AHIP Final Exam Test Questions BEST
STUDYING MATERIAL WITH VERIFIED
ANSWERS LATEST VERSION UPDATE 2024-
2025 WITH 150 QUESTIONS
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?
- CORRECT ANS-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 part of the PPO network.
Mr. Sanchez has just turned 65 and is entitled to Part A but has not enrolled in Part B because
he has coverage through an employer plan. If he wants to enroll in a Medicare Advantage plan,
what will he have to do?
- CORRECT ANS-He will have to enroll in Part B.
Mr. Moy's wife has a Medicare Advantage plan, but he wants to understand what coverage
Medicare Supplemental Insurance provides since his health care needs are different from his
wife's needs. What could you tell Mr. Moy?
- CORRECT ANS-Medicare Supplemental Insurance would help cover his Part A and Part B cost
sharing in Original Fee-for-Service (FFS) Medicare as well as possibly some services that
Medicare does not cover.
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 with respect to her drug coverage?
- CORRECT ANS-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. Young is currently enrolled in Original Medicare (Parts A and B), but she has been working
with Agent Neil Adams in the selection of a Medicare Advantage (MA) plan. It is mid-
,September, and Mrs. Young is going on vacation. Agent Adams is considering suggesting that he
and Mrs. Young complete the application together before she leaves. He will then submit the
paper application prior the start of the annual enrollment period (AEP). What would you say If
you were advising Agent Adams?
- CORRECT ANS-This is a bad idea. Agents are generally prohibited from soliciting or accepting
an enrollment form prior to the start of the AEP.
Another agent working for your agency claims that because you are not employed by the
Medicare Advantage plans that you represent, you are not subject to the same requirements as
the plans themselves. How should you respond to such a statement?
- CORRECT ANS-Your coworker is not correct. Marketing on behalf of a plan is considered
marketing by the plan and requires that all contracted and employed agents comply with all
Medicare marketing rules.
Agent Martinez wishes to solicit Medicare Advantage prospects through e-mail and asks you for
advice as to whether this is possible. What should you tell her?
- CORRECT ANS-Marketing representatives may initiate electronic contact through e-mail but
the subject line must say "marketing" and an opt-out process must be provided.
During a sales presentation, your client asks you whether the Medicare agency recommends
that she sign up for your plan or stay in Original Medicare. What should you tell her?
- CORRECT ANS-Tell her that the Medicare agency does not endorse or recommend any plan.
Ms. Lewis understands that Medicare prescription drug plans may use various methods to
control the use of specific drugs. She has heard about a technique called "step therapy" and is
wondering if you can explain what that is. What should you tell her?
- CORRECT ANS-Step therapy involves using one or more lower priced drugs before trying a
more expensive drug when all are used to treat the same condition.
Mrs. Radford asks whether there are any special eligibility requirements for Medicare
Advantage. What should you tell her?
, - CORRECT ANS-Mrs. Radford must be entitled to Part A and enrolled in Part B to enroll in
Medicare Advantage.
Mr. Castillo, a naturalized citizen, previously enrolled in Medicare Part B but has recently
stopped paying his Part B premium. Mr. Castillo is still covered by Part A. He would like to enroll
in a Medicare Advantage (MA) plan and is still covered by Part A. What should you tell him? -
CORRECT ANS-He is not eligible to enroll in a Medicare Advantage plan until he re-enrolls in
Medicare Part B.
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?
- CORRECT ANS-Gift cards or gift certificates of $15 or less that can be readily converted to cash.
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?
- CORRECT ANS-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?
- CORRECT ANS-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? -
CORRECT ANS-He could enroll in one of the MA plans that include prescription drug coverage or
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