AHIP FINAL EXAM
AHIP FINAL EXAM NEWEST 2025/2026 COMPLETE ALL 250
QUESTIONS AND CORRECT DETAILED ANSWERS |ALREADY
GRADED A+||ALREADY GRADED A+
Mr. Carlini has heard that Medicare prescription drug plans are only offered
through private companies under a program known as Medicare Advantage (MA),
not by the government. He likes Original Medicare and does not want to sign up
for an MA product, but he also wants prescription drug coverage. What should
you tell him?
Mr. Carlini can stay with Original Medicare and also enroll in a Medicare
prescription drug plan through a private company that has contracted with the
government to provide only such drug coverage to eligible Medicare beneficiaries.
Mrs. Walters is entitled to Part A and has medical coverage without drug coverage
through an employer retiree plan. She is not enrolled in Part B. Since the employer
plan does not cover prescription drugs, she wants to enroll in a Medicare
prescription drug plan. Will she be able to?
Yes. Mrs. Walters must be entitled to Part A and/or enrolled in Part B to be eligible
for coverage under the Medicare prescription drug program.
Mr. Hutchinson has drug coverage through his former employer's retiree plan. He
is concerned about the Part D premium penalty if he does not enroll in a Medicare
prescription drug plan, but does not want to purchase extra coverage that he will
not need. What should you tell him?
If the drug coverage he has is not expected to pay, on average, at least as much as
Medicare's standard Part D coverage expects to pay, then he will need to enroll in
Medicare Part D during his initial eligibility period to avoid the late enrollment
penalty.
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, AHIP FINAL EXAM
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.
Mrs. McIntire is enrolled in her state's Medicaid plan and has just become eligible
for Medicare as well. What can she expect will happen to her drug coverage?
Unless she chooses a Medicare Part D prescription drug plan on her own, she will
be automatically enrolled in one available in her area.
Mrs. Cantwell is enrolled in a prescription drug plan. She has heard about
something called True-Out-Pocket costs or "TrOOP" and asks you if any of the
following count toward reaching the catastrophic coverage phase. What do you
say?
I. Her annual PDP deductible
II. A drug manufacturer's discount for brand name drugs after her initial coverage
period
III. The off formulary drug her doctor prescribed but she pays for because the plan
denied her exception request
IV. Her over-the-counter (OTC) allergy medication.
I and II only
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, AHIP FINAL EXAM
Mrs. Fiore is a retired federal worker with coverage under a Federal Employee
Health Benefits (FEHB) plan that includes creditable drug coverage. She is ready to
turn 65 and become Medicare eligible for the first time. What issues might she
consider about whether to enroll in a Medicare prescription drug plan?
She could compare the coverage to see if the Medicare Part D plan offers better
benefits and coverage than the FEHB plan for the specific medications she needs
and whether any additional benefits are worth the Part D premium costs on top of
her FEHB contribution.
Mrs. Berkowitz wants to enroll in a Medicare Advantage plan that does not
include drug coverage and also enroll in a stand-alone Medicare prescription drug
plan. Under what circumstances can she do this?
If the Medicare Advantage plan is a Private Fee-for-Service (PFFS) plan that does
not offer drug coverage or a Medical Savings Account plan, Mrs. Berkowitz can do
this.
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.
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 to obtain the medications
3|Page
, AHIP FINAL EXAM
they need. Alternatively, he could check to see whether his state has a pharmacy
assistance program to help him with his expenses.
Mrs. Fields wants to know whether applying for the Part D low-income subsidy
will be worth the time to fill out the paperwork. What could you tell her?
The Part D low-income subsidy could substantially lower her overall costs. She can
apply by contacting her state Medicaid office or calling the Social Security
Administration.
Which of the following statements about Medicare Part D are correct?
I. Part D plans must enroll any eligible beneficiary who applies regardless of health
status except in limited circumstances.
II. Private fee-for-service (PFFS) plans are not required to use a pharmacy network
but may choose to have one.
III. Beneficiaries enrolled in a MA-Medical Savings Account (MSA) plan may only
obtain Part D benefits through a standalone PDP.
IV. Beneficiaries enrolled in a MA-PPO may obtain Part D benefits through a
standalone PDP or through their plan.
I, II, and III only
Mrs. Lopez is enrolled in a cost plan for her Medicare benefits. She has recently
lost creditable coverage previously available through her husband's employer. She
is interested in enrolling in a Medicare Part D prescription drug plan (PDP). What
should you tell her?
If a Part D benefit is offered through her plan she may choose to enroll in that plan
or a standalone PDP.
