AHIP AHIP
– 5 -ACTUAL 5 exam: QUESTION AND ANSWERS
UPDATED 2025
Study online at https://quizlet.com/_9lcxm3
1. Mr. Garcia was told he qualifies for a Special Enrollment If the SEP is for MA cover-
Period (SEP), but he lost the paper that explains what age, he will generally have
he could do during the SEP. What can you tell him? one opportunity to change
his MA coverage.
2. Mrs. Walters is entitled to Part A and has medical Yes. Mrs. Walters must be
coverage without drug coverage through an employer entitled to Part A or en-
retiree plan. She is not enrolled in Part B. Since the rolled in Part B to be el-
employer plan does not cover prescription drugs, she igible for coverage under
wants to enroll in a Medicare prescription drug plan. the Medicare prescription
Will she be able to? drug program.
3. Mrs. Goodman enrolled in an MA-PD plan during the During the MA Open En-
Annual Election Period. In mid-January of the following rollment Period, from Jan-
year, she wants to switch back to Original Medicare and uary 1 - March 31, she
enroll in a stand-alone prescription drug plan. What may disenroll from the
should you tell her? MA-PD plan into Original
Medicare and also may
add a stand-alone pre-
scription drug plan.
4. Mrs. Berkowitz wants to enroll in a Medicare Advan- If the Medicare Ad-
tage plan that does not include drug coverage and vantage plan is a
also enroll in a stand-alone Medicare prescription drug Private Fee-for-Service
plan. Under what circumstances can she do this? (PFFS) plan that does not
offer drug coverage or a
Medical Savings Account
plan, Mrs. Berkowitz can
do this.
5. Ms. Lee is enrolled in an MA-PD plan but will be moving She is eligible for a Special
out of the plan's service area next month. She is wor- Election Period that be-
, AHIP - 5
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ried that she will not be able to enroll in another plan gins either the month be-
available in her new residence until the Annual Election fore her permanent move,
Period. What should you tell her? if the plan is notified in
advance, or the month
she provides notice of the
move, and this period typ-
ically lasts an additional
two months.
6. You are doing a sales presentation for Mrs. Pearson. "If you're not in very good
You know that Medicare marketing guidelines prohibit health, you will probably
certain types of statements. Apply those guidelines to do better with a different
the following statements and identify which would be product."
prohibited.
7. Mr. Anderson is a very organized individual and has Tell Mr. Anderson that you
filled out and brought to you an enrollment form on cannot accept any enroll-
October 10 for a new plan available January 1 next year. ment forms until the annu-
He is currently enrolled in Original Medicare. What al election period begins.
should you do?
8. You are visiting with Mr. Tully and his daughter at Mr. Tully's daughter can
her request. He has advanced Alzheimer's and is inca- do so only, if she is au-
pable of understanding the implications of choosing thorized under state law
a Medicare Advantage or prescription drug plan. Can as a court-appointed legal
his daughter fill out the enrollment form and sign it for guardian, has a durable
him? power of attorney for
health care decisions, or
is authorized under state
surrogate consent laws to
make health decisions.
9.
, AHIP - 5
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Ms. Gonzales decided to remain in Original Medicare There is a MA Open En-
(Parts A and B) and Part D during the Annual Enroll- rollment Period (OEP) that
ment Period (AEP). At the beginning of January, her takes place between Jan-
neighbor told her about the Medicare Advantage (MA) uary 1 and March 31, but
plan he selected. He also told her there was an open Ms. Gonzales cannot use
enrollment period that she might be able to use to it because eligibility to use
enroll in a MA plan. Ms. Gonzales comes to you for the OEP is available only to
advice shortly after speaking to her neighbor. What MA enrollees.
should you tell her?
10. Ms. Claggett is sixty-six (66) years old. She has been Ms. Claggett has had two
covered under Original Medicare for the last six years IEPs and missed them
due to her disability and has never been enrolled in a both. The first occurred
Medicare Advantage or a Part D plan before. She wants three months before and
to enroll in a Part D plan. She knows that there is such three months after the
a thing as the "Part D Initial Enrollment Period" (IEP) month when she was first
and has concluded that, since she has never enrolled entitled to Part A OR
in such a plan before, she should be eligible to enroll enrolled in Part B. Be-
under this period. What should you tell her about how cause she was eligible for
the Part D Initial Enrollment Period applies to her situ- Medicare before age 65,
ation? Ms. Claggett had a second
IEP based on turning age
65, which has also expired.
11. Mary Samuels recently suffered a stroke while visiting Mary may make an un-
her daughter and grandchildren. As a result, Mary has limited number of MA en-
been admitted to a rehabilitation hospital where she rollment requests and may
is expected to reside for several months. The reha- disenroll from her current
bilitation hospital is located outside the geographic MA plan.
area served by her current Medicare Advantage (MA)
plan. What options are available to Mary regarding her
health plan coverage?
