AHIP 2027 FINAL EXAM PREPARATION
QUESTIONS WITH VERIFIED
ANSWERS.
1. A consumer who is already enrolled in a Medicare Advantage plan wants to switch to
another Medicare Advantage plan during the Medicare Advantage Open Enrollment Period
(MA OEP). Which of the following is true?
A. They can only switch if they have a qualifying life event.
B. They may make one change to their coverage during this period, including moving to
Original Medicare.
C. They can change plans as many times as they want between January 1 and March 31.
D. The MA OEP is only for individuals who are newly eligible for Medicare.
Answer: B
Conceptual Explanation: During the MA OEP (Jan 1 – March 31), individuals enrolled in
an MA plan can make one change to another MA plan or return to Original Medicare and
enroll in a PDP.
,2. Under CMS regulations, which of the following is considered an ‘unsolicited contact’ and is
therefore prohibited?
A. Calling a consumer to follow up on a lead from a third-party data aggregator without a
prior relationship.
B. E-mailing a consumer who provided consent at a marketing event.
C. Contacting a current client to discuss annual plan changes.
D. Mailing a flyer to a specific zip code.
Answer: A
Conceptual Explanation: Cold calling or contacting a consumer without a documented
request for contact or a prior business relationship is a violation of CMS marketing
guidelines.
3. Mr. Lopez is enrolled in a Medicare Advantage PPO plan. He decides to see a provider who
is not in the plan’s network but accepts Medicare. What will likely happen?
A. The plan will not cover any of the costs, and Mr. Lopez must pay 100%.
B. The provider will be paid the same rate as an in-network provider.
C. The provider is legally required to join the network to treat him.
D. Mr. Lopez will pay a higher cost-sharing amount (coinsurance or copayment) than for an
in-network provider.
Answer: D
, Conceptual Explanation: PPO plans generally allow members to see out-of-network
providers who accept Medicare, but usually at a higher cost-sharing rate than in-network
services.
4. Which of the following describes the ‘Coverage Gap’ or ‘Donut Hole’ stage in Medicare Part
D for the year 2027?
A. The stage where the member pays 100% of the drug costs.
B. The stage where the member pays 25% for both generic and brand-name drugs after
reaching the initial coverage limit.
C. The stage where the manufacturer covers 100% of the cost.
D. A stage that was completely eliminated by the Inflation Reduction Act for all Part D
plans.
Answer: B
Conceptual Explanation: Under recent reforms, the coverage gap involves the beneficiary
paying 25% of the cost for both generic and brand-name drugs until the out-of-pocket
maximum is reached.
5. An agent is conducting a sales presentation for a Dual Eligible Special Needs Plan (D-SNP).
What must the agent verify before enrollment?
A. The consumer’s Medicaid eligibility status.
B. The consumer’s credit score.
C. That the consumer has a Medigap policy.
QUESTIONS WITH VERIFIED
ANSWERS.
1. A consumer who is already enrolled in a Medicare Advantage plan wants to switch to
another Medicare Advantage plan during the Medicare Advantage Open Enrollment Period
(MA OEP). Which of the following is true?
A. They can only switch if they have a qualifying life event.
B. They may make one change to their coverage during this period, including moving to
Original Medicare.
C. They can change plans as many times as they want between January 1 and March 31.
D. The MA OEP is only for individuals who are newly eligible for Medicare.
Answer: B
Conceptual Explanation: During the MA OEP (Jan 1 – March 31), individuals enrolled in
an MA plan can make one change to another MA plan or return to Original Medicare and
enroll in a PDP.
,2. Under CMS regulations, which of the following is considered an ‘unsolicited contact’ and is
therefore prohibited?
A. Calling a consumer to follow up on a lead from a third-party data aggregator without a
prior relationship.
B. E-mailing a consumer who provided consent at a marketing event.
C. Contacting a current client to discuss annual plan changes.
D. Mailing a flyer to a specific zip code.
Answer: A
Conceptual Explanation: Cold calling or contacting a consumer without a documented
request for contact or a prior business relationship is a violation of CMS marketing
guidelines.
3. Mr. Lopez is enrolled in a Medicare Advantage PPO plan. He decides to see a provider who
is not in the plan’s network but accepts Medicare. What will likely happen?
A. The plan will not cover any of the costs, and Mr. Lopez must pay 100%.
B. The provider will be paid the same rate as an in-network provider.
C. The provider is legally required to join the network to treat him.
D. Mr. Lopez will pay a higher cost-sharing amount (coinsurance or copayment) than for an
in-network provider.
Answer: D
, Conceptual Explanation: PPO plans generally allow members to see out-of-network
providers who accept Medicare, but usually at a higher cost-sharing rate than in-network
services.
4. Which of the following describes the ‘Coverage Gap’ or ‘Donut Hole’ stage in Medicare Part
D for the year 2027?
A. The stage where the member pays 100% of the drug costs.
B. The stage where the member pays 25% for both generic and brand-name drugs after
reaching the initial coverage limit.
C. The stage where the manufacturer covers 100% of the cost.
D. A stage that was completely eliminated by the Inflation Reduction Act for all Part D
plans.
Answer: B
Conceptual Explanation: Under recent reforms, the coverage gap involves the beneficiary
paying 25% of the cost for both generic and brand-name drugs until the out-of-pocket
maximum is reached.
5. An agent is conducting a sales presentation for a Dual Eligible Special Needs Plan (D-SNP).
What must the agent verify before enrollment?
A. The consumer’s Medicaid eligibility status.
B. The consumer’s credit score.
C. That the consumer has a Medigap policy.
