Page 1 of 51
AHIP 2025 Final Exam , XCEL SOLUTIONS - FINAL EXAM , NAPSRX final
exam
C0MBINED EXAMINATION 2025 – 2026 WITH QUESTIONS WITH CORRECT
ANSWERS VERIFIED 100% GRADED A+
AHIP 2025 Final Exam
Mr. Davies is turning 65 next month. He would like to enroll in a Medicare
health plan, but does not want to be limited in terms of where he obtains his
care. What should you tell him about how a Medicare Cost Plan might fit his
needs?
a. Cost plan enrollees can choose to receive Medicare covered services under
the plan's benefits by going to plan network providers and paying plan cost sharing,
or may receive services from non-network providers and pay cost-sharing due under
Original Medicare.
b. Ms. Lopez is considered a marketing representative of BestCare and
thus is obligated to comply with CMS marketing requirements, including those
regarding using only approved call scripts.
Ms. Lopez is an independent agent under contract with MarketCo, a third-party
marketing organization. MarketCo has a contract with BestCare health plan, a
Medicare Advantage (MA) organization, to offer marketing services through its
contracted agents and agencies. Ms. Lopez returns calls to individuals who contact
MarketCo in response to its mailers promoting BestCare health plan. Which of the
following best describes 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
directly for MarketCo.
b. Ms. Lopez is considered a marketing representative of BestCare and thus is
obligated to comply with CMS marketing requirements, including those regarding
using only approved call scripts.
c. Ms. Lopez no longer needs to be concerned about state licensure since she is
marketing an MA product subject to federal rules.
d. Ms. Lopez needs to maintain state licensure, but because she is working for a
third-party marketing organization she is exempt from CMS training requirements
that apply to BestCare captive agents.
Mr. Edwards, a marketing representative of the ACME Insurance Company,
scheduled a marketing event and expects about 40 people to attend. He has
, Page 2 of 51
hired a magician at a cost of $200 to entertain attendees. Can he do this in a
way that complies with guidance from the Medicare agency?
a. He can do this because the estimated number of attendees is based on the
venue size and response rate and the value of the gift does not exceed $15.
Mrs. Ramos is considering a Medicare Advantage PPO and has questions
about which providers she can go to for her health care. What should you tell
her?
b. Mrs. Ramos can obtain care from any provider who participates in Original
Medicare, but generally will have a higher cost-sharing amount if she sees a provider
who/that is not a part of the PPO network.
Julia Harris is turning 66 in July, at which time she will retire. She has
contacted your office and requested a meeting so that she can learn about
Medicare and the products you represent. How should you respond?
c. Tell Julia that you will meet with her to explain Medicare and should she be
interested you can accept and submit an enrollment request, since this is an initial
enrollment qualifying her for a special enrollment period.
Mr. Rivera has Qualified Medicare Beneficiary (QMB) eligibility and is thus
covered by both Medicare and Medicaid. He decides to enroll in a Medicare
Advantage (MA) PPO plan. Later he sees an out-of-network 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 program.may the
doctor collect from Mr. Rivera?
The doctor may only collect from Mr. Rivera the cost sharing allowable under the
state's Medicaid program.
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?
Choose one answer.
a. A PFFS plan is a type of Medicare Supplement plan and she may enroll
in one if it is available in her area.
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.
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. 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.
Question8
Marks: 1
During an appointment scheduled to discuss a Medicare Advantage
Prescription Drug plan (MA-PD), Mr. Peters asked his agent to describe a
stand-alone prescription drug plan (Part D plan) that his neighbor told him
about. What should his agent do?
Choose one answer.
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
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have to schedule another appointment after at least 48 hours have passed to
discuss the Part D plan with Mr. Peters.
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 can compare
plans and make an informed enrollment choice during the appointment.
c. Since Mr. Peters requested a description of the Part D plan, his agent
must inform Mr. Peters that he can only sign up for the MA-PD plan and cannot
receive a brochure or any other information about the Part D plan now
because he did not agree in advance to discuss that plan
d. Since Mr. Peters requested a description of the Part D plan, his agent
must discuss both the Part D and the MA-PD plans and return after at least 48
hours to complete the Part D plan enrollment form with Mr. Peters.
Question9
Marks: 1
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?
Choose one answer.
a. In general, he must select a single Part D premium payment mechanism
that will be used throughout the year.
b. As long as he fills out the paperwork to begin withholding from his
Social Security check at least 63 days before such withholding should begin,
he can change his method of Part D premium payment and withholding will
begin the month after his savings account is exhausted.
c. During 2017, many people experienced significant problems with
deductions from their Social Security check for their Part D premium. As a
result, this method of payment is no longer an option for Part D premium
payments d. In general, to pay his Part D premium, he only can have automatic
withdrawals made from a checking account, so he will need to transfer the
funds prior to beginning such withdrawals.
