AHIP | Latest Update as of 2025/2026|Verified Questions and
Correct Answers| Graded A+
A client wants to give you an enrollment application on October 1 before the beginning of the
Annual Election Period because he is leaving on vacation for two weeks and does not want to
forget about turning it in. What should you tell him? - Correct Answer ✅💯You must tell
him you are not permitted to take the form. If he sends the form directly to the plan, the plan
will process the enrollment on the day the Annual Election Period begins.
A Medicare beneficiary has walked into your office and requested that you sit down with her
and discuss her options under the Medicare Advantage program. Before engaging in such a
discussion, what should you do? - Correct Answer ✅💯You must have her sign a scope of
appointment form, indicating which products she wishes to discuss. You may then proceed
with the discussion.
ABC is a Medicare Advantage (MA) plan sponsor. It would like to use its enrollees'
information to market non-health related products such as life insurance and annuities. Which
statement best describes ABC's obligation to its enrollees regarding marketing such products?
- Correct Answer ✅💯XXXIt must obtain a HIPAA complaint authorization from an
enrollee that indicates the plan or plan sponsor may use their information for marketing
purposes.
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? - Correct Answer
✅💯Agent Armstrong needs to be licensed and appointed in every state in which
beneficiaries to whom he markets ABC MA plans are located.
Agent Jennings makes a presentation on Medicare advertised as an educational event. Agent
Jennings distributes materials that are solely educational. 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? - Correct Answer ✅💯Yes. When an event has been
advertised as "educational," discussing plan-specific premiums is impermissible.
Agent John Miller is meeting with Jerry Smith, a new prospect. Jerry is currently enrolled in
Medicare Parts A and B. Jerry has also purchased a Medicare Supplement (Medigap) plan
which he has had for several years. However, the plan does not provide drug benefits. How
would you advise Agent John Miller to proceed? - Correct Answer ✅💯Tell prospect Jerry
Smith that he should consider adding a standalone Part D prescription drug coverage policy
to his present coverage.
Agent Martinez wishes to solicit Medicare Advantage prospects through e-mail and asks you
for advice as to whether this is possible. What should you tell her? - Correct Answer
✅💯Marketing representatives may initiate electronic contact through e-mail but an opt-out
process must be provided.
, All plans must cover at least the standard Part D coverage or its actuarial equivalent. Which
of the following statements best describes some of the costs a beneficiary would incur for
prescription drugs under the standard coverage? - Correct Answer ✅💯Standard Part D
coverage would require payment of an annual deductible, and once past the catastrophic
coverage threshold, the beneficiary pays whichever is greater of either the co-pays for generic
and brand name drugs or coinsurance of 5%.
Another agent working for your agency claims that because you are not employed by the
Medicare Advantage plans that you represent, you are not subject to the same marketing
requirements as the plans themselves. How should you respond to such a statement? - Correct
Answer ✅💯Your coworker is not correct. Marketing on behalf of a plan is considered
marketing by the plan and requires that all contracted and employed agents comply with all
Medicare marketing rules.
Another agent you know has engaged in misconduct that has been verified by the plan she
represented. What sort of penalty might the plan impose on this individual? - Correct Answer
✅💯The plan may withhold commission, require retraining, report the misconduct to a state
department of insurance or terminate the contract.
Daniel is a middle-income Medicare beneficiary. He has chronic bronchitis, putting him at
severe risk for pneumonia. Otherwise, he has no problems functioning. Which type of SNP is
likely to be most appropriate for him? - Correct Answer ✅💯C-SNP
Dr. Elizabeth Brennan does not contract with the ABC PFFS plan but accepts the plan's terms
and conditions for payment. Mary Rodgers sees Dr. Brennan for treatment. How much may
Dr. Brennan charge? - Correct Answer ✅💯Dr. Brennan can charge Mary Rogers no more
than the cost sharing specified in the PFFS plan's terms and condition of payment which may
include balance billing up to 15% of the Medicare rate.
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? - Correct Answer
✅💯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.
During a sales presentation, your client asks you whether the Medicare agency recommends
that she sign up for your plan or stay in Original Medicare. What should you tell her? -
Correct Answer ✅💯Tell her that the Medicare agency does not endorse or recommend any
plan.
Juan Perez, who is turning age 65 next month, intends to work for several more years at
Smallcap, Incorporated. Smallcap has a workforce of 15 employees and offers employer-
sponsored healthcare coverage. Juan is a naturalized citizen and has contributed to the
Medicare system for over 20 years. Juan asks you if he will be entitled to Medicare and if he
enrolls how that will impact his employer-sponsored healthcare coverage. How would you
respond? - Correct Answer ✅💯Juan is likely to be eligible for Medicare once he turns age
65 and if he enrolls Medicare would become the primary payor of his healthcare claims and
Smallcap does not have to continue to offer him coverage comparable to those under age 65
under its employer-sponsored group health plan.
