AHIP FINAL EXAM 200 COMPREHENSIVE
STUDY GUIDE 2026 HEALTH INSURANCE AND
MEDICARE PRINCIPLES
◉ 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?
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?
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?
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?
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?
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?
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?
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?
STUDY GUIDE 2026 HEALTH INSURANCE AND
MEDICARE PRINCIPLES
◉ 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?
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?
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?
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?
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?
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?
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?
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?
