AHIP 2025 Final Exam Questions and Answers
100% Pass
Mr. Davies is turning 65 next month. He would like to enroll in a Medicare health plan, but does not
want to be limited in terms of where he obtains his care. What should you tell him about how a Medicare
Cost Plan might fit his needs? - ✔✔a. Cost plan enrollees can choose to receive Medicare covered services
under the plan's benefits by going to plan network providers and paying plan cost sharing, or may
receive services from non-network providers and pay cost-sharing due under Original Medicare.
b. Ms. Lopez is considered a marketing representative of BestCare and thus is obligated to comply with
CMS marketing requirements, including those regarding using only approved call scripts. - ✔✔Ms.
Lopez is an independent agent under contract with MarketCo, a third-party marketing organization.
MarketCo has a contract with BestCare health plan, a Medicare Advantage (MA) organization, to offer
marketing services through its contracted agents and agencies. Ms. Lopez returns calls to individuals
who contact MarketCo in response to its mailers promoting BestCare health plan. Which of the following
best describes the responsibilities of Ms. Lopez?
a. Ms. Lopez is considered a marketing representative of BestCare but is exempt from the marketing rules
regarding approved call scripts because she works directly for MarketCo.
b. Ms. Lopez is considered a marketing representative of BestCare and thus is obligated to comply with
CMS marketing requirements, including those regarding using only approved call scripts.
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,c. Ms. Lopez no longer needs to be concerned about state licensure since she is marketing an MA product
subject to federal rules.
d. Ms. Lopez needs to maintain state licensure, but because she is working for a third-party marketing
organization she is exempt from CMS training requirements that apply to BestCare captive agents.
Mr. Edwards, a marketing representative of the ACME Insurance Company, scheduled a marketing event
and expects about 40 people to attend. He has hired a magician at a cost of $200 to entertain attendees.
Can he do this in a way that complies with guidance from the Medicare agency? - ✔✔a. He can do this
because the estimated number of attendees is based on the venue size and response rate and the value of
the gift does not exceed $15.
Mrs. Ramos is considering a Medicare Advantage PPO and has questions about which providers she can
go to for her health care. What should you tell her? - ✔✔b. Mrs. Ramos can obtain care from any provider
who participates in Original Medicare, but generally will have a higher cost-sharing amount if she sees a
provider who/that is not a part of the PPO network.
Julia Harris is turning 66 in July, at which time she will retire. She has contacted your office and
requested a meeting so that she can learn about Medicare and the products you represent. How should
you respond? - ✔✔c. Tell Julia that you will meet with her to explain Medicare and should she be
interested you can accept and submit an enrollment request, since this is an initial enrollment qualifying
her for a special enrollment period.
Mr. Rivera has Qualified Medicare Beneficiary (QMB) eligibility and is thus covered by both Medicare
and Medicaid. He decides to enroll in a Medicare Advantage (MA) PPO plan. Later he sees an out-of-
network doctor to receive a Medicare covered service. How much The doctor may only collect from Mr.
Rivera the cost sharing allowable under the state's Medicaid program.may the doctor collect from Mr.
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,Rivera? - ✔✔The doctor may only collect from Mr. Rivera the cost sharing allowable under the state's
Medicaid program.
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? - ✔✔
Choose one answer. - ✔✔
- ✔✔a. A PFFS plan is a type of Medicare Supplement plan and she may enroll in one if it is available in
her area.
- ✔✔b. A PFFS plan is exactly the same as Original Medicare, only offered by a private entity and she
may enroll in one if it is available in her area.
- ✔✔c. PFFS plans are designed to cover only prescription drugs and if that is the type of coverage she
wants, she may enroll in one if it is available in her area.
- ✔✔d. 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.
Question8 - ✔✔
Marks: 1 - ✔✔
During an appointment scheduled to discuss a Medicare Advantage Prescription Drug plan (MA-PD),
Mr. Peters asked his agent to describe a stand-alone prescription drug plan (Part D plan) that his
neighbor told him about. What should his agent do? - ✔✔
Choose one answer. - ✔✔
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, - ✔✔a. Since Mr. Peters requested a description of the Part D plan, his agent must leave the Part D plan
brochure, but not an enrollment form, and would have to schedule another appointment after at least 48
hours have passed to discuss the Part D plan with Mr. Peters.
- ✔✔b. Since Mr. Peters requested a description of the Part D plan, his agent must have Mr. Peters sign a
new scope of appointment form that includes Part D, and then the agent may discuss the Part D plan so
Mr. Peters can compare plans and make an informed enrollment choice during the appointment.
- ✔✔c. Since Mr. Peters requested a description of the Part D plan, his agent must inform Mr. Peters that
he can only sign up for the MA-PD plan and cannot receive a brochure or any other information about
the Part D plan now because he did not agree in advance to discuss that plan
- ✔✔d. Since Mr. Peters requested a description of the Part D plan, his agent must discuss both the Part D
and the MA-PD plans and return after at least 48 hours to complete the Part D plan enrollment form with
Mr. Peters.
Question9 - ✔✔
Marks: 1 - ✔✔
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? - ✔✔
Choose one answer. - ✔✔
- ✔✔a. In general, he must select a single Part D premium payment mechanism that will be used
throughout the year.
