AHIP FINAL EXAM TEST QUESTIONS AND
ANSWERS 2025 (DIFFERENT VERSIONS
QUESTIONS AND VERIFIED ANSWERS)
COMPLETE AHIP FINAL EXAM 2025 ALREADY
GRADED A+
Which of the following steps may a Part D sponsor adopt for beneficiaries who
are at risk of misusing or abusing frequently abused drugs? - ANSWER>>I.
Identifying at risk individuals by using criteria that includes the number of
opioid prescriptions the beneficiary has and the II. Locking an at-risk
beneficiary into one pharmacy.
III. Locking an at-risk beneficiary into one prescriber.
Mrs. Wolf wears glasses and dentures and has enjoyed considerable pain relief
from arthritis through acupuncture. She is concerned about whether or not
Medicare will cover these items and services. What should you tell her? -
ANSWER>>Medicare does not cover acupuncture, or, in general, glasses or
dentures.
Which statement best describes PACE plans? - ANSWER>>It includes
comprehensive medical and social service delivery systems using an
interdisciplinary team approach in an adult day health center, supplemented by
in-home and referral services.
Mr. Shultz was still working when he first qualified for Medicare. At that time, he
had employer group coverage that was creditable. During his initial Part D
eligibility period, he decided not to enroll because he was satisfied with his drug
coverage. It is now a year later and Mr. Shultz has lost his employer group
coverage. How would you advise him? - ANSWER>>Mr. Schultz should enroll in a
Part D plan before he has a 63-day break in coverage in order to avoid a premium
penalty.
,For which of the following individuals would a Cost Plan be most appropriate? -
ANSWER>>Ms. Baker who is enrolled in Medicare Part B and is willing to continue
paying Part B premiums plus any plan premiums.
Mrs. Berkowitz wants to enroll in a Medicare Advantage plan that does not
include drug coverage and also enroll in a stand-alone Medicare prescription drug
plan. Under what circumstances can she do this? - ANSWER>>If the Medicare
Advantage plan is a Private Fee-forService (PFFS) plan that does not offer drug
coverage or a Medical Savings Account, Mrs. Berkowitz can do this.
Ms. Goldstein is required by the plan she represents to obtain enrollment forms
that have carbon copies in the back. She gives one to the beneficiary, sends
another to the plan and retains the third. What should she do with her copies of
the enrollment forms? - ANSWER>>She should make every effort to safeguard the
beneficiary information on those enrollment forms.
Mr. Lopez takes several high cost prescription drugs. He would like to enroll in a
standalone Part D prescription drug plan that is available in his area. In what type
of Medicare Health Plan can he enroll? - ANSWER>>Private Fee-for-Service (PFFS)
plan that does not include drug coverage.
Mr. Block is currently enrolled in a Medicare Advantage plan that includes drug
coverage. He found a stand-alone Medicare prescription drug plan in his area that
offers better coverage than that available through his MA-PD plan and in addition
has a low premium. It won't cost him much more and, because he has the means
to do so, he wishes to enroll in the stand-alone prescription drug plan in addition
to his MA-PD plan. What should you tell him? - ANSWER>>If Mr. Block enrolls in
the stand-alone Medicare prescription drug plan, he will be disenrolled from the
Medicare Advantage plan.
Mrs. Chen will be 65 soon, has been a citizen for twelve years, has been employed
full time, and paid taxes during that entire period. She is concerned that she will
not qualify for coverage under part A because she was not born in the United
States. What should you tell her? - ANSWER>>Most individuals who are citizens
and over age 65 are covered under Part A by virtue of having paid Medicare taxes
,while working, though some may be covered as a result of paying monthly
premiums.
Mrs. Lopez is enrolled in a Medicare Advantage cost plan. She has recently lost
creditable coverage previously available through her husband's employer. She is
interested in enrolling in a Medicare Part D prescription drug plan (PDP). What
should you tell her? - ANSWER>>If a Part D benefit is offered through her plan she
must enroll in this plan.
Mr. Schmidt would like to plan for retirement and has asked you what is covered
under Original Fee-for-Service (FFS) Medicare? What could you tell him? -
ANSWER>>Part A, which covers hospital, skilled nursing facility, hospice and home
health services and Part B, which covers professional services such as those
provided by a doctor are covered under Original Medicare.
Mrs. Wellington is enrolled in Parts A and B of Original Medicare. A friend recently
told her that there is an excellent Medicare Advantage (MA) plan with a five-star
rating serving her area. On January 15 she comes to you for advice as to what
options, if any, she has. What should you say regarding special enrollment periods
(SEPs)? - ANSWER>>Mrs. Wellington is eligible for a SEP that may be used once
until November 30 to enroll in the five-star plan.
