AHIP - FINAL EXAMINATION
QUESTIONS AND ANSWERS WITH
VERIFIED SOLUTIONS 100%
CORRECT UPDATE 2026/ 2027
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)? -
CORRECT ANSWES -- Mrs. Wellington is eligible for a SEP
that may be used once until November 30 to enroll in the fivestar plan.
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? - CORRECT ANSWES -- If the Medicare Advantage
plan is a
Private Fee-for-Service (PFFS) plan
that does not offer drug coverage or a
Medical Savings Account, Mrs. Berkowitz can do this.
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? - CORRECT ANSWES --
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? -
CORRECT ANSWES -- Beneficiaries should check with their employer or union group
benefits administrator before changing plans to avoid losing coverage they want to
keep.
Which of the following steps may a Part D sponsor adopt for beneficiaries who are at
risk of misusing or abusing frequently abused drugs?
I. Identifying at risk individuals by using criteria that includes the number of opioid
prescriptions the beneficiary has and the number of prescribers who have written those
prescriptions.
, II. Locking an at-risk beneficiary into one pharmacy.
III. Locking an at-risk beneficiary into one prescriber.
IV. Increasing deductibles and copays for at-risk beneficiaries. - CORRECT ANSWES --
I, II and III only.
Mr. Wells is trying to understand the difference between Original Medicare and
Medicare Advantage. What would be the correct description? - CORRECT ANSWES --
Medicare Advantage is a way of covering all the Original Medicare
benefits through private health insurance
companies.
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? - CORRECT ANSWES -- This
situation is considered a "dual
enrollment" and CMS compensation rules are applied to the two plans at once and
independently of each other.
Mrs. Ridgeway enrolled in Original Medicare and Medigap coverage following her
retirements several years ago. Four months ago, Mrs. Ridgeway dropped her Medigap
policy to enroll in a Medicare Advantage (MA) plan for the first time. Unfortunately, Mrs.
Ridgeway has found that many of her providers are not in the MA plan's network. She
has come to you for advice? What should you tell her? - CORRECT ANSWES -- She
qualifies for a special enrollment
period (SEP) that will allow her to make a one-time election to return to Original
Medicare and she also has a guaranteed eligibility period to rejoin her Medigap plan.
This year you decide to focus your efforts on marketing to employer and union groups.
Which of the following statements best describes what you can and cannot do in order
to stay in compliance? - CORRECT ANSWES -- You are not required to submit
copies of disseminated materials to CMS
at the time of use, but CMS may request and review copies if employee complains
occur.
Since 2004 Ms. Eisenberg has had a Medigap plan that provides some drug coverage.
She has recently received a letter from her Medigap carrier informing her that her drug
coverage is not "creditable." She wants to know what this means. What should you tell
her? - CORRECT ANSWES --
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? - CORRECT ANSWES -- He may sign-up for
Medicare at any time however coverage usually begins on the fourth month after
dialysis treatments start.
QUESTIONS AND ANSWERS WITH
VERIFIED SOLUTIONS 100%
CORRECT UPDATE 2026/ 2027
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)? -
CORRECT ANSWES -- Mrs. Wellington is eligible for a SEP
that may be used once until November 30 to enroll in the fivestar plan.
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? - CORRECT ANSWES -- If the Medicare Advantage
plan is a
Private Fee-for-Service (PFFS) plan
that does not offer drug coverage or a
Medical Savings Account, Mrs. Berkowitz can do this.
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? - CORRECT ANSWES --
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? -
CORRECT ANSWES -- Beneficiaries should check with their employer or union group
benefits administrator before changing plans to avoid losing coverage they want to
keep.
Which of the following steps may a Part D sponsor adopt for beneficiaries who are at
risk of misusing or abusing frequently abused drugs?
I. Identifying at risk individuals by using criteria that includes the number of opioid
prescriptions the beneficiary has and the number of prescribers who have written those
prescriptions.
, II. Locking an at-risk beneficiary into one pharmacy.
III. Locking an at-risk beneficiary into one prescriber.
IV. Increasing deductibles and copays for at-risk beneficiaries. - CORRECT ANSWES --
I, II and III only.
Mr. Wells is trying to understand the difference between Original Medicare and
Medicare Advantage. What would be the correct description? - CORRECT ANSWES --
Medicare Advantage is a way of covering all the Original Medicare
benefits through private health insurance
companies.
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? - CORRECT ANSWES -- This
situation is considered a "dual
enrollment" and CMS compensation rules are applied to the two plans at once and
independently of each other.
Mrs. Ridgeway enrolled in Original Medicare and Medigap coverage following her
retirements several years ago. Four months ago, Mrs. Ridgeway dropped her Medigap
policy to enroll in a Medicare Advantage (MA) plan for the first time. Unfortunately, Mrs.
Ridgeway has found that many of her providers are not in the MA plan's network. She
has come to you for advice? What should you tell her? - CORRECT ANSWES -- She
qualifies for a special enrollment
period (SEP) that will allow her to make a one-time election to return to Original
Medicare and she also has a guaranteed eligibility period to rejoin her Medigap plan.
This year you decide to focus your efforts on marketing to employer and union groups.
Which of the following statements best describes what you can and cannot do in order
to stay in compliance? - CORRECT ANSWES -- You are not required to submit
copies of disseminated materials to CMS
at the time of use, but CMS may request and review copies if employee complains
occur.
Since 2004 Ms. Eisenberg has had a Medigap plan that provides some drug coverage.
She has recently received a letter from her Medigap carrier informing her that her drug
coverage is not "creditable." She wants to know what this means. What should you tell
her? - CORRECT ANSWES --
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? - CORRECT ANSWES -- He may sign-up for
Medicare at any time however coverage usually begins on the fourth month after
dialysis treatments start.