Correct Answers| Graded A+
A client wants to give you an enrollment application on October 1 before the beginning of the
Annual Election Period because he is leaving on vacation for two weeks and does not want to
forget about turning it in. What should you tell him? - Correct Answer ✅💯You must tell
him you are not permitted to take the form. If he sends the form directly to the plan, the plan
will process the enrollment on the day the Annual Election Period begins.
A Medicare beneficiary has walked into your office and requested that you sit down with her
and discuss her options under the Medicare Advantage program. Before engaging in such a
discussion, what should you do? - Correct Answer ✅💯You must have her sign a scope of
appointment form, indicating which products she wishes to discuss. You may then proceed
with the discussion.
ABC is a Medicare Advantage (MA) plan sponsor. It would like to use its enrollees'
information to market non-health related products such as life insurance and annuities. Which
statement best describes ABC's obligation to its enrollees regarding marketing such products?
- Correct Answer ✅💯XXXIt must obtain a HIPAA complaint authorization from an
enrollee that indicates the plan or plan sponsor may use their information for marketing
purposes.
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? - Correct Answer
✅💯Agent Armstrong needs to be licensed and appointed in every state in which
beneficiaries to whom he markets ABC MA plans are located.
Agent Jennings makes a presentation on Medicare advertised as an educational event. Agent
Jennings distributes materials that are solely educational. 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? - Correct Answer ✅💯Yes. When an event has been
advertised as "educational," discussing plan-specific premiums is impermissible.
Agent John Miller is meeting with Jerry Smith, a new prospect. Jerry is currently enrolled in
Medicare Parts A and B. Jerry has also purchased a Medicare Supplement (Medigap) plan
which he has had for several years. However, the plan does not provide drug benefits. How
would you advise Agent John Miller to proceed? - Correct Answer ✅💯Tell prospect Jerry
Smith that he should consider adding a standalone Part D prescription drug coverage policy
to his present coverage.
Agent Martinez wishes to solicit Medicare Advantage prospects through e-mail and asks you
for advice as to whether this is possible. What should you tell her? - Correct Answer
✅💯Marketing representatives may initiate electronic contact through e-mail but an opt-out
process must be provided.
, All plans must cover at least the standard Part D coverage or its actuarial equivalent. Which
of the following statements best describes some of the costs a beneficiary would incur for
prescription drugs under the standard coverage? - Correct Answer ✅💯Standard Part D
coverage would require payment of an annual deductible, and once past the catastrophic
coverage threshold, the beneficiary pays whichever is greater of either the co-pays for generic
and brand name drugs or coinsurance of 5%.
Another agent working for your agency claims that because you are not employed by the
Medicare Advantage plans that you represent, you are not subject to the same marketing
requirements as the plans themselves. How should you respond to such a statement? - Correct
Answer ✅💯Your coworker is not correct. Marketing on behalf of a plan is considered
marketing by the plan and requires that all contracted and employed agents comply with all
Medicare marketing rules.
Another agent you know has engaged in misconduct that has been verified by the plan she
represented. What sort of penalty might the plan impose on this individual? - Correct Answer
✅💯The plan may withhold commission, require retraining, report the misconduct to a state
department of insurance or terminate the contract.
Daniel is a middle-income Medicare beneficiary. He has chronic bronchitis, putting him at
severe risk for pneumonia. Otherwise, he has no problems functioning. Which type of SNP is
likely to be most appropriate for him? - Correct Answer ✅💯C-SNP
Dr. Elizabeth Brennan does not contract with the ABC PFFS plan but accepts the plan's terms
and conditions for payment. Mary Rodgers sees Dr. Brennan for treatment. How much may
Dr. Brennan charge? - Correct Answer ✅💯Dr. Brennan can charge Mary Rogers no more
than the cost sharing specified in the PFFS plan's terms and condition of payment which may
include balance billing up to 15% of the Medicare rate.
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? - Correct Answer
✅💯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.
During a sales presentation, your client asks you whether the Medicare agency recommends
that she sign up for your plan or stay in Original Medicare. What should you tell her? -
Correct Answer ✅💯Tell her that the Medicare agency does not endorse or recommend any
plan.
Juan Perez, who is turning age 65 next month, intends to work for several more years at
Smallcap, Incorporated. Smallcap has a workforce of 15 employees and offers employer-
sponsored healthcare coverage. Juan is a naturalized citizen and has contributed to the
Medicare system for over 20 years. Juan asks you if he will be entitled to Medicare and if he
enrolls how that will impact his employer-sponsored healthcare coverage. How would you
respond? - Correct Answer ✅💯Juan is likely to be eligible for Medicare once he turns age
65 and if he enrolls Medicare would become the primary payor of his healthcare claims and
Smallcap does not have to continue to offer him coverage comparable to those under age 65
under its employer-sponsored group health plan.
