AHIP Final Exam 2025 Questions and
Answers
Alice and Charlotte because each of them currently have health coverage and is in their
initial coverage election period (ICEP). - ANS-Richard is a licensed agent who
represents Spartan Health Plan and its Medicare Advantage (MA) plans. Richard has
several clients who have recently come to him for help who are in their initial coverage
election period (ICEP) and are interested in enrolling in one of Spartan Health Plan's
MA plans. Alice will soon turn 65 and retire. Alice has coverage through Spartan Health
Plan offered by her employer. Bob had health coverage through Spartan but dropped
the coverage when he retired early to travel overseas. Bob, who has just turned age 65,
is now back in the United States. Charlotte, who will turn 65 next month, has coverage
through Athena Health plan - a company Richard also represents. Who qualifies for the
opt-in simplified enrollment mechanism?
An individual who is entitled to Part A or enrolled under Part B is eligible to enroll in a
Medicare prescription drug plan. As long as Mrs. Mulcahy is entitled to Part A, she does
not need to enroll under Part B before enrolling in a prescription drug plan. - ANS-Mrs.
Mulcahy, age 65, is concerned that she may not qualify for enrollment in a Medicare
prescription drug plan because, although she is entitled to Part A, she is not enrolled
under Medicare Part B. What should you tell her?
Before conducting the presentation, obtain and document having obtained her
permission to visit, along with her interest in the specific products you will present. -
ANS-You have set up an appointment for an in-home sales presentation with Mrs.
Fernandez, who expressed interest in the Medicare plans you represent. In preparation
for the sales presentation, what must you do?
Enrollment in Cost plans offering Part D coverage is available only during enrollment
periods under the Part D program, and Cost plans must accept enrollments during
these periods. - ANS-Mrs. Pierce would like to enroll in a Medicare Cost plan that offers
Part D prescription drug coverage. She comes to you for advice about when she can
enroll in a plan you have previously discussed. What should you tell her?
Every Part D drug plan is required to cover a single one-month fill of her existing
medications sometime during a 90-day transition period. - ANS-Mrs. Roswell is a new
Medicare beneficiary who has just retired from retail work. She is interested in selecting
a Medicare Part D prescription drug plan. She takes several medications and is
concerned that she has not been able to identify a plan that covers all of her
medications. She does not want to make an abrupt change to new drugs that would be
covered and asks what she should do. What should you tell her?
, He can enroll in a MA-PD as long as he enrolls in Part B and is entitled to Part A. -
ANS-Mr. Liu turns 65 on June 19. He has never previously qualified for Medicare so his
first Medicare eligibility date will be June 1. Mr. Liu's ICEP and Part D IEP begin on
March 1 and end on September 30. He wants prescription drug coverage with his Part A
and Part B benefits. What advice can you provide him?
He can make as many enrollment changes as he likes during the Annual Election
Period and the last choice made before the end of the period will be the effective one as
of January 1. - ANS-Mr. Ford enrolled in an MA-only plan in mid-November during the
Annual Election Period (AEP). On December 1, he calls you up and says that he has
changed his mind and would like to enroll in a MA-PD plan. What enrollment rules
would apply in this case?
He could enroll either in one of the MA plans that include prescription drug coverage or
Original Medicare with a Medigap plan and standalone Part D prescription drug
coverage, but he cannot enroll in the MA-only PPO plan and a stand-alone prescription
drug plan. - ANS-Mr. Lombardi is interested in a Medicare Advantage (MA) PPO plan
that you represent. It is one of three plans operated by the same organization in Mr.
Lombardi's area. The MA PPO plan does not include drug coverage, but the other two
plans do. Mr. Lombardi likes the PPO plan that does not include drug coverage and
intends to obtain his drug coverage through a stand-alone Medicare prescription drug
plan. What should you tell him about this situation?
He may sign-up for Medicare at any time however coverage usually begins on the fourth
month after dialysis treatments start. - ANS-Mr. Davis is 52 years old and has recently
been diagnosed with end-stage renal disease (ESRD) and will soon begin dialysis. He
is wondering if he can obtain coverage under Medicare. What should you tell him?
He should compare the benefits in his employer-sponsored retiree group health plan
with the benefits in his neighbor's MA-PD plan to determine which one will provide
sufficient coverage for his prescription needs. - ANS-Mr. Romero is 64, retiring soon,
and considering enrollment in his employer-sponsored retiree group health plan that
includes drug coverage with nominal copays. He heard about a neighbor's MA-PD plan
that you represent and because he takes numerous prescription drugs, he is
considering signing up for it. What should you tell him?
He will have to enroll in Part B. - ANS-Mr. Sanchez has just turned 65 and is entitled to
Part A but has not enrolled in Part B because he has coverage through an employer
plan. If he wants to enroll in a Medicare Advantage plan, what will he have to do?
He will need to mail in his payment with his enrollment form. - ANS-Mr. Lopez, who is
fairly well-off financially, would like to enroll in a Medicare prescription drug plan you
represent and simply give you a check to cover his premiums for the entire year. What
should you tell him?
