AHIP EXAM TEST BANK 2025–2026 | 50 VERIFIED QUESTIONS AND CORRECT ANSWERS | LATEST AHIP CE, Exams of Nursing

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AHIP EXAM TEST BANK 2025–2026 | 50

VERIFIED QUESTIONS AND CORRECT

ANSWERS | LATEST AHIP CERTIFICATION

EXAM | GRADED A+ PASS GUARANTEE

Question12 - --CORRECT ANSWER-- - Marks: 1 - --CORRECT ANSWER-- - Under what conditions can a Medicare prescription drug plan reduce its coverage for a given drug during the first 60 days of the year? - --CORRECT ANSWER-- - Choose one --CORRECT ANSWER--. - --CORRECT ANSWER-- -

• --CORRECT ANSWER-- - a. When a formulary change is in response to a drug's removal from the market.
• --CORRECT 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.
• --CORRECT 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.
• --CORRECT 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 - --CORRECT ANSWER-- -

Marks: 1 - --CORRECT 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? - --CORRECT ANSWER-- - Choose one --CORRECT ANSWER--. - --CORRECT ANSWER-- -

• --CORRECT ANSWER-- - a. You may only contact the retirees after the employer has notified them that they will be receiving a call.
• --CORRECT ANSWER-- - b. You may call them but must record every call.
• --CORRECT ANSWER-- - c. You may go ahead and call them.
• --CORRECT ANSWER-- - d. You may not make any unsolicited contact with Medicare beneficiaries. The employer will have to tell its retirees to call you. Question14 - --CORRECT ANSWER-- - Marks: 1 - --CORRECT ANSWER-- - You have sought permission from a hospital to place brochures for your product in their gift shop and cafeteria. The hospital administration expresses some

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? - --CORRECT ANSWER-- - Choose one --CORRECT ANSWER--. - --CORRECT ANSWER-- -

• --CORRECT 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.
• --CORRECT 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.
• --CORRECT 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.
• --CORRECT 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 - --CORRECT ANSWER-- - Marks: 1 - --CORRECT 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? - --CORRECT ANSWER-- - Choose one --CORRECT ANSWER--. - --CORRECT ANSWER-- -

• --CORRECT ANSWER-- - a. Medicare Advantage (MA) HMO-POS plan that does not include drug coverage.
• --CORRECT ANSWER-- - b. Medicare Advantage (MA) PPO that does not include drug coverage.
• --CORRECT ANSWER-- - c. Medicare Advantage (MA) HMO that does not include drug coverage.
• --CORRECT ANSWER-- - d. Private Fee-for-Service (PFFS) plan that does not include drug coverage. Question17 - --CORRECT ANSWER-- - Marks: 1 - --CORRECT ANSWER-- - 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

Choose one --CORRECT ANSWER--. - --CORRECT ANSWER-- -

• --CORRECT 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.
• --CORRECT 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.
• --CORRECT 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.
• --CORRECT 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. Question19 - --CORRECT ANSWER-- - Marks: 1 - --CORRECT ANSWER-- -

Mrs. Walters is entitled to Part A and has medical coverage without drug coverage through an employer retiree plan. She is not enrolled in Part B. Since the employer plan does not cover prescription drugs, she wants to enroll in a Medicare prescription drug plan. Will she be able to? - --CORRECT ANSWER-- - Choose one --CORRECT ANSWER--. - --CORRECT ANSWER-- -

• --CORRECT ANSWER-- - a. Yes, but Mrs. Walters must drop the employer coverage prior to enrolling in a Medicare prescription drug plan.
• --CORRECT ANSWER-- - b. No. Mrs. Walters will have to enroll in Part B in order to qualify for enrollment into the Medicare prescription drug program.
• --CORRECT ANSWER-- - c. No. As long as her employer offers coverage that is equivalent to that available through Medicare, Mrs. Walters cannot enroll in a Medicare prescription drug plan.
• --CORRECT 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 - --CORRECT ANSWER-- - Marks: 1 - --CORRECT 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? - --CORRECT ANSWER-- - Choose one --CORRECT ANSWER--. - --CORRECT ANSWER-- -

• --CORRECT ANSWER-- - a. Mr. Wu has no alternative but to liquidate his remaining assets and apply for coverage through his state's Medicaid program.
• --CORRECT ANSWER-- - b. Mr. Wu may still qualify for help in paying Part D costs through his State Pharmaceutical Assistance Program.
• --CORRECT ANSWER-- - c. Mr. Wu may still qualify for help in paying for Part D costs through the Federal Pharmaceutical Assistance Program.
• --CORRECT ANSWER-- - d. Mr. Wu may still qualify for help in paying for Part D costs through the local Office of the Aging. Question22 - --CORRECT ANSWER-- - Marks: 1 - --CORRECT ANSWER-- - Ms. Stuart has heard about a special needs plan (SNP) that one of her friends is enrolled in and is interested in that product. She wants to be sure she also has coverage for prescription drugs. Would she be able to obtain drug coverage if she enrolled in the SNP? - --CORRECT ANSWER-- -