Mr. Shapiro gets by on a very small fixed income. He has heard there may be extra
help paying for Part D prescription drugs for Medicare beneficiaries with limited
income. He wants to know whether he might qualify. What should you tell him? -
ANSWER>>The extra help is available to beneficiaries whose income and assets
do not exceed annual limits specified by the government.
A client wants to give you an enrollment application on October 1 prior to 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?
- ANSWER>>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.
, Agent Roderick enrolls retiree Mrs. Martinez in a medical savings account (MSA)
Medicare health plan. The MSA plan does not offer prescription drug coverage, so
Agent Roderick also enrolls Mrs. Martinez in a standalone prescription drug plan
(PDP). What CMS compensation rules apply to this situation? - ANSWER>>This
situation is considered a "dual enrollment," and CMS compensation rules are
applied to the two plans at once and independently of each other.
You are meeting with Mrs. Hall in her home. On her scope of appointment form
she asked to discuss Medicare Advantage plans. During the meeting, she asks to
discuss a stand-alone prescription drug plan. She is leaving the next day to visit
her family for a week in another state, so it is important to her to make a decision
before she leaves. What must happen before that additional discussion can take
place? - ANSWER>>Since Mrs. Hall specifically asked that you discuss the stand-
alone Part D plan, you may do so, as long as she signs a new scope of
appointment form first, indicating that she wants to discuss the Part D plan.
You have come to Mrs. Midler's home for a sales presentation. At the beginning
of the presentation, Mrs. Midler tells you that she has a copy of her medical
record available because she thinks this will help you understand her needs. She
suggests that you will know which questions to ask her about her health status in
order to best assist her in selecting a plan. What should you do? - ANSWER>>You
can only ask Mrs. Midler questions about conditions that affect eligibility,
specifically, whether she has end stage renal disease or one of the conditions that
would qualify her for a special needs plan.
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 requirements as the plans themselves. How should you respond to such a
statement? - ANSWER>>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.
Ms. Jensen has heard about "Original Fee-for-Service Medicare" and "Private Fee-
for-Service" plans. She wants to know what the difference is, if any. What should
ANSWERS 2025 (DIFFERENT VERSIONS
QUESTIONS AND VERIFIED ANSWERS)
COMPLETE AHIP FINAL EXAM 2025 ALREADY
GRADED A+
Which of the following steps may a Part D sponsor adopt for beneficiaries who
are at risk of misusing or abusing frequently abused drugs? - ANSWER>>I.
Identifying at risk individuals by using criteria that includes the number of
opioid prescriptions the beneficiary has and the II. Locking an at-risk
beneficiary into one pharmacy.
III. Locking an at-risk beneficiary into one prescriber.
Mrs. Wolf wears glasses and dentures and has enjoyed considerable pain relief
from arthritis through acupuncture. She is concerned about whether or not
Medicare will cover these items and services. What should you tell her? -
ANSWER>>Medicare does not cover acupuncture, or, in general, glasses or
dentures.
Which statement best describes PACE plans? - ANSWER>>It includes
comprehensive medical and social service delivery systems using an
interdisciplinary team approach in an adult day health center, supplemented by
in-home and referral services.
Mr. Shultz was still working when he first qualified for Medicare. At that time, he
had employer group coverage that was creditable. During his initial Part D
eligibility period, he decided not to enroll because he was satisfied with his drug
coverage. It is now a year later and Mr. Shultz has lost his employer group
coverage. How would you advise him? - ANSWER>>Mr. Schultz should enroll in a
Part D plan before he has a 63-day break in coverage in order to avoid a premium
penalty.
,For which of the following individuals would a Cost Plan be most appropriate? -
ANSWER>>Ms. Baker who is enrolled in Medicare Part B and is willing to continue
paying Part B premiums plus any plan premiums.
Mrs. Berkowitz wants to enroll in a Medicare Advantage plan that does not
include drug coverage and also enroll in a stand-alone Medicare prescription drug
plan. Under what circumstances can she do this? - ANSWER>>If the Medicare
Advantage plan is a Private Fee-forService (PFFS) plan that does not offer drug
coverage or a Medical Savings Account, Mrs. Berkowitz can do this.
Ms. Goldstein is required by the plan she represents to obtain enrollment forms
that have carbon copies in the back. She gives one to the beneficiary, sends
another to the plan and retains the third. What should she do with her copies of
the enrollment forms? - ANSWER>>She should make every effort to safeguard the
beneficiary information on those enrollment forms.
