AHIP FINAL EXAM 2025 WITH QUESTIONS
AND VERIFIED ANSWERS FREQUENTLY
TESTED QUESTIONS ALREADY GRADED A
Mr. Chen is enrolled in his employer's group health plan and will be retiring soon. He would like to know
his options since he has decided to drop his retiree coverage and is eligible for Medicare. What should
you tell him? - ANSWER>>Mr. Chen can disenroll from his employer-sponsored coverage to elect a
Medicare Advantage or Part D plan within 2 months of his disenrollment.
Mr. Kumar is considering a Medicare Advantage HMO and has questions about his ability to access
providers. What should you tell him? - ANSWER>>In most Medicare Advantage HMOs, Mr. Kumar must
generally obtain his services only from providers within the plan's network (except in an emergency or
where care is unavailable within the network).
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? - 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.
Mr. Yoo's employer has recently dropped comprehensive creditable prescription drug coverage that was
offered to company retirees. The company told Mr. Yoo that, because he was affected by this change, he
would qualify for a Special election period. Mr. Yoo contacted you to find out more about what this means.
What can you tell him? - ANSWER>>It means that he qualifies for a one-time opportunity to enroll in an
MA-PD or Part D prescription drug plan.
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? - 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.
Mr. Rainey is experiencing paranoid delusions and his physician feels that he should be hospitalized.
What should you tell Mr. Rainey (or his representative) about the length of an inpatient psychiatric
hospital stay that Medicare will cover? - ANSWER>>Medicare will cover a total of 190 days of inpatient
psychiatric care during Mr. Rainey's entire lifetime.
Mr. Moreno invited his neighbor, Agent Tom Smith, to discuss Medicare Advantage (MA) and Part D
plans that Agent Smith sells at the regular Tuesday brunch the neighbors have for senior citizens. What
should Agent Tom Smith tell Mr. Moreno about the kinds of food that can be provided to potential
enrollees who attend the sales presentation? - ANSWER>>A meal cannot be provided, but light snacks
would be permitted.
You have approached a hospital administrator about marketing in her facility. The administrator is
uncomfortable with the suggestion. How could you address her concerns? - ANSWER>>Tell her that
Medicare guidelines allow you to conduct marketing activities in common areas of a provider's facility.
, Mr. and Mrs. Vaughn both take a specialized multivitamin prescription each day. Mr. Vaughn takes a
prescription for helping to regrow his hair. They are anxious to have their Medicare prescription drug plan
cover these drug needs. What should you tell them? - ANSWER>>Medicare prescription drug plans are
not permitted to cover the prescription medications the Vaughns are interested in under Part D coverage,
however, plans may cover them as supplemental benefits and the Vaughn's could look into that
possibility.
Mrs. Berkowitz wants to enroll in a Medicare Advantage plan that does not include drug coverage and
also enroll in a stand-alone Medicare prescription drug plan. Under what circumstances can she do this? -
ANSWER>>If the Medicare Advantage plan is a Private Fee-for-Service (PFFS) plan that does not offer
drug coverage or a Medical Savings Account plan, Mrs. Berkowitz can do this.
Which of the following is/are most likely to be characterized as an involuntary disenrollment from a
Medicare Advantage (MA) plan?
I. The enrollee dies.
II. An SNP enrollee loses special needs status due to substantially improved health.
III. It is determined that the member is not lawfully present in the United States.
IV. The member enrolls in another plan during the Annual Open Enrollment period. - ANSWER>>I, II, and
III only
Ms. Brooks has an aggressive cancer and would like to k - ANSWER>>Medicare covers hospice services
and they will be available for her.
You are working several plans and community organizations to sponsor an educational event. When
putting together advertisements for this event, what should you do? - ANSWER>>You must ensure that
the advertisements indicate it is an educational event, otherwise it will be considered a marketing event.
Which of the following statement is/are correct about a Medicare Savings Account (MSA) Plans?
I. MSAs may have either a partial network, full network, or no network of providers.
II. MSA plans cover Part A and Part B benefits but not Part D prescription drug benefits.
III. An individual who is enrolled in an MSA plan is responsible for a minimal deductible of $500 indexed
for inflation.
IV. Non-network providers must accept the same amount that Original Medicare would pay them as
payment in full. - ANSWER>>I and II, only
Mr. Sinclair has diabetes and heart trouble and is generally satisfied with the care he has received under
Original Medicare, but he would like to know more about Medicare Advantage Special Needs Plans
(SNPs). What could you tell him? - ANSWER>>SNPs have special programs for enrollees with chronic
conditions, like Mr. Sinclair, and they provide prescription drug coverage that could be very helpful as
well.
Mr. Xi will soon turn age 65 and has come to you for advice as to what services are provided under
Original Medicare. What should you tell Mr. Xi that best describes the health coverage provided to
Medicare beneficiaries? - ANSWER>>.
Beneficiaries under Original Medicare have no cost-sharing for most preventive services which include
immunizations such as annual flu shots.
