AHIP Final Exam 2026 – Verified Edition
with Rationales
Mr. Jacob understands that there is a standard Medicare Part D prescription drug
benefit, but when he looks at information on various plans available in his area, he sees
a wide range in what they charge for deductibles, premiums and cost sharing. How can
you explain this to him? - ANSWER-Medicare Part D drug plans may have different
benefit structures, but on average, they must all be at least as good as the standard
model established by the government.
Mrs. West wears glasses and dentures and has enjoyed considerable pain relief from
arthritis through acupuncture. She is concerned about whether or not Medicare will
cover these items and services. What should you tell her? - ANSWER-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? - ANSWER-He could check with the manufacturers of his medications to see if
they offer an assistance program to help people with limited means obtain the
medications they need. Alternatively, he could check to see whether 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 coverage and intends to obtain his drug
coverage through a stand-alone Medicare prescription drug plan. What should you tell
him about this situation? - ANSWER-He could enroll in one of the MA plans that include
, prescription drug coverage or a Medigap plan and a stand-alone prescription drug plan,
but he cannot enroll in the MA-only PPO plan and a stand-alone prescription drug plan.
Agent Armstrong is employed by XYZ Agency, which is under contract with ABC Health
Plan, a Medicare Advantage (MA) plan that offers plans in multiple states. XYZ Agency
maintains a website marketing the MA plans with which it has contracts. Agent
Armstrong follows up with individuals who request more information about ABC MA
plans via the website and tries to persuade them to enroll in ABC plans. What statement
best describes the marketing and compliance rules that apply to Agent Armstrong? -
ANSWER-Agent Armstrong needs to be licensed and appointed in every state in which
beneficiaries to whom he markets 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? - 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.
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? - ANSWER-You will not be able to represent any Medicare
Advantage or Part D plan until you complete the training and achieve an adequate
score, although you will not have to take a test if you exclusively market employer/union
group plans and the companies do not require testing.
Mr. Torres 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? - ANSWER-In general, he must select a single Part D premium
payment mechanism that will be used throughout the year.
with Rationales
Mr. Jacob understands that there is a standard Medicare Part D prescription drug
benefit, but when he looks at information on various plans available in his area, he sees
a wide range in what they charge for deductibles, premiums and cost sharing. How can
you explain this to him? - ANSWER-Medicare Part D drug plans may have different
benefit structures, but on average, they must all be at least as good as the standard
model established by the government.
Mrs. West wears glasses and dentures and has enjoyed considerable pain relief from
arthritis through acupuncture. She is concerned about whether or not Medicare will
cover these items and services. What should you tell her? - ANSWER-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? - ANSWER-He could check with the manufacturers of his medications to see if
they offer an assistance program to help people with limited means obtain the
medications they need. Alternatively, he could check to see whether 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 coverage and intends to obtain his drug
coverage through a stand-alone Medicare prescription drug plan. What should you tell
him about this situation? - ANSWER-He could enroll in one of the MA plans that include
, prescription drug coverage or a Medigap plan and a stand-alone prescription drug plan,
but he cannot enroll in the MA-only PPO plan and a stand-alone prescription drug plan.
Agent Armstrong is employed by XYZ Agency, which is under contract with ABC Health
Plan, a Medicare Advantage (MA) plan that offers plans in multiple states. XYZ Agency
maintains a website marketing the MA plans with which it has contracts. Agent
Armstrong follows up with individuals who request more information about ABC MA
plans via the website and tries to persuade them to enroll in ABC plans. What statement
best describes the marketing and compliance rules that apply to Agent Armstrong? -
ANSWER-Agent Armstrong needs to be licensed and appointed in every state in which
beneficiaries to whom he markets 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? - 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.
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? - ANSWER-You will not be able to represent any Medicare
Advantage or Part D plan until you complete the training and achieve an adequate
score, although you will not have to take a test if you exclusively market employer/union
group plans and the companies do not require testing.
Mr. Torres 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? - ANSWER-In general, he must select a single Part D premium
payment mechanism that will be used throughout the year.