Choose one --CORRECT ANSWER--. - --CORRECT ANSWER-- -

• --CORRECT ANSWER-- - a. Yes. All SNPs are required to provide Part D coverage for prescription drugs.
• --CORRECT ANSWER-- - b. Yes, but only if she qualifies for Part D prescription drug coverage under her state Medicaid program.
• --CORRECT ANSWER-- - c. Maybe. Some SNPs offer Part D coverage for prescription drugs and some do not.
• --CORRECT ANSWER-- - d. No. Medicare beneficiaries who enroll in an SNP must always obtain their drug coverage through a stand-alone Part D Medicare prescription drug plan that they sign up for independent of their enrollment in the SNP. Question23 - --CORRECT ANSWER-- - Marks: 1 - --CORRECT ANSWER-- - Ms. Edwards is enrolled in a Medicare Advantage plan that includes prescription drug plan (PDP) coverage. She is traveling and wishes to fill two of the prescriptions that she has lost. How would you advise her? - --CORRECT ANSWER- - -

• --CORRECT ANSWER-- - a. All that she needs to do is avoid being terminated for cause.
• --CORRECT ANSWER-- - b. All that she needs to do is meet state licensure requirements moving forward.
• --CORRECT ANSWER-- - c. Melanie will need to do nothing to continue receiving renewal fees since the initial sale was made when she met all requirements.
• --CORRECT ANSWER-- - d. Melanie must remain trained, tested, licensed, and appointed, regardless of whether she is actively selling MA products. Question25 - --CORRECT ANSWER-- - Marks: 1 - --CORRECT ANSWER-- - Agent Chan is conducting a sales presentation on senior issues where he hopes to enroll some attendees in the Medicare Advantage (MA) plans he represents. What action(s) may Agent Chan take during the event? - --CORRECT ANSWER-- - Choose one --CORRECT ANSWER--. - --CORRECT ANSWER-- -
• --CORRECT ANSWER-- - a. Sell personal information obtained as part of a raffle to a third-party marketeer.

• --CORRECT ANSWER-- - b. Discuss plan specific information such as premiums and benefits.
• --CORRECT ANSWER-- - c. Indicate that in order participate attendees must provide their contact information.
• --CORRECT ANSWER-- - d. Conduct free health screenings as part of the event. Question26 - --CORRECT ANSWER-- - Marks: 1 - --CORRECT ANSWER-- - Mr. Decaro has looked at Medicare prescription drug plans available in his area and noted a wide range in premiums. He thought that all the drug plans were required to offer the same standard benefits and would like you to explain why there is such a range in premiums. What should you tell him? - --CORRECT ANSWER-- - Choose one --CORRECT ANSWER--. - --CORRECT ANSWER-- -
• --CORRECT ANSWER-- - a. Medicare permits plans that have the highest quality services to reduce their premiums below the standard amount in order to increase their market share. This accounts for the variation in premium amounts.

• --CORRECT ANSWER-- - b. Mrs. Duarte should file an appeal of this initial determination within 90 days of the date she received the MSN in the mail. If she still disagrees with Medicare Administrative Contractor's (MAC's) further decision she should request a reconsideration by a qualified independent party within 10 days.
• --CORRECT ANSWER-- - c. Mrs. Duarte has no right to appeal this determination since her claim has been partially paid.
• --CORRECT ANSWER-- - d. Mrs. Duarte should request a reconsideration of the decision by a qualified independent party within 60 days of the date she received the MSN in the mail. Question28 - --CORRECT ANSWER-- - Marks: 1 - --CORRECT ANSWER-- - Ms. Hernandez has marketed several different types of insurance products in her home state and has typically sought approval of her materials from her State Department of Insurance. What would you advise her regarding seeking such approval for materials she uses to market Medicare Advantage plans? - --CORRECT ANSWER-- - Choose one --CORRECT ANSWER--. - --CORRECT ANSWER-- -

• --CORRECT ANSWER-- - a. Obtaining approval of her materials from the State Department of Insurance is a good practice and she should continue it with materials for the Medicare health plans she represents.
• --CORRECT ANSWER-- - b. Materials for marketing Medicare health plans to individuals are subject to Medicare's uniform national requirements. They do not need to be reviewed by the state, but the company she represents must obtain approval from the Medicare agency (CMS) for any materials she uses.
• --CORRECT ANSWER-- - c. Materials need only be reviewed and approved by the company(s) she represents.
• --CORRECT ANSWER-- - d. States often volunteer to review marketing materials on behalf of the Medicare agency. She should check with her Department of Insurance to see if such a review is available and would satisfy CMS requirements. Question29 - --CORRECT ANSWER-- - Marks: 1 - --CORRECT ANSWER-- - Mr. Shapiro gets by on a very small amount of fixed income. He has heard there may be extra help paying for Part D prescription drugs for Medicare beneficiaries with limited income. He wants to know whether he might qualify. What should you tell him? - --CORRECT ANSWER-- - Choose one --CORRECT ANSWER--. - --CORRECT ANSWER-- -