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AHIP Final Verified Exam - Medicare Advantage and
Part D Certification - 2026/2027 Edition | 250 Verified
Questions
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.
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
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premium payment mechanism that will be used throughout
the year.
Agent Jennings makes a presentation on Medicare
advertised as an educational event. Agent Jennings
distributes materials that are solely educational in nature.
However, she gives a brief presentation that mentions
plan-specific premiums. Is this a prohibited activity at an
event that has been advertised as educational? - Answer-
Yes. When an event has been advertised as "educational,"
discussing plan-specific premiums is impermissible.
Mrs. Mulcahy 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? - Answer-
Everyone 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. Mulcahy is entitled to Part A, she does not
need to enroll under Part B before enrolling in a
prescription drug plan.
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
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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.
Ms. Moore plans to retire when she turns 65 in a few
months. She is in excellent health and will have
considerable income when she retires. She is concerned
that her income will make it impossible for her to qualify for
Medicare. What could you tell her to address her concern?
- Answer-Medicare is a program for people age 65 or older
and those under age 65 with certain disabilities, end stage
renal disease or Lou Gehrig's disease, so she will be
eligible for Medicare.
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
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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.
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
AHIP Final Verified Exam - Medicare Advantage and
Part D Certification - 2026/2027 Edition | 250 Verified
Questions
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.
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
,2|Page
premium payment mechanism that will be used throughout
the year.
Agent Jennings makes a presentation on Medicare
advertised as an educational event. Agent Jennings
distributes materials that are solely educational in nature.
However, she gives a brief presentation that mentions
plan-specific premiums. Is this a prohibited activity at an
event that has been advertised as educational? - Answer-
Yes. When an event has been advertised as "educational,"
discussing plan-specific premiums is impermissible.
Mrs. Mulcahy 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? - Answer-
Everyone 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. Mulcahy is entitled to Part A, she does not
need to enroll under Part B before enrolling in a
prescription drug plan.
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
,3|Page
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.
Ms. Moore plans to retire when she turns 65 in a few
months. She is in excellent health and will have
considerable income when she retires. She is concerned
that her income will make it impossible for her to qualify for
Medicare. What could you tell her to address her concern?
- Answer-Medicare is a program for people age 65 or older
and those under age 65 with certain disabilities, end stage
renal disease or Lou Gehrig's disease, so she will be
eligible for Medicare.
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
, 4|Page
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.
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
