007
AHIP FINAL EXAM LATEST
200+ QUESTIONS AND
CORRECT ANSWERS WITH
RATIONALES GRADED A+
1. Which
of the following is the primary purpose of
Medicare Advantage (Part C)?
A. To provide prescription drug coverage only
B. To offer a private alternative to Original Medicare
C. To replace Medicaid for low-income beneficiaries
D. To provide supplemental coverage only
Answer: B
Rationale: Medicare Advantage plans are private health plan alternatives to
Original Medicare, often including additional benefits like dental, vision, and
hearing.
2. A
beneficiary enrolls in a Medicare Advantage
plan during the Annual Enrollment Period. When
does coverage typically begin?
A. Immediately
B. January 1 of the following year
C. The first day of the month after enrollment
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D. The first day of the month after the plan receives the enrollment request
Answer: D
Rationale: Coverage begins the first day of the month after the plan receives the
enrollment request, per CMS rules.
3. Which Medicare Part covers prescription drugs
when enrolled in Original Medicare?
A. Part A
B. Part B
C. Part C
D. Part D
Answer: D
Rationale: Medicare Part D provides prescription drug coverage for beneficiaries
in Original Medicare and is also included in most Medicare Advantage plans.
4. A
beneficiary calls to enroll in a Medicare Advantage
plan but has limited English proficiency. What is the
most compliant way for the agent to proceed?
A. Proceed with the enrollment and document the call
B. Provide translated materials or offer an interpreter
C. Ask the beneficiary to call back with a family member
D. Decline the enrollment due to language barriers
Answer: B
Rationale: CMS requires culturally competent communication and access to
translation services for LEP beneficiaries. Agents must provide appropriate
support.
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5. A Medicare Advantageplan offers a “free” gift card to
anyone who attends a sales presentation. This is:
A. Allowed if the gift card is under $25
B. Allowed only if the beneficiary signs up
C. Prohibited under CMS marketing guidelines
D. Allowed if it is disclosed in writing
Answer: C
Rationale: CMS prohibits providing gifts or incentives to induce enrollment or
attendance at sales events.
6. Whichof the following is considered a “Marketing
Event” under CMS guidelines?
A. One-on-one appointment
B. Community seminar with plan comparison
C. Enrollment assistance at a pharmacy
D. All of the above
Answer: D
Rationale: All these are considered marketing events and must comply with CMS
rules, including proper documentation and materials.
7. Which of the
following is a key indicator of potential
Medicare fraud?
A. Beneficiary requests additional information
B. Provider submits claims for services not rendered
C. Beneficiary changes doctors frequently
D. Provider uses electronic medical records
Answer: B
Rationale: Claims for services not rendered are a classic fraud indicator and
should be reported.
, 007
AHIP FINAL EXAM LATEST
200+ QUESTIONS AND
CORRECT ANSWERS WITH
RATIONALES GRADED A+
1. Which
of the following is the primary purpose of
Medicare Advantage (Part C)?
A. To provide prescription drug coverage only
B. To offer a private alternative to Original Medicare
C. To replace Medicaid for low-income beneficiaries
D. To provide supplemental coverage only
Answer: B
Rationale: Medicare Advantage plans are private health plan alternatives to
Original Medicare, often including additional benefits like dental, vision, and
hearing.
2. A
beneficiary enrolls in a Medicare Advantage
plan during the Annual Enrollment Period. When
does coverage typically begin?
A. Immediately
B. January 1 of the following year
C. The first day of the month after enrollment
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D. The first day of the month after the plan receives the enrollment request
Answer: D
Rationale: Coverage begins the first day of the month after the plan receives the
enrollment request, per CMS rules.
3. Which Medicare Part covers prescription drugs
when enrolled in Original Medicare?
A. Part A
B. Part B
C. Part C
D. Part D
Answer: D
Rationale: Medicare Part D provides prescription drug coverage for beneficiaries
in Original Medicare and is also included in most Medicare Advantage plans.
4. A
beneficiary calls to enroll in a Medicare Advantage
plan but has limited English proficiency. What is the
most compliant way for the agent to proceed?
A. Proceed with the enrollment and document the call
B. Provide translated materials or offer an interpreter
C. Ask the beneficiary to call back with a family member
D. Decline the enrollment due to language barriers
Answer: B
Rationale: CMS requires culturally competent communication and access to
translation services for LEP beneficiaries. Agents must provide appropriate
support.
,007
5. A Medicare Advantageplan offers a “free” gift card to
anyone who attends a sales presentation. This is:
A. Allowed if the gift card is under $25
B. Allowed only if the beneficiary signs up
C. Prohibited under CMS marketing guidelines
D. Allowed if it is disclosed in writing
Answer: C
Rationale: CMS prohibits providing gifts or incentives to induce enrollment or
attendance at sales events.
6. Whichof the following is considered a “Marketing
Event” under CMS guidelines?
A. One-on-one appointment
B. Community seminar with plan comparison
C. Enrollment assistance at a pharmacy
D. All of the above
Answer: D
Rationale: All these are considered marketing events and must comply with CMS
rules, including proper documentation and materials.
7. Which of the
following is a key indicator of potential
Medicare fraud?
A. Beneficiary requests additional information
B. Provider submits claims for services not rendered
C. Beneficiary changes doctors frequently
D. Provider uses electronic medical records
Answer: B
Rationale: Claims for services not rendered are a classic fraud indicator and
should be reported.
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