AHIP FINAL EXAM Questions and Answers 2026
| Final Revision Guide with Explanations | A+
Verified
• Mr. Edwards, a marketing representative of the ACME Insurance Company, scheduled
a marketing event and expects about 40 people to attend. He has 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 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.
• -✓✓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.
| Final Revision Guide with Explanations | A+
Verified
• Mr. Edwards, a marketing representative of the ACME Insurance Company, scheduled
a marketing event and expects about 40 people to attend. He has 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 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.
• -✓✓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.