Answers
Alice and Charlotte because each of them currently have health coverage and is in their
initial coverage election period (ICEP). - ANS-Richard is a licensed agent who
represents Spartan Health Plan and its Medicare Advantage (MA) plans. Richard has
several clients who have recently come to him for help who are in their initial coverage
election period (ICEP) and are interested in enrolling in one of Spartan Health Plan's
MA plans. Alice will soon turn 65 and retire. Alice has coverage through Spartan Health
Plan offered by her employer. Bob had health coverage through Spartan but dropped
the coverage when he retired early to travel overseas. Bob, who has just turned age 65,
is now back in the United States. Charlotte, who will turn 65 next month, has coverage
through Athena Health plan - a company Richard also represents. Who qualifies for the
opt-in simplified enrollment mechanism?
An individual who is entitled to Part A or enrolled under Part B is eligible to enroll in a
Medicare prescription drug plan. As long as Mrs. Mulcahy is entitled to Part A, she does
not need to enroll under Part B before enrolling in a prescription drug plan. - ANS-Mrs.
Mulcahy, age 65, is concerned that she may not qualify for enrollment in a Medicare
prescription drug plan because, although she is entitled to Part A, she is not enrolled
under Medicare Part B. What should you tell her?
Before conducting the presentation, obtain and document having obtained her
permission to visit, along with her interest in the specific products you will present. -
ANS-You have set up an appointment for an in-home sales presentation with Mrs.
Fernandez, who expressed interest in the Medicare plans you represent. In preparation
for the sales presentation, what must you do?
Enrollment in Cost plans offering Part D coverage is available only during enrollment
periods under the Part D program, and Cost plans must accept enrollments during
these periods. - ANS-Mrs. Pierce would like to enroll in a Medicare Cost plan that offers
Part D prescription drug coverage. She comes to you for advice about when she can
enroll in a plan you have previously discussed. What should you tell her?
Every Part D drug plan is required to cover a single one-month fill of her existing
medications sometime during a 90-day transition period. - ANS-Mrs. Roswell is a new
Medicare beneficiary who has just retired from retail work. She is interested in selecting
a Medicare Part D prescription drug plan. She takes several medications and is
concerned that she has not been able to identify a plan that covers all of her
medications. She does not want to make an abrupt change to new drugs that would be
covered and asks what she should do. What should you tell her?
, He can enroll in a MA-PD as long as he enrolls in Part B and is entitled to Part A. -
ANS-Mr. Liu turns 65 on June 19. He has never previously qualified for Medicare so his
first Medicare eligibility date will be June 1. Mr. Liu's ICEP and Part D IEP begin on
March 1 and end on September 30. He wants prescription drug coverage with his Part A
and Part B benefits. What advice can you provide him?
He can make as many enrollment changes as he likes during the Annual Election
Period and the last choice made before the end of the period will be the effective one as
of January 1. - ANS-Mr. Ford enrolled in an MA-only plan in mid-November during the
Annual Election Period (AEP). On December 1, he calls you up and says that he has
changed his mind and would like to enroll in a MA-PD plan. What enrollment rules
would apply in this case?
He could enroll either in one of the MA plans that include prescription drug coverage or
Original Medicare with a Medigap plan and standalone Part D prescription drug
coverage, but he cannot enroll in the MA-only PPO plan and a stand-alone prescription
drug plan. - ANS-Mr. Lombardi is interested in a Medicare Advantage (MA) PPO plan
that you represent. It is one of three plans operated by the same organization in Mr.
Lombardi's area. The MA PPO plan does not include drug coverage, but the other two
plans do. Mr. Lombardi likes the PPO plan that does not include drug coverage and
intends to obtain his drug coverage through a stand-alone Medicare prescription drug
plan. What should you tell him about this situation?
He may sign-up for Medicare at any time however coverage usually begins on the fourth
month after dialysis treatments start. - ANS-Mr. Davis is 52 years old and has recently
been diagnosed with end-stage renal disease (ESRD) and will soon begin dialysis. He
is wondering if he can obtain coverage under Medicare. What should you tell him?
He should compare the benefits in his employer-sponsored retiree group health plan
with the benefits in his neighbor's MA-PD plan to determine which one will provide
sufficient coverage for his prescription needs. - ANS-Mr. Romero is 64, retiring soon,
and considering enrollment in his employer-sponsored retiree group health plan that
includes drug coverage with nominal copays. He heard about a neighbor's MA-PD plan
that you represent and because he takes numerous prescription drugs, he is
considering signing up for it. What should you tell him?
He will have to enroll in Part B. - ANS-Mr. Sanchez has just turned 65 and is entitled to
Part A but has not enrolled in Part B because he has coverage through an employer
plan. If he wants to enroll in a Medicare Advantage plan, what will he have to do?
He will need to mail in his payment with his enrollment form. - ANS-Mr. Lopez, who is
fairly well-off financially, would like to enroll in a Medicare prescription drug plan you
represent and simply give you a check to cover his premiums for the entire year. What
should you tell him?