Question10
Marks: 1
Since 2004 Ms. Eisenberg has had a Medigap plan that provides some drug
coverage. She has recently received a letter from her Medigap carrier
informing her that her drug coverage is not "creditable." She wants to know
what this means. What should you tell her?
Choose one answer.
a. The letter is to inform her that her Medigap drug coverage must be
supplemented by purchasing coverage under a Part D plan. If she does not do
so within 63 days, she will not be able to obtain Part D coverage at a later date.
b. The letter is to inform her that the drug coverage offered through her
Medigap plan does not offer drug coverage that is at least comparable to that
provided under the Medicare Part D prescription drug program. If she does not
have such creditable coverage during periods when she is first eligible for the
Part D program, she will face a premium penalty if she enrolls in a Part D plan
at a later date.
, Page 4 of 51
c. The letter is to inform her that her Medigap plan's coverage has been
determined by the Federal government to be inadequate and the plan must
therefore discontinue offering such coverage. Ms. Eisenberg will have to
select a different Medigap plan if she wants drug coverage.
d. The letter is to inform her that Medicare Part D prescription drug
coverage is available, but there is no need for her to change her drug
coverage since it is just as good as Part D. She may keep her current coverage
through the Medigap plan.
Question11
Marks: 1
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? Choose one answer.
a. Alice because she will not have a break between her non-Medicare and
Medicare coverage through Spartan Health Plan.
b. Alice and Charlotte because each of them currently have health
coverage and is in their initial coverage election period (ICEP).
c. Alice and Bob because each of them has had coverage through Spartan
Health Plan.
d. Alice, Bob, and Charlotte because electronic health record
interoperability will allow Richard to access any needed information for their
applications.
Question12
Marks: 1
Under what conditions can a Medicare prescription drug plan reduce its
coverage for a given drug during the first 60 days of the year?
Choose one answer.
a. When a formulary change is in response to a drug's removal from the
market.
b. When the Part D plan can demonstrate to CMS that no enrollee has
accessed the medication in the past six months, generally the plan can
remove the drug from its formulary within the first 60 days of the year.
c. Under no conditions can a Medicare Part D prescription drug plan
reduce its coverage for a given drug at any point during the year.
d. If the Medicare prescription drug plan can show that reducing coverage
early in the year will result in savings for the Part D plan and the Medicare
program, generally the plan may make such a change.
Question13
Marks: 1
AHIP 2025 Final Exam , XCEL SOLUTIONS - FINAL EXAM , NAPSRX final
exam
C0MBINED EXAMINATION 2025 – 2026 WITH QUESTIONS WITH CORRECT
ANSWERS VERIFIED 100% GRADED A+
AHIP 2025 Final Exam
Mr. Davies is turning 65 next month. He would like to enroll in a Medicare
health plan, but does not want to be limited in terms of where he obtains his
care. What should you tell him about how a Medicare Cost Plan might fit his
needs?
a. Cost plan enrollees can choose to receive Medicare covered services under
the plan's benefits by going to plan network providers and paying plan cost sharing,
or may receive services from non-network providers and pay cost-sharing due under
Original Medicare.
b. Ms. Lopez is considered a marketing representative of BestCare and
thus is obligated to comply with CMS marketing requirements, including those
regarding using only approved call scripts.
Ms. Lopez is an independent agent under contract with MarketCo, a third-party
marketing organization. MarketCo has a contract with BestCare health plan, a
Medicare Advantage (MA) organization, to offer marketing services through its
contracted agents and agencies. Ms. Lopez returns calls to individuals who contact
MarketCo in response to its mailers promoting BestCare health plan. Which of the
following best describes 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
directly for MarketCo.
b. Ms. Lopez is considered a marketing representative of BestCare and thus is
obligated to comply with CMS marketing requirements, including those regarding
using only approved call scripts.
c. Ms. Lopez no longer needs to be concerned about state licensure since she is
marketing an MA product subject to federal rules.
d. Ms. Lopez needs to maintain state licensure, but because she is working for a
third-party marketing organization she is exempt from CMS training requirements
that apply to BestCare captive agents.
Mr. Edwards, a marketing representative of the ACME Insurance Company,
scheduled a marketing event and expects about 40 people to attend. He has
, Page 2 of 51
hired a magician at a cost of $200 to entertain attendees. Can he do this in a
way that complies with guidance from the Medicare agency?
a. He can do this because the estimated number of attendees is based on the
venue size and response rate and the value of the gift does not exceed $15.
Mrs. Ramos is considering a Medicare Advantage PPO and has questions
about which providers she can go to for her health care. What should you tell
her?
b. Mrs. Ramos can obtain care from any provider who participates in Original
Medicare, but generally will have a higher cost-sharing amount if she sees a provider
who/that is not a part of the PPO network.
