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AHIP 2025 final exam questions and answers 2015/2016
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AHIP 2025 final exam1. A client wants to give you an enrollment application on October 1 before the beginning of
the Annual Election Period because he is leaving on vacation for two weeks and does
not want to forget about turning it in. What should you tell him? >ANS>You must tell him
you are not permitted to take the form. If he sends the form directly to the plan, the plan
will process the enrollment on the day the Annual Election Period begins.
2. ABC is a Medicare Advantage (MA) plan sponsor. It would like to use its enrollees'
information to market non-health related products such as life insurance and annuities.
Which statement best describes ABC's obligation to its enrollees regarding marketing
such products? >ANS>b.
3. It must obtain a HIPAA compliant authorization from an enrollee that indicates the plan or
plan sponsor may use their information for marketing purposes.
4. Agent Daniel Webber has properly set up a sales appointment to meet with client
Edward Young at Agent Webber's office. At the agreed upon appointment time, Mr.
Young arrives with his elderly neighbor - Clara Burton, who wants to learn about her
Medicare Advantage options. What should Agent Daniel Webber do? >ANS>
5. Agent John Miller is meeting with Jerry Smith, a new prospect. Jerry is currently enrolled
in Medicare Parts A and B. Jerry has also purchased a Medicare Supplement (Medigap)
plan which he has had for several years. However, the plan does not provide drug
benefits. How would you advise Agent John Miller to proceed? >ANS>Tell prospect Jerry
Smith that he should consider adding a standalone Part D prescription drug coverage
policy to his present coverage.
6. 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? >ANS>Marketing
representatives may initiate electronic contact through e-mail but an opt-out process
must be provided.
7. Edna, Felix, George, and Harriet are Medicare beneficiaries. Edna lives in an area that
has suffered from major flooding that has been declared a major disaster by both the
Federal government and her state. As a result of dealing with the flooding issues and
being evacuated from her home, Edna missed her chance to enroll in MA during her
Initial Coverage Election Period. Felix lives in an area with a Medicare Advantage plan
with a 4-star rating that he would like to join. George dropped his Medigap policy six
months ago when he first enrolled in a Medicare Advantage plan. He now wants to
return to Original Medicare. Harriet has recently developed diabetes and would like to
enroll in a Medicare Advantage plan that focuses on care for those with that disease.
Which, if any, of these individuals would qualify for a special election period (SEP)?
, >ANS>Edna would qualify for a SEP because government officials have declared a
major disaster for her area and she did not enroll in MA during her ICEP due to the
emergency. George would qualify for an SEP because he enrolled in Medicare
Advantage (MA) plan for the first time and would now like to return to Original Medicare
within the first 12 months of his enrollment. Harriet would also qualify for a SEP to enroll
in a C-SNP because she has developed a chronic condition. Felix would not qualify for a
SEP since he seeks to enroll in a 4-star not a 5-star MA plan.
8. Hector Hernandez is an independent agent. Hector sells plans on behalf of three
Medicare Advantage organizations that offer a total of 10 plans but does not represent
all Medicare Advantage organizations offering plans that are available in his area. Which
of the following statements best describes any steps Hector is required to take?
>ANS>During the first minute of a sales call, Hector must send an email to the prospect
stating that "I represent 3 plans but not every plan available in your area. Please contact
Medicare.gov to get information on all your options.
9. If a beneficiary is enrolled in a stand-alone prescription drug plan and wants to keep that
plan, what type of Medicare health plan could the individual also enroll in, without being
automatically disenrolled from the stand-alone prescription drug plan? >ANS>The
beneficiary could enroll in a private fee-for-service (PFFS) plan that does not include
prescription drug coverage; a cost plan; or a Medicare Medical Savings Account (MSA)
plan.
10. Juan Hernandez is turning 65 next month, Juan legally entered the United States over
twenty years ago but is not a citizen. Since his entry into the country, Juan has worked at
Smallcap Incorporated and contributed to the Medicare system. Juan suffers from
diabetes. He will soon retire and asks you if he can enroll in a Medicare Advantage plan
that you represent. How would you respond? >ANS>Juan is eligible to enroll in a
Medicare Advantage as long as he is entitled to Part A and enrolled in Part B. Juan
should go to the Social Security website to enroll in Medicare Part A and B if he has not
done so already. Once he is enrolled, he can choose a Medicare Advantage plan.
11. Madeline Martinez was widowed several years ago. Her husband worked for many years
and contributed into the Medicare system. He also left a substantial estate which
provides Madeline with an annual income of approximately $130,000. Madeline, who
has only worked part-time for the last three years, will soon turn age 65 and hopes to
enroll in Original Medicare. She comes to you for advice. What should you tell her?
>ANS>You should tell Madeline that she will be able to enroll in Medicare Part A without
paying monthly premiums due to her husband's long work record and participation in the
Medicare system. You should also tell Madeline that she will pay Part B premiums at
more than the standard lowest rate but less than the highest rate due her substantial
income.
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