AHIP ACTUAL EXAM 255 QUESTIONS AND DETAILED
CORRECT ANSWERS 2025-2026 LATEST VERSION
ALREADY GRADED A+
Mrs. Burton is a retiree with substantial income. She is enrolled in an MA-PD plan and was disappointed
with the service she received from her primary care physician because she was told she would have to
wait five weeks to get an appointment when she was feeling ill. She called you to ask what she could do
so she would not have to put up with such poor access to care. What could you tell her?
She could file a grievance with her plan to complain about the lack of timeliness in getting an
appointment.
Agent Jennings makes a presentation on Medicare advertised as an educational event. Agent Jennings
distributes materials that are solely educational. 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.
We have an expert-written solution to this problem!
Mr. Prentice has many clients who are Medicare beneficiaries. He should review the Centers for
Medicare & Medicaid Services (CMS) Communication and Marketing Guidelines to ensure he is
compliant with which type of products.
Medicare Advantage (MA) and Prescription Drug (PDP) plans.
We have an expert-written solution to this problem!
You are mailing invitations to new Medicare beneficiaries for a marketing event. You want an idea of
how many people to expect, so you would like to request RSVPs. What should you keep in mind?
You may request RSVPs, but you are not permitted to require contact information.
,We have an expert-written solution to this problem!
You market many different types of insurance and ordinarily you spend time each evening calling
potential clients. To comply with requirements for marketing Medicare Advantage and Part D plans,
what must you do about contacting potential clients to market those plansl?
You will have to avoid calling any potential client unless he or she initiates contact with you and
specifically asks that you give him or her a call.
During a sales presentation to Ms. Daley for a Medicare Advantage plan that has a 5-star rating in
customer service and care coordination, and received an overall plan performance rating of a 4-star,
which of the following would be the best statement to say to her?
The Medicare Advantage plan received a 5-star rating in customer service and care coordination with an
overall performance rating of 4 stars.
If you are to comply with Medicare's guidance regarding educational events, which of the following
would be acceptable activities?
You may distribute business cards to individuals who request information on how to contact you for
further details on the plan(s) you represent.
Your colleague works at a third-party marketing organization (TMO) and she said she did not need to
take the Medicare training for brokers and agents or pass a test to market Medicare plans since her
contract is with the TMO, not the plans that have the products she sells. What could you say to her?
You could tell her she is wrong, and that only agents selling employer/union group plans are permitted
an exemption from testing, but some employer/union group plans may require testing to promote agent
compliance with CMS marketing requirements.
You have set up an appointment for an in-home sales presentation with Mrs. Fernandez, who expressed
interest in the Medicare plans you represent. In preparation for the sales presentation, what must you
do?
Before conducting the presentation, obtain and document having obtained her permission to visit, along
with her interest in the specific products you will present.gues argues that it is better to focus your tim
,We have an expert-written solution to this problem!
By contacting plans available in your area, you have learned that the plan you represent has a
significantly lower monthly premium than the others. Furthermore, you see that the plan you represent
has a unique benefits package. What should you do to make sure your clients know about these pieces
of information?
You may make comparisons between plans if you can support them with studies or statistical data and
such comparisons are factually based and referenced.
You will be holding a sales event soon, at which you would like to offer door prizes to attendees. Under
guidelines from the Medicare agency, what types of gifts or prizes would not be allowed in this situation
Gift cards or gift certificates of $15 or less that can be readily converted to cash.
While making an appointment to discuss Medicare Advantage (MA) and Part D plans with a potential
enrollee, you are asked to describe other types of insurance products that your client might wish to
purchase. What additional types of insurance can you present during the MA and Part D marketing
appointments?
You can present only health care related lines of business but must obtain the beneficiary's permission
to do so before the presentation occurs and document that you have obtained that permission.
You would like to market a MA plan at a neighborhood pharmacy. What should you keep in mind to
comply with the marketing requirements for MA plans?
You must set up your table, make marketing presentations, and accept enrollment applications only in
common areas outside of where the patient waits for services from the pharmacist.
We have an expert-written solution to this problem!
, A Medicare beneficiary has walked into your office and requested that you sit down with her and discuss
her options under the Medicare Advantage program. Before engaging in such a discussion, what should
you do?
You must have her sign a scope of appointment form, indicating which products she wishes to discuss.
You may then proceed with the discussion.
Mr. Ford enrolled in an MA-only plan in mid-November during the Annual Election Period (AEP). On
December 1, he calls you up and says that he has changed his mind and would like to enroll in a MA-PD
plan. What enrollment rules would apply in this case?
He can make as many enrollment changes as he likes during the Annual Election Period and the last
choice made before the end of the period will be the effective one as of January 1.
Mr. Rodriguez is currently enrolled in a MA plan, but his plan doesn't sufficiently cover his prescription
drug needs. He is interested in changing plans during the upcoming MA Open Enrollment Period. What
are his options during the MA OEP?
He can switch to a MA-PD plan.
Mr. Garcia was told he qualifies for a special election period (SEP), but he lost the paper that explains
what he could do during the SEP. What can you tell him?
If the SEP is for MA coverage, he will generally have one opportunity to change his MA coverage.
Mr. Yoo's employer has recently dropped comprehensive creditable prescription drug coverage that was
offered to company retirees. The company told Mr. Yoo that, because he was affected by this change,
he would qualify for a special election period. Mr. Yoo contacted you to find out more about what this
means. What can you tell him?
It means that he qualifies for a one-time opportunity to enroll in an MA-PD or Part D prescription drug
plan.
