AHIP Final Exam Questions with
Completely Verified Answers| Latest
Update 2025/2026| Guaranteed Perfect
Score Graded A+
A client wants to give you an enrollment application on October 1 before the beginning of the
Annual Election Period because he is leaving on vacation for two weeks and does not want to
forget about turning it in. What should you tell him? - Correct Answers-You must tell him you
are not permitted to take the form. If he sends the form directly to the plan, the plan will
process the enrollment on the day the Annual Election Period begins.
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? - Correct
Answers-It must obtain a HIPAA compliant authorization from an enrollee that indicates the
plan or plan sponsor may use their information for marketing purposes.
Agent Daniel Webber has properly set up a sales appointment to meet with client Edward Young
at Agent Webber's office. At the agreed upon appointment time, Mr. Young arrives with his
elderly neighbor - Clara Burton, who wants to learn about her Medicare Advantage options.
What should Agent Daniel Webber do? - Correct Answers-After executing a scope of
appointment (SOA) with Clara Burton, meet with Edward Young and Clara Burton to discuss
their Medicare Advantage options.
Agent John Miller is meeting with Jerry Smith, a new prospect. Jerry is currently enrolled in
Medicare Parts A and B. Jerry has also purchased a Medicare Supplement (Medigap) plan which
he has had for several years. However, the plan does not provide drug benefits. How would you
advise Agent John Miller to proceed? - Correct Answers-Tell prospect Jerry Smith that he
should consider adding a standalone Part D prescription drug coverage policy to his present
coverage.
Agent Martinez wishes to solicit Medicare Advantage prospects through e-mail and asks you for
advice as to whether this is possible. What should you tell her? - Correct Answers-Marketing
representatives may initiate electronic contact through e-mail but an opt-out process must be
provided.
,Agent Suma has recently had several clients request his assistance in completing their paper
enrollment form. What advice would you give him? - Correct Answers-In most instances,
Agent Suma should be clearly indicating his name on their forms as their marketing
representative.
Another agent working for your agency claims that because you are not employed by the
Medicare Advantage plans that you represent, you are not subject to the same marketing
requirements as the plans themselves. How should you respond to such a statement? -
Correct Answers-Your coworker is not correct. Marketing on behalf of a plan is considered
marketing by the plan and requires that all contracted and employed agents comply with all
Medicare marketing rules.
Another agent you know has engaged in misconduct that has been verified by the plan she
represented. What sort of penalty might the plan impose on this individual? - Correct
Answers-The plan may withhold commission, require retraining, report the misconduct to a
state department of insurance or terminate the contract.
Anthony Boniface turned 65 in 2023. He was not receiving Social Security or Railroad
Retirement Benefits on his 65th birthday. He was interested in obtaining Medicare coverage and
is eligible for premium-free Part A. Before he could enroll in Medicare, his entire area was
impacted by a hurricane causing massive flooding and severe wind damage. The Federal
government declared this to be a natural disaster which has recently ended. During this period
Anthony's initial enrollment period expired. Anthony asks you how he can now obtain Medicare
coverage. What should you say? - Correct Answers-Anthony is eligible for a special
enrollment period (SEP) because he missed an enrollment period due to the impact of the
Federally declared disaster. This SEP will allow Anthony to enroll in Part B up to six months after
the end of the emergency declaration. Anthony may enroll in premium-free Part A at any time
and his Part A coverage will be retroactive for up to 6 months.
Charles McCarthy is a Medicare beneficiary who suffers from diabetes. Mr. McCarthy is
considering enrollment in a MA-PD plan that you represent. He asks you whether his insulin
costs will be covered. What should you say? - Correct Answers-Mr. McCarthy's insulin costs
for a one-month supply cannot be more than $35 in any coverage phase under the prescription
drug plan beginning in 2023.
Daniel is a middle-income Medicare beneficiary. He has chronic bronchitis, putting him at severe
risk for pneumonia. Otherwise, he has no problems functioning. Which type of SNP is likely to
be most appropriate for him? - Correct Answers-C-SNP
, 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? - Correct Answers-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.