Julia Harris is turning 66 in July, at which time she will retire. She has
contacted your office and requested a meeting so that she can learn about
Medicare and the products you represent. How should you respond?
c. Tell Julia that you will meet with her to explain Medicare and should she be
interested you can accept and submit an enrollment request, since this is an initial
enrollment qualifying her for a special enrollment period.
Mr. Rivera has Qualified Medicare Beneficiary (QMB) eligibility and is thus
covered by both Medicare and Medicaid. He decides to enroll in a Medicare
Advantage (MA) PPO plan. Later he sees an out-of-network 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 program.may the
doctor collect from Mr. Rivera?
The doctor may only collect from Mr. Rivera the cost sharing allowable under the
state's Medicaid program.
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?
Choose one answer.
a. A PFFS plan is a type of Medicare Supplement plan and she may enroll
in one if it is available in her area.
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.
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. 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.
Question8
Marks: 1
During an appointment scheduled to discuss a Medicare Advantage
Prescription Drug plan (MA-PD), Mr. Peters asked his agent to describe a
stand-alone prescription drug plan (Part D plan) that his neighbor told him
about. What should his agent do?
Choose one answer.
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
, Page 3 of 51
have to schedule another appointment after at least 48 hours have passed to
discuss the Part D plan with Mr. Peters.
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 can compare
plans and make an informed enrollment choice during the appointment.
c. Since Mr. Peters requested a description of the Part D plan, his agent
must inform Mr. Peters that he can only sign up for the MA-PD plan and cannot
receive a brochure or any other information about the Part D plan now
because he did not agree in advance to discuss that plan
d. Since Mr. Peters requested a description of the Part D plan, his agent
must discuss both the Part D and the MA-PD plans and return after at least 48
hours to complete the Part D plan enrollment form with Mr. Peters.
Question9
Marks: 1
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?
Choose one answer.
a. In general, he must select a single Part D premium payment mechanism
that will be used throughout the year.
b. As long as he fills out the paperwork to begin withholding from his
Social Security check at least 63 days before such withholding should begin,
he can change his method of Part D premium payment and withholding will
begin the month after his savings account is exhausted.
c. During 2017, many people experienced significant problems with
deductions from their Social Security check for their Part D premium. As a
result, this method of payment is no longer an option for Part D premium
payments d. In general, to pay his Part D premium, he only can have automatic
withdrawals made from a checking account, so he will need to transfer the
funds prior to beginning such withdrawals.
Question10
Marks: 1
Since 2004 Ms. Eisenberg has had a Medigap plan that provides some drug
coverage. She has recently received a letter from her Medigap carrier
informing her that her drug coverage is not "creditable." She wants to know
what this means. What should you tell her?
Choose one answer.
a. The letter is to inform her that her Medigap drug coverage must be
supplemented by purchasing coverage under a Part D plan. If she does not do
so within 63 days, she will not be able to obtain Part D coverage at a later date.
b. The letter is to inform her that the drug coverage offered through her
Medigap plan does not offer drug coverage that is at least comparable to that
provided under the Medicare Part D prescription drug program. If she does not
have such creditable coverage during periods when she is first eligible for the
Part D program, she will face a premium penalty if she enrolls in a Part D plan
at a later date.
, Page 4 of 51
c. The letter is to inform her that her Medigap plan's coverage has been
determined by the Federal government to be inadequate and the plan must
therefore discontinue offering such coverage. Ms. Eisenberg will have to
select a different Medigap plan if she wants drug coverage.
d. The letter is to inform her that Medicare Part D prescription drug
coverage is available, but there is no need for her to change her drug
coverage since it is just as good as Part D. She may keep her current coverage
through the Medigap plan.
Question11
Marks: 1
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? Choose one answer.
a. Alice because she will not have a break between her non-Medicare and
Medicare coverage through Spartan Health Plan.
b. Alice and Charlotte because each of them currently have health
coverage and is in their initial coverage election period (ICEP).
c. Alice and Bob because each of them has had coverage through Spartan
Health Plan.
d. Alice, Bob, and Charlotte because electronic health record
interoperability will allow Richard to access any needed information for their
applications.
Question12
Marks: 1
Under what conditions can a Medicare prescription drug plan reduce its
coverage for a given drug during the first 60 days of the year?
Choose one answer.
a. When a formulary change is in response to a drug's removal from the
market.
b. When the Part D plan can demonstrate to CMS that no enrollee has
accessed the medication in the past six months, generally the plan can
remove the drug from its formulary within the first 60 days of the year.
c. Under no conditions can a Medicare Part D prescription drug plan
reduce its coverage for a given drug at any point during the year.
d. If the Medicare prescription drug plan can show that reducing coverage
early in the year will result in savings for the Part D plan and the Medicare
program, generally the plan may make such a change.
Question13
Marks: 1
