AHIP Final Examination Questions Graded A+ 2025/2026
Ms. Stuart has heard about a special needs plan (SNP) that one of her friends is enrolled in and is
interested in that product. She wants to be sure she also has coverage for prescription drugs. Would she
be able to obtain drug coverage if she enrolled in the SNP? - a. Yes. All SNPs are required to provide Part
D coverage for prescription drugs.
b. Yes, but only if she qualifies for Part D prescription drug coverage under her state Medicaid program.
c. No. Medicare beneficiaries who enroll in an SNP must always obtain their drug coverage through a
stand-alone Part D Medicare prescription drug plan that they sign up for independent of their
enrollment in the SNP.
d. Maybe. Some SNPs offer Part D coverage for prescription drugs and some do not.
= ?????
Phiona works in the IT Department of BestCare Health Plan. Phiona is placed in charge of BestCare's
efforts to facilitate electronic enrollment in its Medicare Advantage plans. In setting up the enrollment
site, which of the following must Phiona consider? - II. All data elements required to complete an
enrollment request must be captured.
III. The process must include a clear and distinct step that requires the applicant to activate an "Enroll
Now" or "I Agree" type of button or tool.
Ms. Lewis understands that Medicare prescription drug plans may use various methods to control the
use of specific drugs. She has heard about a technique called "step therapy" and is wondering if you can
explain what that is. What should you tell her? - Step therapy involves using one or more lower priced
drugs before trying a more expensive drug when all are used to treat the same condition.
Mr. Gomez notes that a Private Fee-for-Service (PFFS) plan available in his area has an attractive
premium. He wants to know if he must use doctors in a network as his current HMO plan requires him to
do. What should you tell him? - He may receive health care services from ANY doctor allowed to bill
Medicare, as long as he shows the doctor the plan's identification card and the doctor agrees to accept
the PFFS plan's payment terms and conditions, which could include balance billing.
Mr. Wu is eligible for Medicare. He has limited financial resources but failed to qualify for the Part D low-
income subsidy. Where might he turn for help with his prescription drug costs? - Mr. Wu may still qualify
for help in paying Part D costs through his State Pharmaceutical Assistance Program.
, You have decided to focus on doing in-home presentations to market the Medicare Advantage (MA)
plans you represent. Before you conduct such sales presentations, what must you do? -
Mr. Wong is a single individual. He has had a successful business career and is now able to retire with a
comfortable income. Mr. Wong's taxable income is in excess of $100,000. Mr. Wong has health coverage
through his employer but will sign-up Medicare Part A, Part B and Part D when he leaves the workforce.
How would you advise him as he budgets for Medicare premiums? - a. Due to the provisions of MACRA,
his Part B and D coverage will be combined and covered through a low-cost Medigap policy to
supplement his Part A coverage.
b. Due to his participation in the workforce he will not have to pay premiums for Part A and he will pay
the lowest monthly premium rates for Part B and Part D.
c. Due to his participation in the workforce he will not have to pay premiums for Part A but he will pay
higher premiums for Part B and Part D due to the amount of his income.
d. Due to his participation in the workforce he will not have to pay premiums for Part A and will pay
reduced premiums for Part B and Part D.
?????
Mr. Prentice has many clients who are Medicare beneficiaries. He should review the Centers for
Medicare & Medicaid Services' communication and Marketing Guidelines to ensure he is compliant for
which type of products? - Medicare Advantage (MA) and Prescription Drug (PDP) plans Correct
Ms. Hernandez has marketed several different types of insurance products in her home state and has
typically sought approval of her materials from her State Department of Insurance. What would you
advise her regarding seeking such approval for materials she uses to market Medicare Advantage plans?
- a. States often volunteer to review marketing materials on behalf of the Medicare agency. She should
check with her Department of Insurance to see if such a review is available and would satisfy CMS
requirements.
b. Materials for marketing Medicare health plans to individuals are subject to Medicare's uniform
national requirements. They do not need to be reviewed by the state, but the company she represents
must obtain approval from the Medicare agency (CMS) for any materials she uses.
c. Obtaining approval of her materials from the State Department of Insurance is a good practice and she
should continue it with materials for the Medicare health plans she represents.
d. Materials need only be reviewed and approved by the company(s) she represents.