Mr. Lopez takes several high cost prescription drugs. He would like to enroll in a
standalone Part D prescription drug plan that is available in his area. In what type
of Medicare Health Plan can he enroll? - ANSWER>>Private Fee-for-Service (PFFS)
plan that does not include drug coverage.
Mr. Block is currently enrolled in a Medicare Advantage plan that includes drug
coverage. He found a stand-alone Medicare prescription drug plan in his area that
offers better coverage than that available through his MA-PD plan and in addition
has a low premium. It won't cost him much more and, because he has the means
to do so, he wishes to enroll in the stand-alone prescription drug plan in addition
to his MA-PD plan. What should you tell him? - ANSWER>>If Mr. Block enrolls in
the stand-alone Medicare prescription drug plan, he will be disenrolled from the
Medicare Advantage plan.
Mrs. Chen will be 65 soon, has been a citizen for twelve years, has been employed
full time, and paid taxes during that entire period. She is concerned that she will
not qualify for coverage under part A because she was not born in the United
States. What should you tell her? - ANSWER>>Most individuals who are citizens
and over age 65 are covered under Part A by virtue of having paid Medicare taxes
,while working, though some may be covered as a result of paying monthly
premiums.
Mrs. Lopez is enrolled in a Medicare Advantage cost plan. She has recently lost
creditable coverage previously available through her husband's employer. She is
interested in enrolling in a Medicare Part D prescription drug plan (PDP). What
should you tell her? - ANSWER>>If a Part D benefit is offered through her plan she
must enroll in this plan.
Mr. Schmidt would like to plan for retirement and has asked you what is covered
under Original Fee-for-Service (FFS) Medicare? What could you tell him? -
ANSWER>>Part A, which covers hospital, skilled nursing facility, hospice and home
health services and Part B, which covers professional services such as those
provided by a doctor are covered under Original Medicare.
Mrs. Wellington is enrolled in Parts A and B of Original Medicare. A friend recently
told her that there is an excellent Medicare Advantage (MA) plan with a five-star
rating serving her area. On January 15 she comes to you for advice as to what
options, if any, she has. What should you say regarding special enrollment periods
(SEPs)? - ANSWER>>Mrs. Wellington is eligible for a SEP that may be used once
until November 30 to enroll in the five-star plan.
Mr. Shapiro gets by on a very small fixed income. He has heard there may be extra
help paying for Part D prescription drugs for Medicare beneficiaries with limited
income. He wants to know whether he might qualify. What should you tell him? -
ANSWER>>The extra help is available to beneficiaries whose income and assets
do not exceed annual limits specified by the government.
A client wants to give you an enrollment application on October 1 prior to 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?
- ANSWER>>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.
, Agent Roderick enrolls retiree Mrs. Martinez in a medical savings account (MSA)
Medicare health plan. The MSA plan does not offer prescription drug coverage, so
Agent Roderick also enrolls Mrs. Martinez in a standalone prescription drug plan
(PDP). What CMS compensation rules apply to this situation? - ANSWER>>This
situation is considered a "dual enrollment," and CMS compensation rules are
applied to the two plans at once and independently of each other.
You are meeting with Mrs. Hall in her home. On her scope of appointment form
she asked to discuss Medicare Advantage plans. During the meeting, she asks to
discuss a stand-alone prescription drug plan. She is leaving the next day to visit
her family for a week in another state, so it is important to her to make a decision
before she leaves. What must happen before that additional discussion can take
place? - ANSWER>>Since Mrs. Hall specifically asked that you discuss the stand-
alone Part D plan, you may do so, as long as she signs a new scope of
appointment form first, indicating that she wants to discuss the Part D plan.
You have come to Mrs. Midler's home for a sales presentation. At the beginning
of the presentation, Mrs. Midler tells you that she has a copy of her medical
record available because she thinks this will help you understand her needs. She
suggests that you will know which questions to ask her about her health status in
order to best assist her in selecting a plan. What should you do? - ANSWER>>You
can only ask Mrs. Midler questions about conditions that affect eligibility,
specifically, whether she has end stage renal disease or one of the conditions that
would qualify her for a special needs plan.
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 requirements as the plans themselves. How should you respond to such a
statement? - ANSWER>>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.
Ms. Jensen has heard about "Original Fee-for-Service Medicare" and "Private Fee-
for-Service" plans. She wants to know what the difference is, if any. What should
