AHIP FINAL EXAM TEST QUESTIONS LATEST
VERSION 2024-2025/AHIP FINAL EXAM TEST
REAL EXAM 170 QUESTIONS AND CORRECT
ANSWERS
Mr. Jacob understands that there is a standard Medicare Part D prescription drug benefit, but when he
looks at information on various plans available in his area, he sees a wide range in what they charge for
deductibles, premiums, and cost sharing. How can you explain this to him? - ANSWER-Medicare Part D
drug plans may have different benefit structures, but on average, they must all be at least as good as the
standard model established by the government.
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 to her drug coverage? - ANSWER-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. Cantwell is enrolled in a prescription drug plan. She has heard about something called True-
OutPocket costs or "TrOOP" and asks you if any of the following count toward reaching the catastrophic
coverage phase. What do you say?
I. Her annual PDP deductible
II. A drug manufacturer's discount for brand name drugs after her initial coverage period
III. The off formulary drug her doctor prescribed but she pays for because the plan denied her exception
request
IV. Her over-the-counter (OTC) allergy medication. - ANSWER-I and II only
Mrs. Fiore is a retired federal worker with coverage under a Federal Employee Health Benefits (FEHB)
plan that includes creditable drug coverage. She is ready to turn 65 and become Medicare eligible for
the first time. What issues might she consider about whether to enroll in a Medicare prescription drug
plan? - ANSWER-She could compare the coverage to see if the Medicare Part D plan offers better
benefits and coverage than the FEHB plan for the specific medications she needs and whether any
additional benefits are worth the Part D premium costs on top of her FEHB contribution.
Mrs. Berkowitz 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?
- ANSWER-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. Berkowitz can do this.
,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-In general, he
must select a single Part D premium payment mechanism that will be used throughout the year.
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? - ANSWER-He could check with the
manufacturers of his medications to see if they offer an assistance program to help people with limited
means to 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.
Mrs. Fields wants to know whether applying for the Part D low-income subsidy will be worth the time to
fill out the paperwork. What could you tell her? - ANSWER-The Part D low-income subsidy could
substantially lower her overall costs. She can apply by contacting her state Medicaid office or calling the
Social Security Administration.
Which of the following statements about Medicare Part D are correct?
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 a MA-Medical Savings Account (MSA) plan may only obtain Part D
benefits through a standalone PDP.
IV. Beneficiaries enrolled in a MA-PPO may obtain Part D benefits through a standalone PDP or
through their plan. - ANSWER-I, II, and III only
Mrs. Lopez is enrolled in a cost plan for her Medicare benefits. She has recently lost creditable coverage
previously available through her husband's employer. She is interested in enrolling in a Medicare Part D
prescription drug plan (PDP). What should you tell her? - ANSWER-If a Part D benefit is offered through
her plan she may choose to enroll in that plan or a standalone PDP.
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? - ANSWER-After executing a scope of appointment (SOA) with Clara Burton, meet
with Edward Young and Clara Burton to discuss their Medicare Advantage options.
Mrs. Lu is turning 65 in November and called to ask for your help deciding on a Medicare Advantage
plan. She agreed to sign a scope of appointment form and meet with you on October 15. During the
appointment, what are you permitted to do? - ANSWER-You may provide her with the required
enrollment materials and take her completed enrollment application.
You have approached a hospital administrator about marketing in her facility. The administrator is
uncomfortable with the suggestion. How could you address her concerns? - ANSWER-Tell her that
Medicare guidelines allow you to conduct marketing activities in common areas of a provider's facility.
You are working several plans and community organizations to sponsor an educational event. When
putting together advertisements for this event, what should you do? - ANSWER-You must ensure that
the advertisements indicate it is an educational event, otherwise it will be considered a marketing event.
Miguel Sanchez is a relatively new agent who has come to you for advice as to what he can do during the
Medicare Advantage Open Enrollment Period (MA-OEP). What advice should you give Miguel? -
ANSWER-During the MA-OEP, Miguel can have one-on-one meetings with beneficiaries who have
requested such meetings.
Wendy Park becomes eligible for Medicare for the first time in July. With the help of Agent James Chan,
she enrolls in FeelBetter Medicare Advantage plan with an effective date of July 1st. Which statement
best describes how Agent Chan may be compensated under CMS rules? - ANSWER-FeelBetter will pay
Agent Chan initial year compensation for July through December. The renewal amounts will be paid
starting in January if Ms. Park remains enrolled the following year.
Melissa Meadows is a marketing representative for Best Care which has recently introduced a Medicare
Advantage plan offering comprehensive dental benefits for $15 per month. Best Care has not submitted
any potential posts to CMS for approval. Melissa would like to use the power of social media to reach
potential prospects. What advice would you give her? - ANSWER-As soon as CMS approves Best Care's
social media posts, Agent Meadows could post a tweet stating that "Best Care offers an array of
Medicare Advantage benefit packages. One might be right for you. Call me to find out more!"
Your friend's mother just moved to an assisted living facility and he asked if you could present a program
for the residents about the MA-PD plans you market. What could you tell him? - ANSWER-You
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