AHIP Module 2 Exam Review – Medicare
Advantage Plans, SNPs, HMOs, PPOs & PFFS|
Verified Questions Provided with A+ Graded
Rationales Latest Updated 2026
Mr. Lopez has heard that he can sign up for a product called "Medicare Advantage" but is not
sure about what type of plan designs are available through this program. What should you tell
him about the types of health plans that are available through the Medicare Advantage
program?
a. They are Medicare health plans such as HMOs, PPOs, PFFS, and MSAs. Correct
Mr. Wells is trying to understand the difference between Original Medicare and Medicare
Advantage. What would be a correct description?
b. Medicare Advantage is a way of covering all the Original Medicare benefits through private
health insurance companies. Correct
Mrs. Radford asks whether there are any special eligibility requirements for Medicare
Advantage. What should you tell her?
d. Mrs. Radford must be entitled to Part A and enrolled in Part B to enroll in Medicare
Advantage. Correct
Mr. Castillo, a naturalized citizen, previously enrolled in Medicare Part B but has recently
stopped paying his Part B premium. Mr. Castillo is still covered by Part A. He would like to enroll
in a Medicare Advantage (MA) plan and is still covered by Part A. What should you tell him?
a. He is not eligible to enroll in a Medicare Advantage plan until he re-enrolls in Medicare Part B.
Correct
Mrs. Billings enrolled in the ABC Medicare Advantage (MA) plan several years ago. Her doctor
recently confirmed a diagnosis of end-stage renal disease (ESRD). What options does Mrs.
Billings have in regard to her MA plan during the next open enrollment season?
d. She may remain in her ABC MA plan or enroll in a Special Needs Plan (SNP) for individuals
suffering from ESRD if one is available in her area. Correct
, Daniel is a middle-income Medicare beneficiary. He has chronic bronchitis, putting him at severe
risk for pneumonia. Otherwise, he has no problems functioning. Which type of SNP is likely to
be most appropriate for him?
b. C-SNP Correct
Mr. Kumar is considering a Medicare Advantage HMO and has questions about his ability to
access providers. What should you tell him?
a. In most Medicare Advantage HMOs, Mr. Kumar must obtain his services only from providers
who have a contractual relationship with the plan (except in an emergency). Correct
Mrs. Ramos is considering a Medicare Advantage PPO and has questions about which providers
she can go to for her health care. What should you tell her?
d. Mrs. Ramos can obtain care from any provider who participates in Original Medicare, but
generally will have a higher cost-sharing amount if she sees a provider who/that is not part of
the PPO network. Correct
Mr. Sinclair has diabetes and heart trouble and is generally satisfied with the care he has
received under Original Medicare, but he would like to know more about Medicare Advantage
Special Needs Plans (SNPs). What could you tell him?
b. SNPs have special programs for enrollees with chronic conditions, like Mr. Sinclair, and they
provide prescription drug coverage that could be very helpful as well. Correct
Mr. Greco is in excellent health, lives in his own home, and has a sizeable income from his
investments. He has a friend enrolled in a Medicare Advantage Special Needs Plan (SNP). His
friend has mentioned that the SNP charges very low cost-sharing amounts and Mr. Greco would
like to join that plan. What should you tell him?
c. SNPs limit enrollment to certain sub-populations of beneficiaries. Given his current situation,
he is unlikely to qualify and would not be able to enroll in the SNP. Correct
Mr. Gomez notes that a Private Fee-for-Service (PFFS) plan available in his area has an attractive
premium. He wants to know if he must use doctors in a network like his current HMO plan
requires him to do. What should you tell him?
a. He may receive health care services from any doctor allowed to bill Medicare, as long as he
shows the doctor the plan's identification card and the doctor agrees to accept the PFFS plan's
payment terms and conditions, which could include balance billing. Correct
Mrs. Lee is discussing with you the possibility of enrolling in a Private Fee-for-Service (PFFS)
plan. As part of that discussion, what should you be sure to tell her?