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100% Pass
Mr. Davies is turning 65 next month. He would like to enroll in a Medicare health plan, but does not
want to be limited in terms of where he obtains his care. What should you tell him about how a Medicare
Cost Plan might fit his needs? - ✔✔a. Cost plan enrollees can choose to receive Medicare covered services
under the plan's benefits by going to plan network providers and paying plan cost sharing, or may
receive services from non-network providers and pay cost-sharing due under Original Medicare.
b. Ms. Lopez is considered a marketing representative of BestCare and thus is obligated to comply with
CMS marketing requirements, including those regarding using only approved call scripts. - ✔✔Ms.
Lopez is an independent agent under contract with MarketCo, a third-party marketing organization.
MarketCo has a contract with BestCare health plan, a Medicare Advantage (MA) organization, to offer
marketing services through its contracted agents and agencies. Ms. Lopez returns calls to individuals
who contact MarketCo in response to its mailers promoting BestCare health plan. Which of the following
best describes the responsibilities of Ms. Lopez?
a. Ms. Lopez is considered a marketing representative of BestCare but is exempt from the marketing rules
regarding approved call scripts because she works directly for MarketCo.
b. Ms. Lopez is considered a marketing representative of BestCare and thus is obligated to comply with
CMS marketing requirements, including those regarding using only approved call scripts.
Page 1/32
Crafted for Academic Insight by KatelynWhitman. All rights reserved © 2025
,c. Ms. Lopez no longer needs to be concerned about state licensure since she is marketing an MA product
subject to federal rules.
d. Ms. Lopez needs to maintain state licensure, but because she is working for a third-party marketing
organization she is exempt from CMS training requirements that apply to BestCare captive agents.
Mr. Edwards, a marketing representative of the ACME Insurance Company, scheduled a marketing event
and expects about 40 people to attend. He has hired a magician at a cost of $200 to entertain attendees.
Can he do this in a way that complies with guidance from the Medicare agency? - ✔✔a. He can do this
because the estimated number of attendees is based on the venue size and response rate and the value of
the gift does not exceed $15.
Mrs. Ramos is considering a Medicare Advantage PPO and has questions about which providers she can
go to for her health care. What should you tell her? - ✔✔b. Mrs. Ramos can obtain care from any provider
who participates in Original Medicare, but generally will have a higher cost-sharing amount if she sees a
provider who/that is not a part of the PPO network.
Julia Harris is turning 66 in July, at which time she will retire. She has contacted your office and
requested a meeting so that she can learn about Medicare and the products you represent. How should
you respond? - ✔✔c. Tell Julia that you will meet with her to explain Medicare and should she be
interested you can accept and submit an enrollment request, since this is an initial enrollment qualifying
her for a special enrollment period.
Mr. Rivera has Qualified Medicare Beneficiary (QMB) eligibility and is thus covered by both Medicare
and Medicaid. He decides to enroll in a Medicare Advantage (MA) PPO plan. Later he sees an out-of-
network doctor to receive a Medicare covered service. How much The doctor may only collect from Mr.
Rivera the cost sharing allowable under the state's Medicaid program.may the doctor collect from Mr.
Page 2/32
Crafted for Academic Insight by KatelynWhitman. All rights reserved © 2025
,Rivera? - ✔✔The doctor may only collect from Mr. Rivera the cost sharing allowable under the state's
Medicaid program.
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? - ✔✔
Choose one answer. - ✔✔
- ✔✔a. A PFFS plan is a type of Medicare Supplement plan and she may enroll in one if it is available in
her area.
- ✔✔b. A PFFS plan is exactly the same as Original Medicare, only offered by a private entity and she
may enroll in one if it is available in her area.
- ✔✔c. PFFS plans are designed to cover only prescription drugs and if that is the type of coverage she
wants, she may enroll in one if it is available in her area.
- ✔✔d. 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.
Question8 - ✔✔
Marks: 1 - ✔✔
During an appointment scheduled to discuss a Medicare Advantage Prescription Drug plan (MA-PD),
Mr. Peters asked his agent to describe a stand-alone prescription drug plan (Part D plan) that his
neighbor told him about. What should his agent do? - ✔✔
Choose one answer. - ✔✔
Page 3/32
Crafted for Academic Insight by KatelynWhitman. All rights reserved © 2025
, - ✔✔a. Since Mr. Peters requested a description of the Part D plan, his agent must leave the Part D plan
brochure, but not an enrollment form, and would have to schedule another appointment after at least 48
hours have passed to discuss the Part D plan with Mr. Peters.
- ✔✔b. Since Mr. Peters requested a description of the Part D plan, his agent must have Mr. Peters sign a
new scope of appointment form that includes Part D, and then the agent may discuss the Part D plan so
Mr. Peters can compare plans and make an informed enrollment choice during the appointment.
- ✔✔c. Since Mr. Peters requested a description of the Part D plan, his agent must inform Mr. Peters that
he can only sign up for the MA-PD plan and cannot receive a brochure or any other information about
the Part D plan now because he did not agree in advance to discuss that plan
- ✔✔d. Since Mr. Peters requested a description of the Part D plan, his agent must discuss both the Part D
and the MA-PD plans and return after at least 48 hours to complete the Part D plan enrollment form with
Mr. Peters.
Question9 - ✔✔
Marks: 1 - ✔✔
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? - ✔✔
Choose one answer. - ✔✔
- ✔✔a. In general, he must select a single Part D premium payment mechanism that will be used
throughout the year.
Page 4/32
Crafted for Academic Insight by KatelynWhitman. All rights reserved © 2025
