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AHIP FINAL EXAM, PRACTICE EXAM
AND STUDY GUIDE LATEST 2025/
ACTUAL EXAM QUESTIONS AND
CORRECT ANSWERS RAT
Mr. Edwards, a marketing representative of the ACME Insurance Company, scheduled a marketing event and expects about 40 people to attend. He has hired a magician at a cost of $200 to entertain attendees. Can he do this in a way that complies with guidance from the Medicare agency? - ANSWER-a. He can do this because the estimated number of attendees is based on the venue size and response rate and the value of the gift does not exceed $15. Mrs. Ramos is considering a Medicare Advantage PPO and has questions about which providers she can go to for her health care.
What should you tell her? - ANSWER-b. Mrs. Ramos can obtain care from any provider who participates in Original Medicare, but generally will have a higher cost-sharing amount if she sees a provider who/that is not a part of the PPO network. Julia Harris is turning 66 in July, at which time she will retire. She has contacted your office and requested a meeting so that she can learn about Medicare and the products you represent. How should you respond? - ANSWER-c. Tell Julia that you will meet with her to explain Medicare and should she be interested you can accept and submit an enrollment request, since this is an initial enrollment qualifying her for a special enrollment period. Mr. Rivera has Qualified Medicare Beneficiary (QMB) eligibility and is thus covered by both Medicare and Medicaid. He decides to enroll in a Medicare Advantage (MA) PPO plan. Later he sees an out-of-network doctor to receive a Medicare covered service. How much The doctor may only collect from Mr. Rivera the cost sharing allowable under the state's Medicaid program.may the doctor collect from Mr. Rivera? - ANSWER-The doctor may only collect from Mr. Rivera the cost sharing allowable under the state's Medicaid program. During a sales presentation in Ms. Sullivan's home, she tells you that she has heard about a type of Medicare health plan known as Private Fee-for-Service (PFFS). She wants to know if this would be
During an appointment scheduled to discuss a Medicare Advantage Prescription Drug plan (MA-PD), Mr. Peters asked his agent to describe a stand-alone prescription drug plan (Part D plan) that his neighbor told him about. What should his agent do?
- ANSWER- Choose one answer. - ANSWER-
- ANSWER-a. Since Mr. Peters requested a description of the Part D plan, his agent must leave the Part D plan brochure, but not an enrollment form, and would have to schedule another appointment after at least 48 hours have passed to discuss the Part D plan with Mr. Peters.
- ANSWER-b. Since Mr. Peters requested a description of the Part D plan, his agent must have Mr. Peters sign a new scope of appointment form that includes Part D, and then the agent may discuss the Part D plan so Mr. Peters can compare plans and make an informed enrollment choice during the appointment.
- ANSWER-c. Since Mr. Peters requested a description of the Part D plan, his agent must inform Mr. Peters that he can only sign up for the MA-PD plan and cannot receive a brochure or any other
information about the Part D plan now because he did not agree in advance to discuss that plan
- ANSWER-d. Since Mr. Peters requested a description of the Part D plan, his agent must discuss both the Part D and the MA-PD plans and return after at least 48 hours to complete the Part D plan enrollment form with Mr. Peters. Question9 - ANSWER- Marks: 1 - ANSWER- 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? - ANSWER- Choose one answer. - ANSWER-
- ANSWER-a. In general, he must select a single Part D premium payment mechanism that will be used throughout the year.
"creditable." She wants to know what this means. What should you tell her? - ANSWER- Choose one answer. - ANSWER-
- ANSWER-a. The letter is to inform her that her Medigap drug coverage must be supplemented by purchasing coverage under a Part D plan. If she does not do so within 63 days, she will not be able to obtain Part D coverage at a later date.
- ANSWER-b. The letter is to inform her that the drug coverage offered through her Medigap plan does not offer drug coverage that is at least comparable to that provided under the Medicare Part D prescription drug program. If she does not have such creditable coverage during periods when she is first eligible for the Part D program, she will face a premium penalty if she enrolls in a Part D plan at a later date.
- ANSWER-c. The letter is to inform her that her Medigap plan's coverage has been determined by the Federal government to be inadequate and the plan must therefore discontinue offering such coverage. Ms. Eisenberg will have to select a different Medigap plan if she wants drug coverage.
- ANSWER-d. The letter is to inform her that Medicare Part D prescription drug coverage is available, but there is no need for her to change her drug coverage since it is just as good as Part D. She may keep her current coverage through the Medigap plan. Question11 - ANSWER- Marks: 1 - ANSWER- Richard is a licensed agent who represents Spartan Health Plan and its Medicare Advantage (MA) plans. Richard has several clients who have recently come to him for help who are in their initial coverage election period (ICEP) and are interested in enrolling in one of Spartan Health Plan's MA plans. Alice will soon turn 65 and retire. Alice has coverage through Spartan Health Plan offered by her employer. Bob had health coverage through Spartan but dropped the coverage when he retired early to travel overseas. Bob, who has just turned age 65, is now back in the United States. Charlotte, who will turn 65 next month, has coverage through Athena Health plan - a company Richard also represents. Who qualifies for the opt-in simplified enrollment mechanism? - ANSWER- Choose one answer. - ANSWER-
Choose one answer. - ANSWER-
- ANSWER-a. When a formulary change is in response to a drug's removal from the market.
