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Free AHIP Medicare Plus FWA Practice Questions

10 free, exam-style AHIP Medicare Plus FWA (AHIP Medicare Plus FWA) practice questions with answers and explanations. No signup required. Work through them below, then take the full free AHIP Medicare Plus FWA practice test to study every exam domain.

Question 1

Mrs. Rivera has been enrolled in Original Medicare for three years and has never had a Medicare Advantage plan. It is February 10th and she contacts an agent asking about joining an MA plan. What should the agent advise?

  1. She may enroll now - the MA Open Enrollment Period runs January 1 through March 31 and is open to all Medicare beneficiaries who wish to join or change plans
  2. She cannot use the MA Open Enrollment Period; it is only available to beneficiaries who are already enrolled in a Medicare Advantage plan
  3. She may use the General Enrollment Period to join an MA plan, with coverage beginning the month after her application is received
  4. She is eligible to enroll at any time of year since she has remained continuously enrolled in Original Medicare for more than 24 months
Show answer & explanation

Correct answer: B - She cannot use the MA Open Enrollment Period; it is only available to beneficiaries who are already enrolled in a Medicare Advantage plan

Question 2

Mr. Thompson initiates a phone call to an insurance agency asking about Medicare Advantage plans and says he would like to meet tomorrow afternoon. Which of the following accurately describes the agent's Scope of Appointment obligation?

  1. The agent must collect a signed SOA immediately and allow the required 48-hour cooling-off period before the appointment can be scheduled for tomorrow
  2. A verbal SOA collected on this call is sufficient, and the agent may proceed with tomorrow's appointment without any further documentation
  3. Because Mr. Thompson initiated the call, the 48-hour wait is waived - though he must still sign a Scope of Appointment before the meeting
  4. No Scope of Appointment is required because the beneficiary made first contact, and the agent may discuss plan specifics immediately
Show answer & explanation

Correct answer: C - Because Mr. Thompson initiated the call, the 48-hour wait is waived - though he must still sign a Scope of Appointment before the meeting

Question 3

By October, Mrs. Chen has accumulated $2,100 in out-of-pocket costs for her covered Part D drugs under her standalone PDP. What is her cost-sharing responsibility for covered drugs for the remainder of the plan year?

  1. She continues to pay 25% coinsurance through December 31, as the initial coverage phase applies for the full plan year
  2. Her cost-sharing drops to 5% under the catastrophic coverage rules for the remainder of the year
  3. Her monthly premium is waived for the final months of the year to offset the drug costs she has incurred
  4. She pays $0 for all covered Part D drugs for the rest of the plan year
Show answer & explanation

Correct answer: D - She pays $0 for all covered Part D drugs for the rest of the plan year

Question 4

Mr. Patel is enrolled in an HMO Medicare Advantage plan that includes prescription drug coverage (MA-PD). He finds a standalone Part D plan with lower premiums and submits an enrollment application. What will occur as a result?

  1. He will be automatically disenrolled from his MA plan and returned to Original Medicare
  2. He will be enrolled in both plans and may use whichever provides lower cost-sharing for each individual prescription
  3. The Part D plan will absorb the drug benefit, and Mr. Patel will retain all other medical benefits under his MA-HMO plan
  4. CMS will deny the Part D enrollment application because MA-PD enrollees are prohibited from applying for standalone drug coverage
Show answer & explanation

Correct answer: A - He will be automatically disenrolled from his MA plan and returned to Original Medicare

Question 5

Mrs. Washington is enrolled in the Qualified Medicare Beneficiary (QMB) program. After a routine physician visit, she receives a bill from the provider's office charging her the standard Part B deductible. Which of the following is correct?

  1. She must pay the deductible; QMB only covers Part B premiums and does not waive beneficiary cost-sharing obligations
  2. She should contact her state Medicaid office to request retroactive reimbursement for the amount billed
  3. The provider is prohibited by federal law from billing her for this amount, and she does not owe it
  4. She may negotiate a reduced payment directly with the provider, since QMB beneficiaries are entitled to discounted rather than fully waived cost-sharing
Show answer & explanation

Correct answer: C - The provider is prohibited by federal law from billing her for this amount, and she does not owe it

Question 6

An independent agent represents eight Medicare Advantage organizations offering a combined twenty products in the local service area. A prospective enrollee calls with questions about plan options. What must the agent disclose within the first minute of the call?