– 5 -ACTUAL 5 exam: QUESTION AND ANSWERS
UPDATED 2025
Study online at https://quizlet.com/_9lcxm3
1. Mr. Garcia was told he qualifies for a Special Enrollment If the SEP is for MA cover-
Period (SEP), but he lost the paper that explains what age, he will generally have
he could do during the SEP. What can you tell him? one opportunity to change
his MA coverage.
2. Mrs. Walters is entitled to Part A and has medical Yes. Mrs. Walters must be
coverage without drug coverage through an employer entitled to Part A or en-
retiree plan. She is not enrolled in Part B. Since the rolled in Part B to be el-
employer plan does not cover prescription drugs, she igible for coverage under
wants to enroll in a Medicare prescription drug plan. the Medicare prescription
Will she be able to? drug program.
3. Mrs. Goodman enrolled in an MA-PD plan during the During the MA Open En-
Annual Election Period. In mid-January of the following rollment Period, from Jan-
year, she wants to switch back to Original Medicare and uary 1 - March 31, she
enroll in a stand-alone prescription drug plan. What may disenroll from the
should you tell her? MA-PD plan into Original
Medicare and also may
add a stand-alone pre-
scription drug plan.
4. Mrs. Berkowitz wants to enroll in a Medicare Advan- If the Medicare Ad-
tage plan that does not include drug coverage and vantage plan is a
also enroll in a stand-alone Medicare prescription drug Private Fee-for-Service
plan. Under what circumstances can she do this? (PFFS) plan that does not
offer drug coverage or a
Medical Savings Account
plan, Mrs. Berkowitz can
do this.
5. Ms. Lee is enrolled in an MA-PD plan but will be moving She is eligible for a Special
out of the plan's service area next month. She is wor- Election Period that be-
, AHIP - 5
Study online at https://quizlet.com/_9lcxm3
ried that she will not be able to enroll in another plan gins either the month be-
available in her new residence until the Annual Election fore her permanent move,
Period. What should you tell her? if the plan is notified in
advance, or the month
she provides notice of the
move, and this period typ-
ically lasts an additional
two months.
6. You are doing a sales presentation for Mrs. Pearson. "If you're not in very good
You know that Medicare marketing guidelines prohibit health, you will probably
certain types of statements. Apply those guidelines to do better with a different
the following statements and identify which would be product."
prohibited.
7. Mr. Anderson is a very organized individual and has Tell Mr. Anderson that you
filled out and brought to you an enrollment form on cannot accept any enroll-
October 10 for a new plan available January 1 next year. ment forms until the annu-
He is currently enrolled in Original Medicare. What al election period begins.
should you do?
8. You are visiting with Mr. Tully and his daughter at Mr. Tully's daughter can
her request. He has advanced Alzheimer's and is inca- do so only, if she is au-
pable of understanding the implications of choosing thorized under state law
a Medicare Advantage or prescription drug plan. Can as a court-appointed legal
his daughter fill out the enrollment form and sign it for guardian, has a durable
him? power of attorney for
health care decisions, or
is authorized under state
surrogate consent laws to
make health decisions.
9.
, AHIP - 5
Study online at https://quizlet.com/_9lcxm3
Ms. Gonzales decided to remain in Original Medicare There is a MA Open En-
(Parts A and B) and Part D during the Annual Enroll- rollment Period (OEP) that
ment Period (AEP). At the beginning of January, her takes place between Jan-
neighbor told her about the Medicare Advantage (MA) uary 1 and March 31, but
plan he selected. He also told her there was an open Ms. Gonzales cannot use
enrollment period that she might be able to use to it because eligibility to use
enroll in a MA plan. Ms. Gonzales comes to you for the OEP is available only to
advice shortly after speaking to her neighbor. What MA enrollees.
should you tell her?
10. Ms. Claggett is sixty-six (66) years old. She has been Ms. Claggett has had two
covered under Original Medicare for the last six years IEPs and missed them
due to her disability and has never been enrolled in a both. The first occurred
Medicare Advantage or a Part D plan before. She wants three months before and
to enroll in a Part D plan. She knows that there is such three months after the
a thing as the "Part D Initial Enrollment Period" (IEP) month when she was first
and has concluded that, since she has never enrolled entitled to Part A OR
in such a plan before, she should be eligible to enroll enrolled in Part B. Be-
under this period. What should you tell her about how cause she was eligible for
the Part D Initial Enrollment Period applies to her situ- Medicare before age 65,
ation? Ms. Claggett had a second
IEP based on turning age
65, which has also expired.
11. Mary Samuels recently suffered a stroke while visiting Mary may make an un-
her daughter and grandchildren. As a result, Mary has limited number of MA en-
been admitted to a rehabilitation hospital where she rollment requests and may
is expected to reside for several months. The reha- disenroll from her current
bilitation hospital is located outside the geographic MA plan.
area served by her current Medicare Advantage (MA)
plan. What options are available to Mary regarding her
health plan coverage?
