AHIP FINAL EXAM (2025/2026) TEST QUESTIONS
with CORRECT ANSWERS
Mrs. West 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? - CORRECT ANSWER -
Medicare does not cover acupuncture, or, in general, glasses or dentures.
Mr. Bickford did not quite qualify for the extra help low-income subsidy under the
Medicare Part D Prescription Drug program and he is wondering if there is any other option
he has for obtaining help with his considerable drug costs. What should you tell him? -
CORRECT
ANSWER -He could check with the manufacturers of his medications to see if they offer
an assistance program to help people with limited means obtain the medications they
need.
Alternatively, he could check to see whether his state has a pharmacy assistance program
to help him with his expenses.
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?
- CORRECT ANSWER -He could enroll in one of the MA plans that include prescription drug
coverage or a Medigap plan and a stand-alone prescription drug plan, but he cannot enroll
in the MA-only PPO plan and a stand-alone prescription drug plan.
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? - CORRECT ANSWER -In general, he must select a single Part D
premium payment mechanism that will be used throughout the year.
Agent Jennings makes a presentation on Medicare advertised as an educational event. Agent
Jennings distributes materials that are solely educational in nature. However, she gives a
brief presentation that mentions plan-specific premiums. Is this a prohibited activity at an
, event that has been advertised as educational? - CORRECT ANSWER -Yes. When an event
has been advertised as "educational," discussing plan-specific premiums is impermissible.
Mrs. Mulcahy 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? - CORRECT ANSWER -Everyone 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.
Mr. Jacob understands that there is a standard Medicare Part D prescription drug benefit,
but when he looks at information on various plans available in his area, he sees a wide
range in what they charge for deductibles, premiums and cost sharing. How can you explain
this to him? - CORRECT ANSWER -Medicare Part D drug plans may have different benefit
structures, but on average, they must all be at least as good as the standard model
established by the government.
Ms. Moore plans to retire when she turns 65 in a few months. She is in excellent health and
will have considerable income when she retires. She is concerned that her income will make
it impossible for her to qualify for Medicare. What could you tell her to address her
concern?
- CORRECT ANSWER -Medicare is a program for people age 65 or older and those under
age 65 with certain disabilities, end stage renal disease or Lou Gehrig's disease, so she will
be eligible for Medicare.
Agent Armstrong is employed by XYZ Agency, which is under contract with ABC Health Plan,
a Medicare Advantage (MA) plan that offers plans in multiple states. XYZ Agency maintains
a website marketing the MA plans with which it has contracts. Agent Armstrong follows up
with individuals who request more information about ABC MA plans via the website and
tries to persuade them to enroll in ABC plans. What statement best describes the marketing
and compliance rules that apply to Agent Armstrong? - CORRECT ANSWER -Agent
Armstrong needs to be licensed and appointed in every state in which beneficiaries to
whom he markets ABC MA plans are located.
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? - CORRECT ANSWER -
Part A, which covers hospital, skilled nursing facility, hospice and home health services and
with CORRECT ANSWERS
Mrs. West 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? - CORRECT ANSWER -
Medicare does not cover acupuncture, or, in general, glasses or dentures.
Mr. Bickford did not quite qualify for the extra help low-income subsidy under the
Medicare Part D Prescription Drug program and he is wondering if there is any other option
he has for obtaining help with his considerable drug costs. What should you tell him? -
CORRECT
ANSWER -He could check with the manufacturers of his medications to see if they offer
an assistance program to help people with limited means obtain the medications they
need.
Alternatively, he could check to see whether his state has a pharmacy assistance program
to help him with his expenses.
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?
- CORRECT ANSWER -He could enroll in one of the MA plans that include prescription drug
coverage or a Medigap plan and a stand-alone prescription drug plan, but he cannot enroll
in the MA-only PPO plan and a stand-alone prescription drug plan.
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? - CORRECT ANSWER -In general, he must select a single Part D
premium payment mechanism that will be used throughout the year.
Agent Jennings makes a presentation on Medicare advertised as an educational event. Agent
Jennings distributes materials that are solely educational in nature. However, she gives a
brief presentation that mentions plan-specific premiums. Is this a prohibited activity at an
, event that has been advertised as educational? - CORRECT ANSWER -Yes. When an event
has been advertised as "educational," discussing plan-specific premiums is impermissible.
Mrs. Mulcahy 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? - CORRECT ANSWER -Everyone 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.
Mr. Jacob understands that there is a standard Medicare Part D prescription drug benefit,
but when he looks at information on various plans available in his area, he sees a wide
range in what they charge for deductibles, premiums and cost sharing. How can you explain
this to him? - CORRECT ANSWER -Medicare Part D drug plans may have different benefit
structures, but on average, they must all be at least as good as the standard model
established by the government.
Ms. Moore plans to retire when she turns 65 in a few months. She is in excellent health and
will have considerable income when she retires. She is concerned that her income will make
it impossible for her to qualify for Medicare. What could you tell her to address her
concern?
- CORRECT ANSWER -Medicare is a program for people age 65 or older and those under
age 65 with certain disabilities, end stage renal disease or Lou Gehrig's disease, so she will
be eligible for Medicare.
Agent Armstrong is employed by XYZ Agency, which is under contract with ABC Health Plan,
a Medicare Advantage (MA) plan that offers plans in multiple states. XYZ Agency maintains
a website marketing the MA plans with which it has contracts. Agent Armstrong follows up
with individuals who request more information about ABC MA plans via the website and
tries to persuade them to enroll in ABC plans. What statement best describes the marketing
and compliance rules that apply to Agent Armstrong? - CORRECT ANSWER -Agent
Armstrong needs to be licensed and appointed in every state in which beneficiaries to
whom he markets ABC MA plans are located.
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? - CORRECT ANSWER -
Part A, which covers hospital, skilled nursing facility, hospice and home health services and