  1. That the agent is not employed by or affiliated with the federal government or CMS, does not speak on behalf of any Medicare program, and has no authority to make coverage decisions on behalf of any government entity
  2. The number of organizations and products represented, and how the beneficiary can reach Medicare.gov, 1-800-MEDICARE, and SHIP for a complete view of local options
  3. The agent's state license number, National Producer Number, and the full legal name of each organization they are contracted with in the service area
  4. A statement that Medicare Advantage plans are not government-endorsed, that benefits vary by insurer, and that the agent receives commissions on plan enrollments
Show answer & explanation

Correct answer: B - The number of organizations and products represented, and how the beneficiary can reach Medicare.gov, 1-800-MEDICARE, and SHIP for a complete view of local options

Question 7

Mrs. Johnson's Part D plan sends her a 'Likely to Benefit' notice indicating her projected out-of-pocket drug costs will exceed $2,000 for the year. She asks her agent about the Medicare Prescription Payment Plan (M3P). Which of the following is accurate?

  1. Enrollment is automatic for any beneficiary whose plan issues a 'Likely to Benefit' notice, and no action is required on her part
  2. M3P is only available to beneficiaries who also qualify for the Low-Income Subsidy, as it is specifically designed for limited-income enrollees
  3. M3P allows beneficiaries to defer their drug costs to the following plan year, with a small processing fee charged by the plan
  4. Mrs. Johnson can choose to opt in and spread her out-of-pocket drug costs across monthly installments with no added interest or fees
Show answer & explanation

Correct answer: D - Mrs. Johnson can choose to opt in and spread her out-of-pocket drug costs across monthly installments with no added interest or fees

Question 8

Mr. Rodriguez is a full dual-eligible beneficiary currently enrolled in an MA-HMO plan. In March, he contacts an agent wanting to switch to a different MA-HMO plan with better dental benefits, and believes his dual-eligible status gives him a monthly enrollment right. What should the agent explain?

  1. Mr. Rodriguez can switch to any Medicare Advantage plan at any time during the year because full dual-eligible beneficiaries have a continuous monthly Special Enrollment Period
  2. The Dual/LIS SEP can only be used to enroll in a standalone Part D plan or return to Original Medicare - it does not permit switching between MA plans
  3. He must wait until the Annual Election Period in October, as no Special Enrollment Period allows mid-year Medicare Advantage plan changes for dual-eligible beneficiaries
  4. He may switch MA plans using the Integrated Care SEP, which is available to all dual-eligible beneficiaries regardless of their current plan type or Medicaid arrangement
Show answer & explanation

Correct answer: B - The Dual/LIS SEP can only be used to enroll in a standalone Part D plan or return to Original Medicare - it does not permit switching between MA plans

Question 9

Dr. Harrison's billing department submits Medicare claims for physical therapy sessions that were never performed. Separately, Dr. Harrison also orders a comprehensive lab panel for every patient visit regardless of clinical indication. How should these two practices be classified?

  1. Billing for services not rendered is fraud; routinely ordering medically unnecessary tests is waste
  2. Both practices constitute fraud, because each results in Medicare reimbursing services that were not medically justified
  3. Billing for unperformed services is abuse; ordering unnecessary tests is fraud, because it reflects an established pattern of improper billing conduct
  4. Both practices constitute waste, because classifying conduct as fraud requires a formal government investigation, and neither has been formally investigated
Show answer & explanation

Correct answer: A - Billing for services not rendered is fraud; routinely ordering medically unnecessary tests is waste

Question 10

Mrs. Evans became eligible for Medicare in June 2022 and enrolled in Part B that same month. She is shopping for a Medigap policy and is interested in Plan F because her neighbor, who enrolled in 2015, has it and recommends it highly. What should the agent explain?

  1. Plan F may be available to her, but carriers can require medical underwriting since she has likely passed the six-month Medigap Open Enrollment Period
  2. Plan F is still available and provides the most comprehensive Medigap coverage, though Plan G offers nearly identical benefits at a lower premium
  3. Plan F is not available to Mrs. Evans because she first became eligible for Medicare on or after January 1, 2020
  4. Plan F is unavailable only if Mrs. Evans was already enrolled in a Medigap policy on January 1, 2020 - since she was not enrolled at that time, she may still apply for it
Show answer & explanation

Correct answer: C - Plan F is not available to Mrs. Evans because she first became eligible for Medicare on or after January 1, 2020

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