Advantage Plans, SNPs, HMOs, PPOs & PFFS|
Verified Questions Provided with A+ Graded
Rationales Latest Updated 2026
Mr. Lopez has heard that he can sign up for a product called "Medicare Advantage" but is not
sure about what type of plan designs are available through this program. What should you tell
him about the types of health plans that are available through the Medicare Advantage
program?
a. They are Medicare health plans such as HMOs, PPOs, PFFS, and MSAs. Correct
Mr. Wells is trying to understand the difference between Original Medicare and Medicare
Advantage. What would be a correct description?
b. Medicare Advantage is a way of covering all the Original Medicare benefits through private
health insurance companies. Correct
Mrs. Radford asks whether there are any special eligibility requirements for Medicare
Advantage. What should you tell her?
d. Mrs. Radford must be entitled to Part A and enrolled in Part B to enroll in Medicare
Advantage. Correct
Mr. Castillo, a naturalized citizen, previously enrolled in Medicare Part B but has recently
stopped paying his Part B premium. Mr. Castillo is still covered by Part A. He would like to enroll
in a Medicare Advantage (MA) plan and is still covered by Part A. What should you tell him?
a. He is not eligible to enroll in a Medicare Advantage plan until he re-enrolls in Medicare Part B.
Correct
Mrs. Billings enrolled in the ABC Medicare Advantage (MA) plan several years ago. Her doctor
recently confirmed a diagnosis of end-stage renal disease (ESRD). What options does Mrs.
Billings have in regard to her MA plan during the next open enrollment season?
d. She may remain in her ABC MA plan or enroll in a Special Needs Plan (SNP) for individuals
suffering from ESRD if one is available in her area. Correct
, Daniel is a middle-income Medicare beneficiary. He has chronic bronchitis, putting him at severe
risk for pneumonia. Otherwise, he has no problems functioning. Which type of SNP is likely to
be most appropriate for him?
b. C-SNP Correct
Mr. Kumar is considering a Medicare Advantage HMO and has questions about his ability to
access providers. What should you tell him?
a. In most Medicare Advantage HMOs, Mr. Kumar must obtain his services only from providers
who have a contractual relationship with the plan (except in an emergency). Correct
Mrs. Ramos is considering a Medicare Advantage PPO and has questions about which providers
she can go to for her health care. What should you tell her?
d. Mrs. Ramos can obtain care from any provider who participates in Original Medicare, but
generally will have a higher cost-sharing amount if she sees a provider who/that is not part of
the PPO network. Correct
Mr. Sinclair has diabetes and heart trouble and is generally satisfied with the care he has
received under Original Medicare, but he would like to know more about Medicare Advantage
Special Needs Plans (SNPs). What could you tell him?
b. SNPs have special programs for enrollees with chronic conditions, like Mr. Sinclair, and they
provide prescription drug coverage that could be very helpful as well. Correct
Mr. Greco is in excellent health, lives in his own home, and has a sizeable income from his
investments. He has a friend enrolled in a Medicare Advantage Special Needs Plan (SNP). His
friend has mentioned that the SNP charges very low cost-sharing amounts and Mr. Greco would
like to join that plan. What should you tell him?
c. SNPs limit enrollment to certain sub-populations of beneficiaries. Given his current situation,
he is unlikely to qualify and would not be able to enroll in the SNP. Correct
Mr. Gomez notes that a Private Fee-for-Service (PFFS) plan available in his area has an attractive
premium. He wants to know if he must use doctors in a network like his current HMO plan
requires him to do. What should you tell him?
a. He may receive health care services from any doctor allowed to bill Medicare, as long as he
shows the doctor the plan's identification card and the doctor agrees to accept the PFFS plan's
payment terms and conditions, which could include balance billing. Correct
Mrs. Lee is discussing with you the possibility of enrolling in a Private Fee-for-Service (PFFS)
plan. As part of that discussion, what should you be sure to tell her?
