AHIP Modules 1-5 Actual Test With 100% Verified
Answers & Explanations 2025
Mr. and Mrs. Cole both take a specialized multivitamin prescription each day. Mr. Cole
takes a prescription to help regrow his hair. They are anxious to have their Medicare
prescription drug plan cover these drug needs. What should you tell them? correct
answers
Medicare prescription drug plans are not permitted to cover the prescription
medications the Coles are interested in under Part D coverage, however, plans may
cover them as supplemental benefits and the Coles could look into that possibility.
Ms. Ramos is enrolled in a Medicare Advantage plan that includes prescription drug
plan (PDP) coverage. She is traveling and wishes to fill two of the prescriptions that
she has lost. How would you advise her? correct answers
She may fill prescriptions for covered drugs at non-network pharmacies, but likely at a
higher cost than paid at an in-network pharmacy.
Mr. Chen was still working when he first qualified for Medicare. At that time, he had
employer group coverage that was creditable. During his initial Part D eligibility
period, he decided not to enroll because he was satisfied with his drug coverage. It is
now a year later and Mr. Chen has lost his employer group coverage within the last
two weeks. How would you advise him? correct answers
Mr. Chen should enroll in a Part D plan before he has a 63-day break in coverage in
order to avoid a premium penalty.
Mrs. Kelly 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? correct answers
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. Kelly can do this.
,John Cohen is a Medicare beneficiary who suffers from diabetes. Mr. Cohen is
considering enrollment in an MA-PD plan that you represent. He asks you whether his
insulin costs will be covered. What should you say? correct answers
Mr. Cohen's insulin costs for a one-month supply cannot be more than $35 in any
coverage phase.
Mrs. Strickland is a new Medicare beneficiary who has just retired from retail work.
She is interested in selecting a Medicare Part D prescription drug plan. She takes
several medications and is concerned that she has not been able to identify a plan that
covers all of her medications. She does not want to make an abrupt change to new
drugs that would be covered and asks what she should do. What should you tell her?
correct answers
Every Part D drug plan is required to cover a single one-month fill of her existing
medications sometime during a 90-day transition period.
What types of tools can Medicare Part D prescription drug plans use that affect the
way their enrollees can access medications? correct answers
Part D plans do not have to cover all medications. As a result, their formularies, or
lists of covered drugs, will vary from plan to plan. In addition, they can use cost
containment techniques such as tiered co-payments and step therapy.
Which of the following statements about Medicare Part D is/are correct? correct
answers
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 an MA-Medical Savings Account (MSA) plan may only
obtain Part D benefits through a standalone PDP.
IV. Beneficiaries enrolled in an MA-PPO may obtain Part D benefits through a
standalone PDP or through their plan.
I, II, and III only
, Mrs. Sharma has Original Medicare and would like to enroll in a Private Fee-for-
Service (PFFS) plan. All types of PFFS plans are available in her area. Which options
could Mrs. Sharma consider before selecting a PFFS plan? correct answers
A Medicare Advantage Prescription Drug (MA-PD) PFFS plan that combines medical
benefits and Part D prescription drug coverage, a PFFS plan offering only medical
benefits, or a PFFS plan in combination with a stand-alone prescription drug plan.
Mr. Aguilar is a newly enrolled Medicare Part D beneficiary and one of your clients. In
addition to drugs on his plan's formulary, he takes several other medications. These
include a prescription drug not on his plan's formulary, over-the-counter medications
for colds and allergies, vitamins, and drugs from an Internet-based Canadian
pharmacy to promote hair growth and reduce joint swelling. His neighbor recently told
him about a concept called TrOOP and he asks you if any of his other medications
could count toward TrOOP should he ever reach the Part D catastrophic limit. What
should you say? correct answers
None of the costs of Mr. Aguilar's other medications would currently count toward
TrOOP but he may wish to ask his plan for an exception to cover the prescription, not
on its formulary.
Steban Marsh is a newly appointed agent. Steban intends to conduct an educational
session on Medicare at a senior citizens center near his home. He has advertised the
session as an educational event. Steban asks you what is permissible at such an
event. What should you say? correct answers
Steban may provide a meal as long as its value is $15 or less per attendee and he may
make available business reply cards (BRCs).
Maria Valesquez is a marketing representative with RitzCo, a third-party marketing
organization (TPMO). Maria meets with Henry Smythe, who has a website that
provides information about different ways to get Medicare. The website allows
beneficiaries to put in their name and contact information in order to receive
additional information. Henry offers to sell Maria leads obtained through the website.
