plan) that his
neighbor told him about. What
should his agent do?
16. a. Since Mr. Peters requested a description of the Part
D plan, his agent must leave the Part D plan brochure,
but not an enrollment form, and would have to sched-
ule another appointment after at least 48 hours have
passed to discuss the Part D plan with Mr. Peters.
17. b. Since Mr. Peters requested a description of the Part D
plan, his agent must have Mr. Peters sign a new scope
of appointment form that includes Part D, and then
the agent may discuss the Part D plan so Mr. Peters
AHIP FINAL EXAM, PRACTICE EXAM AND STUDY GUIDE LATEST
ACTUAL EXAM
Study online at https://quizlet.com/_hbouih
1. Mr. Davies is turning 65 next a. Cost plan enrollees can choose to receive Medicare
month. He would like to enroll in covered services under the plan's benefits by going to
a Medicare health plan, but does plan network providers and paying plan cost sharing,
not want to be limited in terms of or may receive services from non-network providers
where he obtains his care. What and pay cost-sharing due under Original Medicare.
should you tell him about how a
Medicare Cost Plan might fit his
needs?
2. b. Ms. Lopez is considered a mar- Ms. Lopez is an independent agent under contract
keting representative of BestCare with MarketCo, a third-party marketing organization.
and thus is obligated to comply MarketCo has a contract with BestCare health plan,
with CMS marketing requirements, a Medicare Advantage (MA) organization, to offer
including those regarding using marketing services through its contracted agents and
only approved call scripts. agencies. Ms. Lopez returns calls to individuals who
contact MarketCo in response to its mailers promoting
BestCare health plan. Which of the following best de-
scribes the responsibilities of Ms. Lopez?
a. Ms. Lopez is considered a marketing representative
of BestCare but is exempt from the marketing rules
regarding approved call scripts because she works di-
rectly for MarketCo.
b. Ms. Lopez is considered a marketing representa-
tive of BestCare and thus is obligated to comply with
CMS marketing requirements, including those regard-
ing using only approved call scripts.
c. Ms. Lopez no longer needs to be concerned about
state licensure since she is marketing an MA product
, AHIP FINAL EXAM, PRACTICE EXAM AND STUDY GUIDE LATEST 2025/202
AHIP FINAL EXAM, PRACTICE EXAM AND STUDY GUIDE LATEST
ACTUAL EXAM
Study online at https://quizlet.com/_hbouih
subject to federal rules.
d. Ms. Lopez needs to maintain state licensure, but be-
cause she is working for a third-party marketing orga-
nization she is exempt from CMS training requirements
that apply to BestCare captive agents.
3. Mr. Edwards, a marketing repre- a. He can do this because the estimated number of
sentative of the ACME Insurance attendees is based on the venue size and response rate
Company, scheduled a marketing and the value of the gift does not exceed $15.
event and expects about 40 people
to attend. He has hired a magician
at a cost of $200 to entertain at-
tendees. Can he do this in a way
that complies with guidance from
the Medicare agency?
4. Mrs. Ramos is considering a b. Mrs. Ramos can obtain care from any provider
Medicare Advantage PPO and has who participates in Original Medicare, but generally
questions about which providers will have a higher cost-sharing amount if she sees a
she can go to for her health care. provider who/that is not a part of the PPO network.
What should you tell her?
5. Julia Harris is turning 66 in July, at c. Tell Julia that you will meet with her to explain
which time she will retire. She has Medicare and should she be interested you can accept
contacted your office and request- and submit an enrollment request, since this is an ini-
ed a meeting so that she can learn tial enrollment qualifying her for a special enrollment
about Medicare and the products period.
you represent. How should you re-
spond?
6.
, AHIP FINAL EXAM, PRACTICE EXAM AND STUDY GUIDE LATEST 2025/202
AHIP FINAL EXAM, PRACTICE EXAM AND STUDY GUIDE LATEST
ACTUAL EXAM
Study online at https://quizlet.com/_hbouih
Mr. Rivera has Qualified Medicare The doctor may only collect from Mr. Rivera the cost
Beneficiary (QMB) eligibility and is sharing allowable under the state's Medicaid program.
thus covered by both Medicare and
Medicaid. He decides to enroll in
a Medicare Advantage (MA) PPO
plan. Later he sees an out-of-net-
work doctor to receive a Medicare
covered service. How much The
doctor may only collect from Mr.
Rivera the cost sharing allowable
under the state's Medicaid pro-
gram.may the doctor collect from
Mr. Rivera?
7. During a sales presentation in Ms.
Sullivan's home, she tells you that
she has heard about a type of
Medicare health plan known as
Private Fee-for-Service (PFFS). She
wants to know if this would be
available to her. What should you
tell her about PFFS plans?
8. Choose one answer.
9. a. A PFFS plan is a type of Medicare Supplement plan
and she may enroll in one if it is available in her area.
10. b. A PFFS plan is exactly the same as Original Medicare,
only offered by a private entity and she may enroll in
one if it is available in her area.
, AHIP FINAL EXAM, PRACTICE EXAM AND STUDY GUIDE LATEST 2025/202
AHIP FINAL EXAM, PRACTICE EXAM AND STUDY GUIDE LATEST
ACTUAL EXAM
Study online at https://quizlet.com/_hbouih
11. c. PFFS plans are designed to cover only prescription
drugs and if that is the type of coverage she wants, she
may enroll in one if it is available in her area.
12. d. A PFFS plan is one of the various types of Medicare
Advantage plans offered by private entities and she
may enroll in one if it is available in her area.
13. Question8
14. Marks: 1
15. During an appointment scheduled
to discuss a Medicare Advantage
Prescription Drug plan (MA-PD),
Mr. Peters asked his agent to de-
scribe a stand-alone prescription
drug plan (Part D plan) that his
neighbor told him about. What
should his agent do?
16. a. Since Mr. Peters requested a description of the Part
D plan, his agent must leave the Part D plan brochure,
but not an enrollment form, and would have to sched-
ule another appointment after at least 48 hours have
passed to discuss the Part D plan with Mr. Peters.
17. b. Since Mr. Peters requested a description of the Part D
plan, his agent must have Mr. Peters sign a new scope
of appointment form that includes Part D, and then
the agent may discuss the Part D plan so Mr. Peters