- ANSWER-b. When the Part D plan can demonstrate to CMS that no enrollee has accessed the medication in the past six months, generally the plan can remove the drug from its formulary within the first 60 days of the year.
- ANSWER-c. Under no conditions can a Medicare Part D prescription drug plan reduce its coverage for a given drug at any point during the year.
- ANSWER-d. If the Medicare prescription drug plan can show that reducing coverage early in the year will result in savings for the Part D plan and the Medicare program, generally the plan may make such a change. Question13 - ANSWER- Marks: 1 - ANSWER-
This year you have decided to focus your efforts on marketing to employer group plans. One employer provides you with a list of their retirees and asks you to contact them to explain the characteristics of the plan they have selected. What should you do? - ANSWER- Choose one answer. - ANSWER-
- ANSWER-a. You may only contact the retirees after the employer has notified them that they will be receiving a call.
- ANSWER-b. You may call them but must record every call.
- ANSWER-c. You may go ahead and call them.
- ANSWER-d. You may not make any unsolicited contact with Medicare beneficiaries. The employer will have to tell its retirees to call you. Question14 - ANSWER- Marks: 1 - ANSWER-
Marks: 1 - ANSWER- Mrs. Disraeli is enrolled in Original Medicare (Parts A and B) and a standalone Part D prescription drug plan. She has recently developed diabetes and has suffered from heart disease for several years. She has also recently learned that her area is served by a SNP for individuals suffering from such a combination of chronic diseases (C-SNP). Mrs. Disraeli is concerned however, that she will have few rights or protections if she enrolls in a C-SNP. How would you respond? - ANSWER- Choose one answer. - ANSWER-
- ANSWER-a. The SNP would select her primary care provider (PCP) but she could file a grievance within 90 days if the PCP proved incapable.
- ANSWER-b. Mrs. Disraeli would have substantial restrictions on obtaining emergency care and must use network facilities or be responsible for most emergency care costs.
- ANSWER-c. Enrollees, while able to select their primary care provider (PCP), do have substantial restrictions and financial
responsibilities regarding emergency care whether obtained at in- network or out-of-network facilities.
- ANSWER-d. Enrollees in SNPs must have access to provider networks that include enough doctors, specialists, and hospitals to provide all covered services necessary to meet enrollee needs within reasonable travel time. Question16 - ANSWER- Marks: 1 - ANSWER- Mr. Lopez takes several high-cost prescription drugs. He would like to enroll in a standalone Part D prescription drug plan that is available in his area. In what type of Medicare Health Plan can he enroll? - ANSWER- Choose one answer. - ANSWER-
- ANSWER-a. Medicare Advantage (MA) HMO-POS plan that does not include drug coverage.
- ANSWER-b. The beneficiary could only stay in a stand-alone prescription drug plan if he or she has original fee-for-service Medicare
- ANSWER-c. The beneficiary could enroll in a private fee-for- service (PFFS) plan that does not include prescription drug coverage; an 1876 cost plan; or a Medicare Medical Savings Account (MSA) plan
- ANSWER-d. The beneficiary could only choose an 1876 Cost Plan. Question18 - ANSWER- Marks: 1 - ANSWER- Mrs. Sanchez lives in a state located near Canada. She has recently become eligible for Medicare and is considering enrollment in Part D prescription drug coverage. One of her friends has told her that she needs to be aware of something called TrOOP. What should you tell her when she asks you about TrOOP? - ANSWER-
Choose one answer. - ANSWER-
- ANSWER-a. TrOOP are out-of-pocket costs that count toward the annual out-of-pocket threshold to move into catastrophic coverage and generally include the annual deductible(s) and costs for drugs on the plan's formulary purchased at a plan's participating pharmacy. In some instances, amounts not directly paid by the enrollee (like manufacturer discounts) count toward TrOOP.
- ANSWER-b. TrOOP is calculated on a cumulative basis and consists of the sum of an enrollee's out-of-pocket deductibles from the date of his or her enrollment in Part D plus outlays for over-the-counter drugs.
- ANSWER-c. TrOOP is calculated on an annual basis and consists of an enrollee's out-of-pocket deductible plus any amounts paid on behalf of an enrollee by Medicaid.
- ANSWER-d. TrOOP are out-of-pocket costs that count toward the annual out-of-pocket threshold to move into catastrophic coverage and generally include, in addition to the annual deductible, costs for drugs not on the Part D plan's formulary and drugs purchased outside the United States.
- ANSWER-d. Yes. Mrs. Walters must be entitled to Part A or enrolled in Part B to be eligible for coverage under the Medicare prescription drug program. Question20 - ANSWER- Marks: 1 - ANSWER- Mrs. Roberts 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. Roberts consider before selecting a PFFS plan? - ANSWER- Choose one answer. - ANSWER-
- ANSWER-a. A PFFS plan offering only medical benefits or a PFFS Medigap Supplemental Insurance plan.
- ANSWER-b. 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.
- ANSWER-c. A stand-alone prescription drug plan in combination with a PFFS plan or a PFFS Medigap Supplemental Insurance plan.
- ANSWER-d. 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 PFFS Medigap Supplemental Insurance plan. Question21 - ANSWER- Marks: 1 - ANSWER- Mr. Wu is eligible for Medicare. He has limited financial resources but failed to qualify for the Part D low-income subsidy. Where might he turn for help with his prescription drug costs? - ANSWER- Choose one answer. - ANSWER-
