AHIP 2025 Final Exam Updated Questions and Verified Answers,
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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? - 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? - 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? - 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? - 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? - 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? -
Agent Armstrong needs to be licensed and appointed in every state in which
beneficiaries to whom he markets ABC MA plans are located.
,Mrs. West wears glasses and dentures and has enjoyed considerable pain relief from
arthritis through acupuncture. She is concerned about whether or not Medicare will
cover these items and services. What should you tell her? - Medicare does not cover
acupuncture, or, in general, glasses or dentures.
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? - 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? - 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. Schmidt would like to plan for retirement and has asked you what is covered under
Original Fee-for-Service (FFS) Medicare? What could you tell him? - Part A, which
covers hospital, skilled nursing facility, hospice and home health services and Part B,
which covers professional services such as those provided by a doctor are covered
under Original Medicare.
You are seeking to represent an individual Medicare Advantage plan and an individual
Part D plan in your state. You have completed the required training for each plan, but
you did not achieve a passing score on the tests that came after the training. What can
you do in this situation? - You will not be able to represent any Medicare Advantage or
Part D plan until you complete the training and achieve an adequate score, although
you will not have to take a test if you exclusively market employer/union group plans
and the companies do not require testing.
Mr. Chen is enrolled in his employer's group health plan and will be retiring soon. He
would like to know his options since he has decided to drop his retiree coverage and is
eligible for Medicare. What should you tell him? - Mr. Chen can disenroll from his
employer-sponsored coverage to elect a Medicare Advantage or Part D plan within 2
months of his disenrollment, but he should revaluate if he really wants to drop his
employer coverage.
Mr. Davis is 52 years old and has recently been diagnosed with end-stage renal disease
(ESRD) and will soon begin dialysis. He is wondering if he can obtain coverage under
, Medicare. What should you tell him? - He may sign-up for Medicare at any time
however coverage usually begins on the fourth month after dialysis treatments start.
Mr. Johannsen is entitled to Medicare Part A and Part B. He gains the Part D low-
income subsidy. How does that affect his ability to enroll or disenroll in a Part D plan? -
He qualifies for a special election period and can enroll in or disenroll from a Part D plan
once during that period.
Mr. Lopez, who is fairly well-off financially, would like to enroll in a Medicare prescription
drug plan you represent and simply give you a check to cover his premiums for the
entire year. What should you tell him? - Enrollees should pay using automatic
withdrawal from a bank account or credit or debit card, direct monthly billing from the
plan, or deductions from their Social Security check.
You have approached a hospital administrator about marketing in her facility. The
administrator is uncomfortable with the suggestion. How could you address her
concerns? - Tell her that Medicare guidelines allow you to conduct marketing activities
in common areas of a provider's facility.
You have come to Mrs. Midler's home for a sales presentation. At the beginning of the
presentation, Mrs. Midler tells you that she has a copy of her medical record available
because she thinks this will help you understand her needs. She suggests that you will
know which questions to ask her about her health status in order to best assist her in
selecting a plan. What should you do? - You can only ask Mrs. Midler questions about
conditions that affect eligibility, specifically, whether she has end stage renal disease or
one of the conditions that would qualify her for a special needs plan.
Mrs. Reeves is newly eligible to enroll in a Medicare Advantage plan and her MA Initial
Coverage Election Period (ICEP) has just begun. Which of the following can she not do
during the ICEP? - She can enroll in a Medigap plan to supplement the benefits of the
MA plan that she's also enrolling in.
Mrs. Chi is age 75 and enjoys a comfortable but not extremely high-income level. She
wishes to enroll in a MA MSA plan that she heard about from her neighbor. She also
wants to have prescription drug coverage since her doctor recently prescribed several
expensive medications. Currently, she is enrolled in Original Medicare and a standalone
Part D plan. How would you advise Mrs. Chi? - Mrs. Chi may enroll in a MS MSA plan
and remain in her current standalone Part D prescription drug plan.
Alice is enrolled in a MA-PD plan. She makes a permanent move across the country
and wonders what her options are for continuing MA-PD coverage. What would you say
to her in regard to a special enrollment period (SEP)? - She is likely to qualify for a SEP.
She can choose an effective date of up to three months after the month in which the
enrollment form is received by the new plan, but the effective date may not be earlier
than the date of her permanent move.