Edna, Felix, George, and Harriet are Medicare beneficiaries. Edna lives in an area that has
suffered from major flooding that has been declared a major disaster by both the Federal
government and her state. As a result of dealing with the flooding issues and being evacuated
from her home, Edna missed her chance to enroll in MA during her Initial Coverage Election
Period. Felix lives in an area with a Medicare Advantage plan with a 4-star rating that he would
like to join. George dropped his Medigap policy six months ago when he first enrolled in a
Medicare Advantage plan. He now wants to return to Original Medicare. Harriet has recently
developed diabetes and would like to enroll in a Medicare Advantage plan that focuses on care
for those with that disease. Which, if any, of these individuals would qualify for a special
election period (SEP)? - Correct Answers-Edna would qualify for a SEP because government
officials have declared a major disaster for her area and she did not enroll in MA during her ICEP
due to the emergency. George would qualify for an SEP because he enrolled in Medicare
Advantage (MA) plan for the first time and would now like to return to Original Medicare within
the first 12 months of his enrollment. Harriet would also qualify for a SEP to enroll in a C-SNP
because she has developed a chronic condition. Felix would not qualify for a SEP since he seeks
to enroll in a 4-star not a 5-star MA plan.
Edward IP suffered from serious kidney disease. As a result. Edward became eligible for
Medicare coverage due to end-stage renal disease (ESRD). A close relative donated their kidney
and Edward successfully underwent transplant surgery 12 months ago. Edward is now age 50
and asks you if his Medicare coverage will continue, what should you say? - Correct Answers-
Individuals eligible for Medicare based on ESRD generally lose eligibility 36 months after the
month in which the individual receives a kidney transplant unless they are eligible for Medicare
on another basis such as age or disability. Edward may, however, remain enrolled in Part B but
solely for coverage of immunosuppressive drugs if he has no other health care coverage that
would cover the drugs.
Evan Marsh is a newly appointed agent. Evan intends to conduct an educational session on
Medicare at a senior citizens center near his home. He has advertised the session as an
educational event. Evan asks you what is permissible at such an event. What should you say? -
Correct Answers-Evan may provide a meal as long as its value is $15 or less per attendee and
he may make available business reply cards (BRCs).
Completely Verified Answers| Latest
Update 2025/2026| Guaranteed Perfect
Score Graded A+
A client wants to give you an enrollment application on October 1 before the beginning of the
Annual Election Period because he is leaving on vacation for two weeks and does not want to
forget about turning it in. What should you tell him? - Correct Answers-You must tell him you
are not permitted to take the form. If he sends the form directly to the plan, the plan will
process the enrollment on the day the Annual Election Period begins.
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? - Correct
Answers-It must obtain a HIPAA compliant authorization from an enrollee that indicates the
plan or plan sponsor may use their information for marketing purposes.
Agent Daniel Webber has properly set up a sales appointment to meet with client Edward Young
at Agent Webber's office. At the agreed upon appointment time, Mr. Young arrives with his
elderly neighbor - Clara Burton, who wants to learn about her Medicare Advantage options.
What should Agent Daniel Webber do? - Correct Answers-After executing a scope of
appointment (SOA) with Clara Burton, meet with Edward Young and Clara Burton to discuss
their Medicare Advantage options.
Agent John Miller is meeting with Jerry Smith, a new prospect. Jerry is currently enrolled in
Medicare Parts A and B. Jerry has also purchased a Medicare Supplement (Medigap) plan which
he has had for several years. However, the plan does not provide drug benefits. How would you
advise Agent John Miller to proceed? - Correct Answers-Tell prospect Jerry Smith that he
should consider adding a standalone Part D prescription drug coverage policy to his present
coverage.
Agent Martinez wishes to solicit Medicare Advantage prospects through e-mail and asks you for
advice as to whether this is possible. What should you tell her? - Correct Answers-Marketing
representatives may initiate electronic contact through e-mail but an opt-out process must be
provided.
,Agent Suma has recently had several clients request his assistance in completing their paper
enrollment form. What advice would you give him? - Correct Answers-In most instances,
Agent Suma should be clearly indicating his name on their forms as their marketing
representative.
