2025 AHIP Final Exam Latest Update 2024-2025
Actual Exam 140 Questions and 100% Verified
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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? - CORRECT ANSWER: You must have her
sign a scope of appointment form, indicating which products she wishes to discuss. You
may then proceed with the discussion.
Agent Harriet Walker has recently begun marketing Medicare Advantage and related
products aimed at meeting the needs of senior citizens. Client Mildred Jones has
expressed interest in a Medicare Advantage plan. It is now the beginning of September.
If you were in Agent Walker's position, what would you do? - CORRECT ANSWER:
Inquire whether the client qualifies for a special enrollment period, and if not, solicit an
enrollment application once the annual open enrollment election period begins on
October 15th.
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? - CORRECT ANSWER: Yes. When
an event has been advertised as "educational," discussing plan-specific premiums is
impermissible.
Alice is enrolled in a MA-PD plan. She makes a permanent move across the country
and wonders what her options are for continuing MA-PD coverage. What would you say
to her in regard to a special enrollment period (SEP)? - CORRECT ANSWER: She is
likely to qualify for a SEP. She can choose an effective date of up to three months after
the month in which the enrollment form is received by the new plan, but the effective
date may not be earlier than the date of her permanent move.
Anita Magri will turn age 65 in August 2023. Anita intends to enroll in Original Medicare
Part A and Part B. She would also like to enroll in a Medicare Supplement (Medigap)
plan. Anita's older neighbor Mel has told her about the Medigap Plan F in which he is
enrolled. It not only provides foreign travel emergency benefits but also covers his
Medicare Part B deductible. Anita comes to you for advice. What should you tell her? -
,CORRECT ANSWER: You are sorry to disappoint Anita, but a Medigap F plan is no
longer available to those who turn age 65 after January 1, 2020. Anita might instead
consider other Medigap plans that offer foreign travel benefits but do not cover the Part
B deductible.
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? - CORRECT ANSWER: You
may make comparisons between plans if you can support them with studies or
statistical data and such comparisons are factually based and referenced.
Dr. Elizabeth Brennan does not contract with the ABC PFFS plan but accepts the plan's
terms and conditions for payment. Mary Rodgers sees Dr. Brennan for treatment. How
much may Dr. Brennan charge? - CORRECT ANSWER: Dr. Brennan can charge Mary
Rogers no more than the cost sharing specified in the PFFS plan's terms and condition
of payment which may include balance billing up to 15%of the Medicare rate.
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? - CORRECT ANSWER: The Medicare Advantage plan received a 5-star rating in
customer service and care coordination with an overall performance rating of 4 stars.
Hank's Fish Store, Inc. is a small company with just 15 employees located in Florida.
Hank, the store owner, has provided excellent health benefits to the store's workforce.
William, one of the store's long-time employees, will soon be reaching age 65 and
eligible for Medicare. William is in good health. He intends to remain an active full-time
employee, working several years after becoming eligible for Medicare. What type(s) of
retiree health benefit will Hank's Fish Store be able to offer William? - CORRECT
ANSWER: Hank's can continue to offer William the same employee health benefit plan,
or, if William enrolls in Medicare Part B, it can enroll him in a Medicare Advantage plan
that is offered to the public.
If you are to comply with Medicare's guidance regarding educational events, which of
the following would be acceptable activities? - CORRECT ANSWER: You may distribute
business cards to individuals who request information on how to contact you for further
details on the plan(s) you represent.
, Mr. Alonso receives some help paying for his two generic prescription drugs from his
employer's retiree coverage, but he wants to compare it to a Part D prescription drug
plan. He asks you what costs he would generally expect to encounter when enrolling
into a standard Medicare Part D prescription drug plan. What should you tell him? -
CORRECT ANSWER: He generally would pay a monthly premium, annual deductible,
and per-prescription cost-sharing.
Mr. and Mrs. Nunez attended one of your sales presentations. They've asked you to
come to their home to clear up a few questions. During the presentation, Mrs. Nunez
feels tired and tells you that her husband can finish things up. She goes to bed. At the
end of your discussion, Mr. Nunez says that he wants to enroll both himself and his wife.
What should you do? - CORRECT ANSWER: As long as she can do so, only Mrs.
Nunez can sign her enrollment form. Mrs. Nunez will have to wake up to sign her form
or do so at another time.
Mr. and Mrs. Vaughn both take a specialized multivitamin prescription each day. Mr.
Vaughn takes a prescription to help to regrow his hair. They are anxious to have their
Medicare prescription drug plan cover these drug needs. What should you tell them? -
CORRECT ANSWER: Medicare prescription drug plans are not permitted to cover the
prescription medications the Vaughns are interested in under Part D coverage, however,
plans may cover them as supplemental benefits and the Vaughns could look into that
possibility.
Mr. Anderson is a very organized individual and has filled out and brought to you an
enrollment form on October 10 for a new plan available on January 1 next year. He is
currently enrolled in Original Medicare. What should you do? - CORRECT ANSWER:
Tell Mr. Anderson that you cannot accept any enrollment forms until the annual election
period begins.
Mr. Barker enjoys a comfortable retirement income. He recently had surgery and
expected that he would have certain services and items covered by the plan with
minimal out-of-pocket costs because his MA-PD coverage has been very good.
However, when he received the bill, he was surprised to see large charges in excess of
his maximum out-of-pocket limit that included some services and items he thought
would be fully covered. He called you to ask what he could do? What could you tell
him? - CORRECT ANSWER: You can offer to review the plans appeal process to help
him ask the plan to review the coverage decision.
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