2025/2026 AHIP QUESTIONS AND CORRECT ANSWERS
One of your clients, Lauren Nichols, has heard about a Medicare concept from one of her neighbors
called TrOOP. She asks you to explain it. What do you say? - Correct Answer: TrOOP stands for true outof-pocket expenses that count toward the Medicare Part D catastrophic limit and include not
onlyexpenses paid by a benefi ciary but also in some instances drug manufacturer discounts.
Mrs. Chou likes a Private Fee-for-Service (PFFS) plan available in her area that does not include drug
coverage. She wants to enroll in theplan and enroll in a stand-alone prescription drug plan. What should
you tell her? - Correct Answer: She could enroll in a PFFS plan and a stand-alone Medicare prescription
drug plan
Mr. Hutchinson has drug coverage through his former employer's retiree plan. He is concerned about the
Part D premium penalty if he does notenroll in a Medicare prescription drug plan, but does not want to
purchase extra coverage that he will not need. What should you tell him? - Correct Answer: If the drug
coverage he has is not expected to pay, on average, at least as much as Medicare's standard Part D
coverageexpects to pay, then he will need to enroll in Medicare Part D during his initial eligibility period
to avoid the late enrollmentpenalty.
Mr.
Robinson was quite ill recently and forgot to pay his
monthly premium for his MA-PD plan. He
is worried that he will lose his coverage nowwhen he needs it the most. He is certain his plan will
disenroll him
because that is what happened to a friend of his in a similar type of
plan. What can you tell Mr. Robinson about
his situation? - Correct Answer: Plan sponsors have the option to do nothing
when a plan member does not pay their premiums or disenroll the member after a
graceperiod and notice
 - Correct Answer: Mr. Alonso receives some help paying for his two generic prescription drugs from his
employer's retiree coverage, but he wants tocompare it to a Part D prescription drug plan. He asks you