AHIP FINAL EXAM, PRACTICE EXAM AND STUDY GUIDE LATEST
2025/2026 ACTUAL EXAM
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? - correct answer 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. - correct answer 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.
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? - correct answer 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? - correct answer 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? - correct answer 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. Rivera? - correct answer 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? - correct answer
Choose one answer. - correct answer
- correct 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.
- correct answer 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.
- correct answer 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.
- correct answer 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 - correct answer
Marks: 1 - correct answer
, 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? - correct answer
Choose one answer. - correct answer
- correct answer 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.
- correct answer 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.
- correct answer 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
- correct answer 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 - correct answer
Marks: 1 - correct answer
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? - correct
answer
Choose one answer. - correct answer
- correct answer a. In general, he must select a single Part D premium payment mechanism
that will be used throughout the year.
- correct answer b. As long as he fills out the paperwork to begin withholding from his Social
Security check at least 63 days before such withholding should begin, he can change his method
of Part D premium payment and withholding will begin the month after his savings account is
exhausted.
2025/2026 ACTUAL EXAM
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? - correct answer 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. - correct answer 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.
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? - correct answer 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? - correct answer 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? - correct answer 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. Rivera? - correct answer 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? - correct answer
Choose one answer. - correct answer
- correct 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.
- correct answer 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.
- correct answer 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.
- correct answer 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 - correct answer
Marks: 1 - correct answer
, 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? - correct answer
Choose one answer. - correct answer
- correct answer 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.
- correct answer 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.
- correct answer 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
- correct answer 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 - correct answer
Marks: 1 - correct answer
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? - correct
answer
Choose one answer. - correct answer
- correct answer a. In general, he must select a single Part D premium payment mechanism
that will be used throughout the year.
- correct answer b. As long as he fills out the paperwork to begin withholding from his Social
Security check at least 63 days before such withholding should begin, he can change his method
of Part D premium payment and withholding will begin the month after his savings account is
exhausted.
