2025 AHIP FINAL FINAL TEST 2026
QUESTIONS WITH CORRECT
ANSWERS GRADED A+
◍ 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?.
Answer: 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.
◍ Mrs. Shields is covered by Original Medicare. She sustained a hip fracture
and is being successfully treated for that condition. However, she and her
physicians feel that after her lengthy hospital stay, she will need a month or
two of nursing and rehabilitative care. What should you tell them about
Original Medicare's coverage of care in a skilled nursing facility?.
Answer: Medicare will cover Mrs. Shield's skilled nursing services provided
during the first 20 days of her stay, after which she would have a copay until
she has been in the facility for 100 days.
◍ Mrs. West wears glasses and dentures and has enjoyed considerable pain
relief from arthritis through massage therapy. She is concerned about
whether or not Medicare will cover these items and services. What should
you tell her?.
Answer: Medicare does not cover massage therapy, or, in general, glasses or
dentures.
◍ 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..
Answer: 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.
◍ 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?.
Answer: 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?.
Answer: 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?.
Answer: 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.
◍ Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What
could you tell Mrs. Park that might be of assistance?.
Answer: She should contact her state Medicaid agency to see if she qualifies
for one of several programs that can help with Medicare costs for which she
is responsible.
◍ 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?.
Answer: The doctor may only collect from Mr. Rivera the cost sharing
allowable under the state's Medicaid program.
◍ Mr. Alonso receives some help paying for his two generic prescription drugs
from his employer's retiree coverage, but he wants to compare it to a Part D
prescription drug plan. He asks you what costs he would generally expect to
encounter when enrolling into a standard Medicare Part D prescription drug
plan. What should you tell him?.
Answer: He generally would pay a monthly premium, annual deductible,
and per-prescription cost-sharing.
◍ Mrs. Gonzalez is enrolled in Original Medicare and has a Medigap policy as
well, but it provides no drug coverage. She would like to keep the coverage
she has but replace her existing Medigap plan with one that provides drug
coverage. What should you tell her?.
QUESTIONS WITH CORRECT
ANSWERS GRADED A+
◍ 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?.
Answer: 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.
◍ Mrs. Shields is covered by Original Medicare. She sustained a hip fracture
and is being successfully treated for that condition. However, she and her
physicians feel that after her lengthy hospital stay, she will need a month or
two of nursing and rehabilitative care. What should you tell them about
Original Medicare's coverage of care in a skilled nursing facility?.
Answer: Medicare will cover Mrs. Shield's skilled nursing services provided
during the first 20 days of her stay, after which she would have a copay until
she has been in the facility for 100 days.
◍ Mrs. West wears glasses and dentures and has enjoyed considerable pain
relief from arthritis through massage therapy. She is concerned about
whether or not Medicare will cover these items and services. What should
you tell her?.
Answer: Medicare does not cover massage therapy, or, in general, glasses or
dentures.
◍ 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..
Answer: 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.
◍ 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?.
Answer: 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?.
Answer: 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?.
Answer: 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.
◍ Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What
could you tell Mrs. Park that might be of assistance?.
Answer: She should contact her state Medicaid agency to see if she qualifies
for one of several programs that can help with Medicare costs for which she
is responsible.
◍ 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?.
Answer: The doctor may only collect from Mr. Rivera the cost sharing
allowable under the state's Medicaid program.
◍ Mr. Alonso receives some help paying for his two generic prescription drugs
from his employer's retiree coverage, but he wants to compare it to a Part D
prescription drug plan. He asks you what costs he would generally expect to
encounter when enrolling into a standard Medicare Part D prescription drug
plan. What should you tell him?.
Answer: He generally would pay a monthly premium, annual deductible,
and per-prescription cost-sharing.
◍ Mrs. Gonzalez is enrolled in Original Medicare and has a Medigap policy as
well, but it provides no drug coverage. She would like to keep the coverage
she has but replace her existing Medigap plan with one that provides drug
coverage. What should you tell her?.
