A+ Graded Paper
AHIP 2025/2026 Certification - Final Exam +
(Updated) Verified Q&A
Questions and Mark scheme
Version: Final 1.1
,Richard is a licensed agent who represents Spartan Health Plan and its Medicare Advantage (MA) plans. Richard has
several clients who have recently come to him for help who are in their initial coverage election period (ICEP) and are
interested in enrolling in one of Spartan Health Plan's MA plans. Alice will soon turn 65 and retire. Alice has coverage
through Spartan Health Plan offered by her employer. Bob had health coverage through Spartan but dropped the
coverage when he retired early to travel overseas. Bob, who has just turned age 65, is now back in the United States.
Charlotte, who will turn 65 next month, has coverage through Athena Health plan - a company Richard also represents.
Who qualifies for the opt-in simplified enrollment mechanism? - ✔✔
Choose one answer. - ✔✔
- ✔✔a. Alice because she will not have a break between her non-Medicare and Medicare coverage through Spartan
Health Plan.
- ✔✔b. Alice and Charlotte because each of them currently have health coverage and is in their initial coverage election
period (ICEP).
- ✔✔c. Alice and Bob because each of them has had coverage through Spartan Health Plan.
- ✔✔d. Alice, Bob, and Charlotte because electronic health record interoperability will allow Richard to access any
needed information for their applications.
Question12 - ✔✔
Marks: 1 - ✔✔
Under what conditions can a Medicare prescription drug plan reduce its coverage for a given drug during the first 60
days of the year? - ✔✔
Choose one answer. - ✔✔
- ✔✔a. When a formulary change is in response to a drug's removal from the market.
, - ✔✔b. When the Part D plan can demonstrate to CMS that no enrollee has accessed the medication in the past six
months, generally the plan can remove the drug from its formulary within the first 60 days of the year.
- ✔✔c. Under no conditions can a Medicare Part D prescription drug plan reduce its coverage for a given drug at any
point during the year.
- ✔✔d. If the Medicare prescription drug plan can show that reducing coverage early in the year will result in savings for
the Part D plan and the Medicare program, generally the plan may make such a change.
Question13 - ✔✔
Marks: 1 - ✔✔
This year you have decided to focus your efforts on marketing to employer group plans. One employer provides you with
a list of their retirees and asks you to contact them to explain the characteristics of the plan they have selected. What
should you do? - ✔✔
Choose one answer. - ✔✔
- ✔✔a. You may only contact the retirees after the employer has notified them that they will be receiving a call.
- ✔✔b. You may call them but must record every call.
- ✔✔c. You may go ahead and call them.
- ✔✔d. You may not make any unsolicited contact with Medicare beneficiaries. The employer will have to tell its
retirees to call you.
Question14 - ✔✔
Marks: 1 - ✔✔
AHIP 2025/2026 Certification - Final Exam +
(Updated) Verified Q&A
Questions and Mark scheme
Version: Final 1.1
,Richard is a licensed agent who represents Spartan Health Plan and its Medicare Advantage (MA) plans. Richard has
several clients who have recently come to him for help who are in their initial coverage election period (ICEP) and are
interested in enrolling in one of Spartan Health Plan's MA plans. Alice will soon turn 65 and retire. Alice has coverage
through Spartan Health Plan offered by her employer. Bob had health coverage through Spartan but dropped the
coverage when he retired early to travel overseas. Bob, who has just turned age 65, is now back in the United States.
Charlotte, who will turn 65 next month, has coverage through Athena Health plan - a company Richard also represents.
Who qualifies for the opt-in simplified enrollment mechanism? - ✔✔
Choose one answer. - ✔✔
- ✔✔a. Alice because she will not have a break between her non-Medicare and Medicare coverage through Spartan
Health Plan.
- ✔✔b. Alice and Charlotte because each of them currently have health coverage and is in their initial coverage election
period (ICEP).
- ✔✔c. Alice and Bob because each of them has had coverage through Spartan Health Plan.
- ✔✔d. Alice, Bob, and Charlotte because electronic health record interoperability will allow Richard to access any
needed information for their applications.
Question12 - ✔✔
Marks: 1 - ✔✔
Under what conditions can a Medicare prescription drug plan reduce its coverage for a given drug during the first 60
days of the year? - ✔✔
Choose one answer. - ✔✔
- ✔✔a. When a formulary change is in response to a drug's removal from the market.
, - ✔✔b. When the Part D plan can demonstrate to CMS that no enrollee has accessed the medication in the past six
months, generally the plan can remove the drug from its formulary within the first 60 days of the year.
- ✔✔c. Under no conditions can a Medicare Part D prescription drug plan reduce its coverage for a given drug at any
point during the year.
- ✔✔d. If the Medicare prescription drug plan can show that reducing coverage early in the year will result in savings for
the Part D plan and the Medicare program, generally the plan may make such a change.
Question13 - ✔✔
Marks: 1 - ✔✔
This year you have decided to focus your efforts on marketing to employer group plans. One employer provides you with
a list of their retirees and asks you to contact them to explain the characteristics of the plan they have selected. What
should you do? - ✔✔
Choose one answer. - ✔✔
- ✔✔a. You may only contact the retirees after the employer has notified them that they will be receiving a call.
- ✔✔b. You may call them but must record every call.
- ✔✔c. You may go ahead and call them.
- ✔✔d. You may not make any unsolicited contact with Medicare beneficiaries. The employer will have to tell its
retirees to call you.
Question14 - ✔✔
Marks: 1 - ✔✔