CORRECT ANSWERS 2025-2026 LATEST VERSION
ALREADY GRADED A+
Mrs. Burton is a retiree with substantial income. She is enrolled in an MA-PD plan and was disappointed
with the service she received from her primary care physician because she was told she would have to
wait five weeks to get an appointment when she was feeling ill. She called you to ask what she could do
so she would not have to put up with such poor access to care. What could you tell her?
She could file a grievance with her plan to complain about the lack of timeliness in getting an
appointment.
Agent Jennings makes a presentation on Medicare advertised as an educational event. Agent Jennings
distributes materials that are solely educational. 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.
We have an expert-written solution to this problem!
Mr. Prentice has many clients who are Medicare beneficiaries. He should review the Centers for
Medicare & Medicaid Services (CMS) Communication and Marketing Guidelines to ensure he is
compliant with which type of products.
Medicare Advantage (MA) and Prescription Drug (PDP) plans.
We have an expert-written solution to this problem!
You are mailing invitations to new Medicare beneficiaries for a marketing event. You want an idea of
how many people to expect, so you would like to request RSVPs. What should you keep in mind?
You may request RSVPs, but you are not permitted to require contact information.
,We have an expert-written solution to this problem!
You market many different types of insurance and ordinarily you spend time each evening calling
potential clients. To comply with requirements for marketing Medicare Advantage and Part D plans,
what must you do about contacting potential clients to market those plansl?
You will have to avoid calling any potential client unless he or she initiates contact with you and
specifically asks that you give him or her a call.
During a sales presentation to Ms. Daley for a Medicare Advantage plan that has a 5-star rating in
customer service and care coordination, and received an overall plan performance rating of a 4-star,
which of the following would be the best statement to say to her?
The Medicare Advantage plan received a 5-star rating in customer service and care coordination with an
overall performance rating of 4 stars.
If you are to comply with Medicare's guidance regarding educational events, which of the following
would be acceptable activities?
You may distribute business cards to individuals who request information on how to contact you for
further details on the plan(s) you represent.
Your colleague works at a third-party marketing organization (TMO) and she said she did not need to
take the Medicare training for brokers and agents or pass a test to market Medicare plans since her
contract is with the TMO, not the plans that have the products she sells. What could you say to her?
You could tell her she is wrong, and that only agents selling employer/union group plans are permitted
an exemption from testing, but some employer/union group plans may require testing to promote agent
compliance with CMS marketing requirements.
You have set up an appointment for an in-home sales presentation with Mrs. Fernandez, who expressed
interest in the Medicare plans you represent. In preparation for the sales presentation, what must you
do?
Before conducting the presentation, obtain and document having obtained her permission to visit, along
with her interest in the specific products you will present.gues argues that it is better to focus your tim
,We have an expert-written solution to this problem!
By contacting plans available in your area, you have learned that the plan you represent has a
significantly lower monthly premium than the others. Furthermore, you see that the plan you represent
has a unique benefits package. What should you do to make sure your clients know about these pieces
of information?
You may make comparisons between plans if you can support them with studies or statistical data and
such comparisons are factually based and referenced.
You will be holding a sales event soon, at which you would like to offer door prizes to attendees. Under
guidelines from the Medicare agency, what types of gifts or prizes would not be allowed in this situation
Gift cards or gift certificates of $15 or less that can be readily converted to cash.
While making an appointment to discuss Medicare Advantage (MA) and Part D plans with a potential
enrollee, you are asked to describe other types of insurance products that your client might wish to
purchase. What additional types of insurance can you present during the MA and Part D marketing
appointments?
You can present only health care related lines of business but must obtain the beneficiary's permission
to do so before the presentation occurs and document that you have obtained that permission.
You would like to market a MA plan at a neighborhood pharmacy. What should you keep in mind to
comply with the marketing requirements for MA plans?
You must set up your table, make marketing presentations, and accept enrollment applications only in
common areas outside of where the patient waits for services from the pharmacist.
We have an expert-written solution to this problem!
, A Medicare beneficiary has walked into your office and requested that you sit down with her and discuss
her options under the Medicare Advantage program. Before engaging in such a discussion, what should
you do?
You must have her sign a scope of appointment form, indicating which products she wishes to discuss.
You may then proceed with the discussion.
Mr. Ford enrolled in an MA-only plan in mid-November during the Annual Election Period (AEP). On
December 1, he calls you up and says that he has changed his mind and would like to enroll in a MA-PD
plan. What enrollment rules would apply in this case?
He can make as many enrollment changes as he likes during the Annual Election Period and the last
choice made before the end of the period will be the effective one as of January 1.
Mr. Rodriguez is currently enrolled in a MA plan, but his plan doesn't sufficiently cover his prescription
drug needs. He is interested in changing plans during the upcoming MA Open Enrollment Period. What
are his options during the MA OEP?
He can switch to a MA-PD plan.
Mr. Garcia was told he qualifies for a special election period (SEP), but he lost the paper that explains
what he could do during the SEP. What can you tell him?
If the SEP is for MA coverage, he will generally have one opportunity to change his MA coverage.
Mr. Yoo's employer has recently dropped comprehensive creditable prescription drug coverage that was
offered to company retirees. The company told Mr. Yoo that, because he was affected by this change,
he would qualify for a special election period. Mr. Yoo contacted you to find out more about what this
means. What can you tell him?
It means that he qualifies for a one-time opportunity to enroll in an MA-PD or Part D prescription drug
plan.