What should Maria do? correct answers
Maria should pass on Henry's offer. Henry's website is a TPMO, and for a TPMO to
provide contact information to another TPMO (including an agent/broker or FMO), it
Answers & Explanations 2025
Mr. and Mrs. Cole both take a specialized multivitamin prescription each day. Mr. Cole
takes a prescription to help regrow his hair. They are anxious to have their Medicare
prescription drug plan cover these drug needs. What should you tell them? correct
answers
Medicare prescription drug plans are not permitted to cover the prescription
medications the Coles are interested in under Part D coverage, however, plans may
cover them as supplemental benefits and the Coles could look into that possibility.
Ms. Ramos is enrolled in a Medicare Advantage plan that includes prescription drug
plan (PDP) coverage. She is traveling and wishes to fill two of the prescriptions that
she has lost. How would you advise her? correct answers
She may fill prescriptions for covered drugs at non-network pharmacies, but likely at a
higher cost than paid at an in-network pharmacy.
Mr. Chen was still working when he first qualified for Medicare. At that time, he had
employer group coverage that was creditable. During his initial Part D eligibility
period, he decided not to enroll because he was satisfied with his drug coverage. It is
now a year later and Mr. Chen has lost his employer group coverage within the last
two weeks. How would you advise him? correct answers
Mr. Chen should enroll in a Part D plan before he has a 63-day break in coverage in
order to avoid a premium penalty.
Mrs. Kelly 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? correct answers
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. Kelly can do this.
,John Cohen is a Medicare beneficiary who suffers from diabetes. Mr. Cohen is
considering enrollment in an MA-PD plan that you represent. He asks you whether his
insulin costs will be covered. What should you say? correct answers
Mr. Cohen's insulin costs for a one-month supply cannot be more than $35 in any
coverage phase.
Mrs. Strickland is a new Medicare beneficiary who has just retired from retail work.
She is interested in selecting a Medicare Part D prescription drug plan. She takes
several medications and is concerned that she has not been able to identify a plan that
covers all of her medications. She does not want to make an abrupt change to new
drugs that would be covered and asks what she should do. What should you tell her?
correct answers
Every Part D drug plan is required to cover a single one-month fill of her existing
medications sometime during a 90-day transition period.
What types of tools can Medicare Part D prescription drug plans use that affect the
way their enrollees can access medications? correct answers
Part D plans do not have to cover all medications. As a result, their formularies, or
lists of covered drugs, will vary from plan to plan. In addition, they can use cost
containment techniques such as tiered co-payments and step therapy.
Which of the following statements about Medicare Part D is/are correct? correct
answers
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 an MA-Medical Savings Account (MSA) plan may only
obtain Part D benefits through a standalone PDP.
IV. Beneficiaries enrolled in an MA-PPO may obtain Part D benefits through a
standalone PDP or through their plan.
I, II, and III only
, Mrs. Sharma has Original Medicare and would like to enroll in a Private Fee-for-
Service (PFFS) plan. All types of PFFS plans are available in her area. Which options
could Mrs. Sharma consider before selecting a PFFS plan? correct answers
A Medicare Advantage Prescription Drug (MA-PD) PFFS plan that combines medical
benefits and Part D prescription drug coverage, a PFFS plan offering only medical
benefits, or a PFFS plan in combination with a stand-alone prescription drug plan.
Mr. Aguilar is a newly enrolled Medicare Part D beneficiary and one of your clients. In
addition to drugs on his plan's formulary, he takes several other medications. These
include a prescription drug not on his plan's formulary, over-the-counter medications
for colds and allergies, vitamins, and drugs from an Internet-based Canadian
pharmacy to promote hair growth and reduce joint swelling. His neighbor recently told
him about a concept called TrOOP and he asks you if any of his other medications
could count toward TrOOP should he ever reach the Part D catastrophic limit. What
should you say? correct answers
None of the costs of Mr. Aguilar's other medications would currently count toward
TrOOP but he may wish to ask his plan for an exception to cover the prescription, not
on its formulary.
Steban Marsh is a newly appointed agent. Steban intends to conduct an educational
session on Medicare at a senior citizens center near his home. He has advertised the
session as an educational event. Steban asks you what is permissible at such an
event. What should you say? correct answers
Steban may provide a meal as long as its value is $15 or less per attendee and he may
make available business reply cards (BRCs).
Maria Valesquez is a marketing representative with RitzCo, a third-party marketing
organization (TPMO). Maria meets with Henry Smythe, who has a website that
provides information about different ways to get Medicare. The website allows
beneficiaries to put in their name and contact information in order to receive
additional information. Henry offers to sell Maria leads obtained through the website.
What should Maria do? correct answers
Maria should pass on Henry's offer. Henry's website is a TPMO, and for a TPMO to
provide contact information to another TPMO (including an agent/broker or FMO), it