4|Page
AHIP FINAL EXAM NEWEST 2025/2026 COMPLETE ALL 250
QUESTIONS AND CORRECT DETAILED ANSWERS |ALREADY
GRADED A+||ALREADY GRADED A+
Mr. Carlini has heard that Medicare prescription drug plans are only offered
through private companies under a program known as Medicare Advantage (MA),
not by the government. He likes Original Medicare and does not want to sign up
for an MA product, but he also wants prescription drug coverage. What should
you tell him?
Mr. Carlini can stay with Original Medicare and also enroll in a Medicare
prescription drug plan through a private company that has contracted with the
government to provide only such drug coverage to eligible Medicare beneficiaries.
Mrs. Walters is entitled to Part A and has medical coverage without drug coverage
through an employer retiree plan. She is not enrolled in Part B. Since the employer
plan does not cover prescription drugs, she wants to enroll in a Medicare
prescription drug plan. Will she be able to?
Yes. Mrs. Walters must be entitled to Part A and/or enrolled in Part B to be eligible
for coverage under the Medicare prescription drug program.
Mr. Hutchinson has drug coverage through his former employer's retiree plan. He
is concerned about the Part D premium penalty if he does not enroll in a Medicare
prescription drug plan, but does not want to purchase extra coverage that he will
not need. What should you tell him?
If the drug coverage he has is not expected to pay, on average, at least as much as
Medicare's standard Part D coverage expects to pay, then he will need to enroll in
Medicare Part D during his initial eligibility period to avoid the late enrollment
penalty.
1|Page
, AHIP FINAL EXAM
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.
Mrs. McIntire is enrolled in her state's Medicaid plan and has just become eligible
for Medicare as well. What can she expect will happen to her drug coverage?
Unless she chooses a Medicare Part D prescription drug plan on her own, she will
be automatically enrolled in one available in her area.
Mrs. Cantwell is enrolled in a prescription drug plan. She has heard about
something called True-Out-Pocket costs or "TrOOP" and asks you if any of the
following count toward reaching the catastrophic coverage phase. What do you
say?
I. Her annual PDP deductible
II. A drug manufacturer's discount for brand name drugs after her initial coverage
period
III. The off formulary drug her doctor prescribed but she pays for because the plan
denied her exception request
IV. Her over-the-counter (OTC) allergy medication.
I and II only
2|Page
, AHIP FINAL EXAM
Mrs. Fiore is a retired federal worker with coverage under a Federal Employee
Health Benefits (FEHB) plan that includes creditable drug coverage. She is ready to
turn 65 and become Medicare eligible for the first time. What issues might she
consider about whether to enroll in a Medicare prescription drug plan?
She could compare the coverage to see if the Medicare Part D plan offers better
benefits and coverage than the FEHB plan for the specific medications she needs
and whether any additional benefits are worth the Part D premium costs on top of
her FEHB contribution.
Mrs. Berkowitz wants to enroll in a Medicare Advantage plan that does not
include drug coverage and also enroll in a stand-alone Medicare prescription drug
plan. Under what circumstances can she do this?
If the Medicare Advantage plan is a Private Fee-for-Service (PFFS) plan that does
not offer drug coverage or a Medical Savings Account plan, Mrs. Berkowitz can do
this.
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.
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 to obtain the medications
3|Page
, AHIP FINAL EXAM
they need. Alternatively, he could check to see whether his state has a pharmacy
assistance program to help him with his expenses.
Mrs. Fields wants to know whether applying for the Part D low-income subsidy
will be worth the time to fill out the paperwork. What could you tell her?
The Part D low-income subsidy could substantially lower her overall costs. She can
apply by contacting her state Medicaid office or calling the Social Security
Administration.
Which of the following statements about Medicare Part D are correct?
I. Part D plans must enroll any eligible beneficiary who applies regardless of health
status except in limited circumstances.
II. Private fee-for-service (PFFS) plans are not required to use a pharmacy network
but may choose to have one.
III. Beneficiaries enrolled in a MA-Medical Savings Account (MSA) plan may only
obtain Part D benefits through a standalone PDP.
IV. Beneficiaries enrolled in a MA-PPO may obtain Part D benefits through a
standalone PDP or through their plan.
I, II, and III only
Mrs. Lopez is enrolled in a cost plan for her Medicare benefits. She has recently
lost creditable coverage previously available through her husband's employer. She
is interested in enrolling in a Medicare Part D prescription drug plan (PDP). What
should you tell her?
If a Part D benefit is offered through her plan she may choose to enroll in that plan
or a standalone PDP.
4|Page