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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? - 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? - 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? - 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? - 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? - 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? -
Agent Armstrong needs to be licensed and appointed in every state in which
beneficiaries to whom he markets ABC MA plans are located.
,Mrs. West wears glasses and dentures and has enjoyed considerable pain relief from
arthritis through acupuncture. She is concerned about whether or not Medicare will
cover these items and services. What should you tell her? - Medicare does not cover
acupuncture, or, in general, glasses or dentures.
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? - 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? - 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. Schmidt would like to plan for retirement and has asked you what is covered under
Original Fee-for-Service (FFS) Medicare? What could you tell him? - Part A, which
covers hospital, skilled nursing facility, hospice and home health services and Part B,
which covers professional services such as those provided by a doctor are covered
under Original Medicare.
You are seeking to represent an individual Medicare Advantage plan and an individual
Part D plan in your state. You have completed the required training for each plan, but
you did not achieve a passing score on the tests that came after the training. What can
you do in this situation? - You will not be able to represent any Medicare Advantage or
Part D plan until you complete the training and achieve an adequate score, although
you will not have to take a test if you exclusively market employer/union group plans
and the companies do not require testing.
Mr. Chen is enrolled in his employer's group health plan and will be retiring soon. He
would like to know his options since he has decided to drop his retiree coverage and is
eligible for Medicare. What should you tell him? - Mr. Chen can disenroll from his
employer-sponsored coverage to elect a Medicare Advantage or Part D plan within 2
months of his disenrollment, but he should revaluate if he really wants to drop his
employer coverage.
Mr. Davis is 52 years old and has recently been diagnosed with end-stage renal disease
(ESRD) and will soon begin dialysis. He is wondering if he can obtain coverage under
, Medicare. What should you tell him? - He may sign-up for Medicare at any time
however coverage usually begins on the fourth month after dialysis treatments start.
Mr. Johannsen is entitled to Medicare Part A and Part B. He gains the Part D low-
income subsidy. How does that affect his ability to enroll or disenroll in a Part D plan? -
He qualifies for a special election period and can enroll in or disenroll from a Part D plan
once during that period.
Mr. Lopez, who is fairly well-off financially, would like to enroll in a Medicare prescription
drug plan you represent and simply give you a check to cover his premiums for the
entire year. What should you tell him? - Enrollees should pay using automatic
withdrawal from a bank account or credit or debit card, direct monthly billing from the
plan, or deductions from their Social Security check.
You have approached a hospital administrator about marketing in her facility. The
administrator is uncomfortable with the suggestion. How could you address her
concerns? - Tell her that Medicare guidelines allow you to conduct marketing activities
in common areas of a provider's facility.
You have come to Mrs. Midler's home for a sales presentation. At the beginning of the
presentation, Mrs. Midler tells you that she has a copy of her medical record available
because she thinks this will help you understand her needs. She suggests that you will
know which questions to ask her about her health status in order to best assist her in
selecting a plan. What should you do? - You can only ask Mrs. Midler questions about
conditions that affect eligibility, specifically, whether she has end stage renal disease or
one of the conditions that would qualify her for a special needs plan.
Mrs. Reeves is newly eligible to enroll in a Medicare Advantage plan and her MA Initial
Coverage Election Period (ICEP) has just begun. Which of the following can she not do
during the ICEP? - She can enroll in a Medigap plan to supplement the benefits of the
MA plan that she's also enrolling in.
Mrs. Chi is age 75 and enjoys a comfortable but not extremely high-income level. She
wishes to enroll in a MA MSA plan that she heard about from her neighbor. She also
wants to have prescription drug coverage since her doctor recently prescribed several
expensive medications. Currently, she is enrolled in Original Medicare and a standalone
Part D plan. How would you advise Mrs. Chi? - Mrs. Chi may enroll in a MS MSA plan
and remain in her current standalone Part D prescription drug plan.
Alice is enrolled in a MA-PD plan. She makes a permanent move across the country
and wonders what her options are for continuing MA-PD coverage. What would you say
to her in regard to a special enrollment period (SEP)? - She is likely to qualify for a SEP.
She can choose an effective date of up to three months after the month in which the
enrollment form is received by the new plan, but the effective date may not be earlier
than the date of her permanent move.
