AHIP Final Exam & Practice Exam – 2025 Updated Questions with Verified Solutions
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
benefitsby going to plan network providers and paying plan cost sharing, or may receive services
from nonnetwork providers and pay cost-sharing due under Original Medicare.
b. Ms. Lopez is considered a marketing representative of BestCare and thus is obligated
tocomply 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
themarketing 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
complywith 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
MAproduct subject to federal rules.
d. Ms. Lopez needs to maintain state licensure, but because she is working for a third-
partymarketing 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
andresponse 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,
butgenerally 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
canaccept 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?
, 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
isavailable in her area.
b. A PFFS plan is exactly the same as Original Medicare, only offered by a private entity
andshe 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
ofcoverage 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
privateentities and she may enroll in one if it is available in her area.
Question8
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
benefitsby going to plan network providers and paying plan cost sharing, or may receive services
from nonnetwork providers and pay cost-sharing due under Original Medicare.
b. Ms. Lopez is considered a marketing representative of BestCare and thus is obligated
tocomply 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
themarketing 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
complywith 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
MAproduct subject to federal rules.
d. Ms. Lopez needs to maintain state licensure, but because she is working for a third-
partymarketing 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
andresponse 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,
butgenerally 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
canaccept 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?
, 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
isavailable in her area.
b. A PFFS plan is exactly the same as Original Medicare, only offered by a private entity
andshe 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
ofcoverage 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
privateentities and she may enroll in one if it is available in her area.
Question8