AND VERIFIED ANSWERS FREQUENTLY
TESTED QUESTIONS ALREADY GRADED A
Mr. Chen is enrolled in his employer's group health plan and will be retiring soon. He would like to know
his options since he has decided to drop his retiree coverage and is eligible for Medicare. What should
you tell him? - ANSWER>>Mr. Chen can disenroll from his employer-sponsored coverage to elect a
Medicare Advantage or Part D plan within 2 months of his disenrollment.
Mr. Kumar is considering a Medicare Advantage HMO and has questions about his ability to access
providers. What should you tell him? - ANSWER>>In most Medicare Advantage HMOs, Mr. Kumar must
generally obtain his services only from providers within the plan's network (except in an emergency or
where care is unavailable within the network).
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? - 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.
Mr. Yoo's employer has recently dropped comprehensive creditable prescription drug coverage that was
offered to company retirees. The company told Mr. Yoo that, because he was affected by this change, he
would qualify for a Special election period. Mr. Yoo contacted you to find out more about what this means.
What can you tell him? - ANSWER>>It means that he qualifies for a one-time opportunity to enroll in an
MA-PD or Part D prescription drug plan.
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? - 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.
Mr. Rainey is experiencing paranoid delusions and his physician feels that he should be hospitalized.
What should you tell Mr. Rainey (or his representative) about the length of an inpatient psychiatric
hospital stay that Medicare will cover? - ANSWER>>Medicare will cover a total of 190 days of inpatient
psychiatric care during Mr. Rainey's entire lifetime.
Mr. Moreno invited his neighbor, Agent Tom Smith, to discuss Medicare Advantage (MA) and Part D
plans that Agent Smith sells at the regular Tuesday brunch the neighbors have for senior citizens. What
should Agent Tom Smith tell Mr. Moreno about the kinds of food that can be provided to potential
enrollees who attend the sales presentation? - ANSWER>>A meal cannot be provided, but light snacks
would be permitted.
You have approached a hospital administrator about marketing in her facility. The administrator is
uncomfortable with the suggestion. How could you address her concerns? - ANSWER>>Tell her that
Medicare guidelines allow you to conduct marketing activities in common areas of a provider's facility.
, Mr. and Mrs. Vaughn both take a specialized multivitamin prescription each day. Mr. Vaughn takes a
prescription for helping to regrow his hair. They are anxious to have their Medicare prescription drug plan
cover these drug needs. What should you tell them? - ANSWER>>Medicare prescription drug plans are
not permitted to cover the prescription medications the Vaughns are interested in under Part D coverage,
however, plans may cover them as supplemental benefits and the Vaughn's could look into that
possibility.
Mrs. Berkowitz wants to enroll in a Medicare Advantage plan that does not include drug coverage and
also enroll in a stand-alone Medicare prescription drug plan. Under what circumstances can she do this? -
ANSWER>>If the Medicare Advantage plan is a Private Fee-for-Service (PFFS) plan that does not offer
drug coverage or a Medical Savings Account plan, Mrs. Berkowitz can do this.
Which of the following is/are most likely to be characterized as an involuntary disenrollment from a
Medicare Advantage (MA) plan?
I. The enrollee dies.
II. An SNP enrollee loses special needs status due to substantially improved health.
III. It is determined that the member is not lawfully present in the United States.
IV. The member enrolls in another plan during the Annual Open Enrollment period. - ANSWER>>I, II, and
III only
Ms. Brooks has an aggressive cancer and would like to k - ANSWER>>Medicare covers hospice services
and they will be available for her.
You are working several plans and community organizations to sponsor an educational event. When
putting together advertisements for this event, what should you do? - ANSWER>>You must ensure that
the advertisements indicate it is an educational event, otherwise it will be considered a marketing event.
Which of the following statement is/are correct about a Medicare Savings Account (MSA) Plans?
I. MSAs may have either a partial network, full network, or no network of providers.
II. MSA plans cover Part A and Part B benefits but not Part D prescription drug benefits.
III. An individual who is enrolled in an MSA plan is responsible for a minimal deductible of $500 indexed
for inflation.
IV. Non-network providers must accept the same amount that Original Medicare would pay them as
payment in full. - ANSWER>>I and II, only
Mr. Sinclair has diabetes and heart trouble and is generally satisfied with the care he has received under
Original Medicare, but he would like to know more about Medicare Advantage Special Needs Plans
(SNPs). What could you tell him? - ANSWER>>SNPs have special programs for enrollees with chronic
conditions, like Mr. Sinclair, and they provide prescription drug coverage that could be very helpful as
well.
Mr. Xi will soon turn age 65 and has come to you for advice as to what services are provided under
Original Medicare. What should you tell Mr. Xi that best describes the health coverage provided to
Medicare beneficiaries? - ANSWER>>.
Beneficiaries under Original Medicare have no cost-sharing for most preventive services which include
immunizations such as annual flu shots.