Ms. Stuart has heard about a special needs plan (SNP) that one of her friends is enrolled in and is
interested in that product. She wants to be sure she also has coverage for prescription drugs. Would she
be able to obtain drug coverage if she enrolled in the SNP? - a. Yes. All SNPs are required to provide Part
D coverage for prescription drugs.
b. Yes, but only if she qualifies for Part D prescription drug coverage under her state Medicaid program.
c. No. Medicare beneficiaries who enroll in an SNP must always obtain their drug coverage through a
stand-alone Part D Medicare prescription drug plan that they sign up for independent of their
enrollment in the SNP.
d. Maybe. Some SNPs offer Part D coverage for prescription drugs and some do not.
= ?????
Phiona works in the IT Department of BestCare Health Plan. Phiona is placed in charge of BestCare's
efforts to facilitate electronic enrollment in its Medicare Advantage plans. In setting up the enrollment
site, which of the following must Phiona consider? - II. All data elements required to complete an
enrollment request must be captured.
III. The process must include a clear and distinct step that requires the applicant to activate an "Enroll
Now" or "I Agree" type of button or tool.
Ms. Lewis understands that Medicare prescription drug plans may use various methods to control the
use of specific drugs. She has heard about a technique called "step therapy" and is wondering if you can
explain what that is. What should you tell her? - Step therapy involves using one or more lower priced
drugs before trying a more expensive drug when all are used to treat the same condition.
Mr. Gomez notes that a Private Fee-for-Service (PFFS) plan available in his area has an attractive
premium. He wants to know if he must use doctors in a network as his current HMO plan requires him to
do. What should you tell him? - He may receive health care services from ANY doctor allowed to bill
Medicare, as long as he shows the doctor the plan's identification card and the doctor agrees to accept
the PFFS plan's payment terms and conditions, which could include balance billing.
Mr. Wu is eligible for Medicare. He has limited financial resources but failed to qualify for the Part D low-
income subsidy. Where might he turn for help with his prescription drug costs? - Mr. Wu may still qualify
for help in paying Part D costs through his State Pharmaceutical Assistance Program.
, You have decided to focus on doing in-home presentations to market the Medicare Advantage (MA)
plans you represent. Before you conduct such sales presentations, what must you do? -
Mr. Wong is a single individual. He has had a successful business career and is now able to retire with a
comfortable income. Mr. Wong's taxable income is in excess of $100,000. Mr. Wong has health coverage
through his employer but will sign-up Medicare Part A, Part B and Part D when he leaves the workforce.
How would you advise him as he budgets for Medicare premiums? - a. Due to the provisions of MACRA,
his Part B and D coverage will be combined and covered through a low-cost Medigap policy to
supplement his Part A coverage.
b. Due to his participation in the workforce he will not have to pay premiums for Part A and he will pay
the lowest monthly premium rates for Part B and Part D.
c. Due to his participation in the workforce he will not have to pay premiums for Part A but he will pay
higher premiums for Part B and Part D due to the amount of his income.
d. Due to his participation in the workforce he will not have to pay premiums for Part A and will pay
reduced premiums for Part B and Part D.
?????
Mr. Prentice has many clients who are Medicare beneficiaries. He should review the Centers for
Medicare & Medicaid Services' communication and Marketing Guidelines to ensure he is compliant for
which type of products? - Medicare Advantage (MA) and Prescription Drug (PDP) plans Correct
Ms. Hernandez has marketed several different types of insurance products in her home state and has
typically sought approval of her materials from her State Department of Insurance. What would you
advise her regarding seeking such approval for materials she uses to market Medicare Advantage plans?
- a. States often volunteer to review marketing materials on behalf of the Medicare agency. She should
check with her Department of Insurance to see if such a review is available and would satisfy CMS
requirements.
b. Materials for marketing Medicare health plans to individuals are subject to Medicare's uniform
national requirements. They do not need to be reviewed by the state, but the company she represents
must obtain approval from the Medicare agency (CMS) for any materials she uses.
c. Obtaining approval of her materials from the State Department of Insurance is a good practice and she
should continue it with materials for the Medicare health plans she represents.
d. Materials need only be reviewed and approved by the company(s) she represents.
