AHA PALS Practice exam
AHIP Final Exam Study Guide Questions
with Verified Answers 2025 Graded A+
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.
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,AHA PALS Practice exam
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.
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,AHA PALS Practice exam
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-
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, AHA PALS Practice exam
- 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
- ANSWERS-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 - ANSWERS-
Marks: 1 - ANSWERS-
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? - ANSWERS-
Choose one answer. - ANSWERS-
4|Page
AHIP Final Exam Study Guide Questions
with Verified Answers 2025 Graded A+
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.
1|Page
,AHA PALS Practice exam
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.
2|Page
,AHA PALS Practice exam
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-
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, AHA PALS Practice exam
- 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
- ANSWERS-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 - ANSWERS-
Marks: 1 - ANSWERS-
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? - ANSWERS-
Choose one answer. - ANSWERS-
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