Another agent working for your agency claims that because you are not employed by the
Medicare Advantage plans that you represent, you are not subject to the same marketing
requirements as the plans themselves. How should you respond to such a statement? -
Correct Answers-Your coworker is not correct. Marketing on behalf of a plan is considered
marketing by the plan and requires that all contracted and employed agents comply with all
Medicare marketing rules.
Another agent you know has engaged in misconduct that has been verified by the plan she
represented. What sort of penalty might the plan impose on this individual? - Correct
Answers-The plan may withhold commission, require retraining, report the misconduct to a
state department of insurance or terminate the contract.
Anthony Boniface turned 65 in 2023. He was not receiving Social Security or Railroad
Retirement Benefits on his 65th birthday. He was interested in obtaining Medicare coverage and
is eligible for premium-free Part A. Before he could enroll in Medicare, his entire area was
impacted by a hurricane causing massive flooding and severe wind damage. The Federal
government declared this to be a natural disaster which has recently ended. During this period
Anthony's initial enrollment period expired. Anthony asks you how he can now obtain Medicare
coverage. What should you say? - Correct Answers-Anthony is eligible for a special
enrollment period (SEP) because he missed an enrollment period due to the impact of the
Federally declared disaster. This SEP will allow Anthony to enroll in Part B up to six months after
the end of the emergency declaration. Anthony may enroll in premium-free Part A at any time
and his Part A coverage will be retroactive for up to 6 months.
Charles McCarthy is a Medicare beneficiary who suffers from diabetes. Mr. McCarthy is
considering enrollment in a MA-PD plan that you represent. He asks you whether his insulin
costs will be covered. What should you say? - Correct Answers-Mr. McCarthy's insulin costs
for a one-month supply cannot be more than $35 in any coverage phase under the prescription
drug plan beginning in 2023.
Daniel is a middle-income Medicare beneficiary. He has chronic bronchitis, putting him at severe
risk for pneumonia. Otherwise, he has no problems functioning. Which type of SNP is likely to
be most appropriate for him? - Correct Answers-C-SNP
, 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? - Correct Answers-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.
Edna, Felix, George, and Harriet are Medicare beneficiaries. Edna lives in an area that has
suffered from major flooding that has been declared a major disaster by both the Federal
government and her state. As a result of dealing with the flooding issues and being evacuated
from her home, Edna missed her chance to enroll in MA during her Initial Coverage Election
Period. Felix lives in an area with a Medicare Advantage plan with a 4-star rating that he would
like to join. George dropped his Medigap policy six months ago when he first enrolled in a
Medicare Advantage plan. He now wants to return to Original Medicare. Harriet has recently
developed diabetes and would like to enroll in a Medicare Advantage plan that focuses on care
for those with that disease. Which, if any, of these individuals would qualify for a special
election period (SEP)? - Correct Answers-Edna would qualify for a SEP because government
officials have declared a major disaster for her area and she did not enroll in MA during her ICEP
due to the emergency. George would qualify for an SEP because he enrolled in Medicare
Advantage (MA) plan for the first time and would now like to return to Original Medicare within
the first 12 months of his enrollment. Harriet would also qualify for a SEP to enroll in a C-SNP
because she has developed a chronic condition. Felix would not qualify for a SEP since he seeks
to enroll in a 4-star not a 5-star MA plan.
Edward IP suffered from serious kidney disease. As a result. Edward became eligible for
Medicare coverage due to end-stage renal disease (ESRD). A close relative donated their kidney
and Edward successfully underwent transplant surgery 12 months ago. Edward is now age 50
and asks you if his Medicare coverage will continue, what should you say? - Correct Answers-
Individuals eligible for Medicare based on ESRD generally lose eligibility 36 months after the
month in which the individual receives a kidney transplant unless they are eligible for Medicare
on another basis such as age or disability. Edward may, however, remain enrolled in Part B but
solely for coverage of immunosuppressive drugs if he has no other health care coverage that
would cover the drugs.
Evan Marsh is a newly appointed agent. Evan intends to conduct an educational session on
Medicare at a senior citizens center near his home. He has advertised the session as an
educational event. Evan asks you what is permissible at such an event. What should you say? -
Correct Answers-Evan may provide a meal as long as its value is $15 or less per attendee and
he may make available business reply cards (BRCs).
