AHIP Exam Latest (2025/2026) | 400
Questions and Correct Answers |
Graded A+
Ms. Hernandez has marketed several different types of insurance products in her home state
and has typically sough 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? - answers :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.
Ms. Gibson recently lost her employer group health and drug coverage and now she wants to
enroll in a PPO that does not include drug coverage. What should you tell her about obtaining
drug coverage? - answers :She can enroll in the PPO, but she will not be able to purchase a
stand-alone Medicare Part D prescription drug plan.
Mrs. Quinn has recently turned 66 and decided after many years of work to begin receiving
Social Security benefits. Shortly thereafter Mrs. Quinn and received a letter informing her that
she has been automatically enrolled in Medicare Part B. She wants to understand what this
means. What should you tell Mrs. Quinn? - answers :Part B primarily covers physician services.
She will be paying a monthly premium and, with the exception of many preventive and
screening tests, generally will have 20% co-payments for these services, in addition to an annual
deductible.
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? - answers :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. - answers :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? - answers :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? - answers :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? - answers :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? - answers :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? - answers :
Choose one answer. - answers :
- answers :a. A PFFS plan is a type of Medicare Supplement plan and she may enroll in one if it
is available in her area.
- answers :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.
, - answers :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.
- answers :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 - answers :
Marks: 1 - answers :
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? - answers :
Choose one answer. - answers :
- answers :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.
- answers :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.
- answers :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
Questions and Correct Answers |
Graded A+
Ms. Hernandez has marketed several different types of insurance products in her home state
and has typically sough 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? - answers :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.
Ms. Gibson recently lost her employer group health and drug coverage and now she wants to
enroll in a PPO that does not include drug coverage. What should you tell her about obtaining
drug coverage? - answers :She can enroll in the PPO, but she will not be able to purchase a
stand-alone Medicare Part D prescription drug plan.
Mrs. Quinn has recently turned 66 and decided after many years of work to begin receiving
Social Security benefits. Shortly thereafter Mrs. Quinn and received a letter informing her that
she has been automatically enrolled in Medicare Part B. She wants to understand what this
means. What should you tell Mrs. Quinn? - answers :Part B primarily covers physician services.
She will be paying a monthly premium and, with the exception of many preventive and
screening tests, generally will have 20% co-payments for these services, in addition to an annual
deductible.
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? - answers :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. - answers :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? - answers :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? - answers :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? - answers :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? - answers :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? - answers :
Choose one answer. - answers :
- answers :a. A PFFS plan is a type of Medicare Supplement plan and she may enroll in one if it
is available in her area.
- answers :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.
, - answers :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.
- answers :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 - answers :
Marks: 1 - answers :
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? - answers :
Choose one answer. - answers :
- answers :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.
- answers :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.
- answers :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
