AHIP MODULE 5 2026 COMPREHENSIVE
STUDY GUIDE QUESTIONS AND ANSWERS
VERIFIED PRACTICE REVIEW GRADED A+
⩥ Choose one answer.
Answer:
⩥
Answer: a. Medicare permits plans that have the highest quality services
to reduce their premiums below the standard amount in order to increase
their market share. This accounts for the variation in premium amounts.
⩥
Answer: b. Some prescription drug plans may have higher operating
costs and/or may offer enhanced coverage in return for an additional
premium amount. He could look at plan designs to see if one of the
enhanced plans would serve his needs better than a plan based on the
standard design.
⩥
Answer: c. The premiums differ because some plans intend to market to
sicker beneficiaries and have set their premiums to reflect expected
greater costs.
,⩥
Answer: d. All drug plans must offer exactly the same coverage model.
The difference in premium is a result of the differing financial estimates
of the companies offering the plans.
⩥ Question27
Answer:
⩥ Marks: 1
Answer:
⩥ Mrs. Duarte is enrolled in Original Medicare Parts A and B. She has
recently reviewed her Medicare Summary Notice (MSN) and disagrees
with a determination that partially denied one of her claims for services.
What advice would you give her?
Answer:
⩥ Choose one answer.
Answer:
⩥
Answer: a. Mrs. Duarte should file an appeal of this initial determination
within 120 days of the date she received the MSN in the mail.
,⩥
Answer: b. Mrs. Duarte should file an appeal of this initial determination
within 90 days of the date she received the MSN in the mail. If she still
disagrees with Medicare Administrative Contractor's (MAC's) further
decision she should request a reconsideration by a qualified independent
party within 10 days.
⩥
Answer: c. Mrs. Duarte has no right to appeal this determination since
her claim has been partially paid.
⩥
Answer: d. Mrs. Duarte should request a reconsideration of the decision
by a qualified independent party within 60 days of the date she received
the MSN in the mail.
⩥ Question28
Answer:
⩥ Marks: 1
Answer:
⩥ Ms. Hernandez has marketed several different types of insurance
products in her home state and has typically sought approval of her
, materials from her State Department of Insurance. What would you
advise her regarding seeking such approval for materials she uses to
market Medicare Advantage plans?
Answer:
⩥ Choose one answer.
Answer:
⩥
Answer: a. Obtaining approval of her materials from the State
Department of Insurance is a good practice and she should continue it
with materials for the Medicare health plans she represents.
⩥
Answer: b. Materials for marketing Medicare health plans to individuals
are subject to Medicare's uniform national requirements. They do not
need to be reviewed by the state, but the company she represents must
obtain approval from the Medicare agency (CMS) for any materials she
uses.
⩥
Answer: c. Materials need only be reviewed and approved by the
company(s) she represents.
STUDY GUIDE QUESTIONS AND ANSWERS
VERIFIED PRACTICE REVIEW GRADED A+
⩥ Choose one answer.
Answer:
⩥
Answer: a. Medicare permits plans that have the highest quality services
to reduce their premiums below the standard amount in order to increase
their market share. This accounts for the variation in premium amounts.
⩥
Answer: b. Some prescription drug plans may have higher operating
costs and/or may offer enhanced coverage in return for an additional
premium amount. He could look at plan designs to see if one of the
enhanced plans would serve his needs better than a plan based on the
standard design.
⩥
Answer: c. The premiums differ because some plans intend to market to
sicker beneficiaries and have set their premiums to reflect expected
greater costs.
,⩥
Answer: d. All drug plans must offer exactly the same coverage model.
The difference in premium is a result of the differing financial estimates
of the companies offering the plans.
⩥ Question27
Answer:
⩥ Marks: 1
Answer:
⩥ Mrs. Duarte is enrolled in Original Medicare Parts A and B. She has
recently reviewed her Medicare Summary Notice (MSN) and disagrees
with a determination that partially denied one of her claims for services.
What advice would you give her?
Answer:
⩥ Choose one answer.
Answer:
⩥
Answer: a. Mrs. Duarte should file an appeal of this initial determination
within 120 days of the date she received the MSN in the mail.
,⩥
Answer: b. Mrs. Duarte should file an appeal of this initial determination
within 90 days of the date she received the MSN in the mail. If she still
disagrees with Medicare Administrative Contractor's (MAC's) further
decision she should request a reconsideration by a qualified independent
party within 10 days.
⩥
Answer: c. Mrs. Duarte has no right to appeal this determination since
her claim has been partially paid.
⩥
Answer: d. Mrs. Duarte should request a reconsideration of the decision
by a qualified independent party within 60 days of the date she received
the MSN in the mail.
⩥ Question28
Answer:
⩥ Marks: 1
Answer:
⩥ Ms. Hernandez has marketed several different types of insurance
products in her home state and has typically sought approval of her
, materials from her State Department of Insurance. What would you
advise her regarding seeking such approval for materials she uses to
market Medicare Advantage plans?
Answer:
⩥ Choose one answer.
Answer:
⩥
Answer: a. Obtaining approval of her materials from the State
Department of Insurance is a good practice and she should continue it
with materials for the Medicare health plans she represents.
⩥
Answer: b. Materials for marketing Medicare health plans to individuals
are subject to Medicare's uniform national requirements. They do not
need to be reviewed by the state, but the company she represents must
obtain approval from the Medicare agency (CMS) for any materials she
uses.
⩥
Answer: c. Materials need only be reviewed and approved by the
company(s) she represents.
