AHIP FINAL EXAM, PRACTICE EXAM AND STUDY
GUIDE LATEST 2025/2026 ACTUAL EXAM
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? - ✔ANASWER✔-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? - ✔ANASWER✔-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? -
✔ANASWER✔-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? -
✔ANASWER✔-The doctor may only collect from Mr. Rivera the cost
sharing allowable under the state's Medicaid program.
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? - ✔ANASWER✔-
Choose one answer. - ✔ANASWER✔-
- ✔ANASWER✔-a. A PFFS plan is a type of Medicare Supplement plan
and she may enroll in one if it is available in her area.
- ✔ANASWER✔-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.
, - ✔ANASWER✔-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.
- ✔ANASWER✔-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.
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? - ✔ANASWER✔-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. - ✔ANASWER✔-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.
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.
Question8 - ✔ANASWER✔-
Marks: 1 - ✔ANASWER✔-
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? - ✔ANASWER✔-
Choose one answer. - ✔ANASWER✔-
- ✔ANASWER✔-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.
GUIDE LATEST 2025/2026 ACTUAL EXAM
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? - ✔ANASWER✔-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? - ✔ANASWER✔-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? -
✔ANASWER✔-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? -
✔ANASWER✔-The doctor may only collect from Mr. Rivera the cost
sharing allowable under the state's Medicaid program.
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? - ✔ANASWER✔-
Choose one answer. - ✔ANASWER✔-
- ✔ANASWER✔-a. A PFFS plan is a type of Medicare Supplement plan
and she may enroll in one if it is available in her area.
- ✔ANASWER✔-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.
, - ✔ANASWER✔-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.
- ✔ANASWER✔-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.
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? - ✔ANASWER✔-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. - ✔ANASWER✔-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.
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.
Question8 - ✔ANASWER✔-
Marks: 1 - ✔ANASWER✔-
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? - ✔ANASWER✔-
Choose one answer. - ✔ANASWER✔-
- ✔ANASWER✔-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.
