AHIP FINAL EXAM 200 REVISION HANDBOOK
2026 COMPLIANCE RULES AND ENROLLMENT
GUIDELINES
◉ Which of the following statement(s) is/are correct about a
Medicare Savings Account (MSA) Plans?
I. MSAs may have either a partial network, full network, or no
network of providers.
II. MSA plans cover Part A and Part B benefits but not Part D
prescription drug benefits.
III. An individual who is enrolled in an MSA plan is responsible for a
minimal deductible of $500 indexed for inflation.
IV. Non-network providers must accept the same amount that
Original Medicare would pay them as payment in full.
Answer: I, II, and IV only
◉ Mrs. Chi is age 75 and enjoys a comfortable but not extremely
high-income level. She wishes to enroll in a MA MSA plan that she
heard about from her neighbor. She also wants to have prescription
drug coverage since her doctor recently prescribed several
expensive medications. Currently, she is enrolled in Original
Medicare and a standalone Part D plan. How would you advise Mrs.
Chi?
,Answer: Mrs. Chi may enroll in a MA MSA plan and remain in her
current standalone Part D prescription drug plan.
◉ Mrs. Lyons is in good health, uses a single prescription, and lives
independently in her own home. She is attracted by the idea of
maintaining control over a Medical Savings Account (MSA) but is not
sure if the plan associated with the account will fit her needs. What
specific piece of information about a Medicare MSA plan would it be
important for her to know, prior to enrolling in such a plan?
Answer: All MSAs cover Part A and Part B benefits, but not Part D
prescription drug benefits, which could be obtained by also
enrolling in a separate prescription drug plan.
◉ Mrs. Burton is a retiree with substantial income. She is enrolled in
an MA-PD plan and was disappointed with the service she received
from her primary care physician because she was told she would
have to wait five weeks to get an appointment when she was feeling
ill. She called you to ask what she could do so she would not have to
put up with such poor access to care. What could you tell her?
Answer: She could file a grievance with her plan to complain about
the lack of timeliness in getting an appointment.
◉ Mrs. Radford asks whether there are any special eligibility
requirements for Medicare Advantage. What should you tell her?
Answer: Mrs. Radford must be entitled to Part A and enrolled in Part
B to enroll in Medicare Advantage.
, ◉ Mr. Kelly wants to know whether he is eligible to sign up for a
private fee-for-service (PFFS) plan. What questions would you need
to ask to determine his eligibility?
Answer: You would need to ask Mr. Kelly if he is entitled to Part A,
enrolled in Part B, and if he lives in the PFFS plan's service area.
◉ Mr. Romero is 64, retiring soon, and considering enrollment in his
employer-sponsored retiree group health plan that includes drug
coverage with nominal copays. He heard about a neighbor's MA-PD
plan that you represent and because he takes numerous prescription
drugs, he is considering signing up for it. What should you tell him?
Answer: He should compare the benefits in his employer-sponsored
retiree group health plan with the benefits in his neighbor's MA-PD
plan to determine which one will provide sufficient coverage for his
prescription needs.
◉ Ms. Gibson recently lost her employer group health and drug
coverage and now she wants to enroll in a PPO that does not include
drug coverage. What should you tell her about obtaining drug
coverage?
Answer: She can enroll in the PPO, but she will not be able to
purchase a stand-alone Medicare Part D prescription drug plan.
◉ Dr. Elizabeth Brennan does not contract with the ABC PFFS plan
but accepts the plan's terms and conditions for payment. Mary
2026 COMPLIANCE RULES AND ENROLLMENT
GUIDELINES
◉ Which of the following statement(s) is/are correct about a
Medicare Savings Account (MSA) Plans?
I. MSAs may have either a partial network, full network, or no
network of providers.
II. MSA plans cover Part A and Part B benefits but not Part D
prescription drug benefits.
III. An individual who is enrolled in an MSA plan is responsible for a
minimal deductible of $500 indexed for inflation.
IV. Non-network providers must accept the same amount that
Original Medicare would pay them as payment in full.
Answer: I, II, and IV only
◉ Mrs. Chi is age 75 and enjoys a comfortable but not extremely
high-income level. She wishes to enroll in a MA MSA plan that she
heard about from her neighbor. She also wants to have prescription
drug coverage since her doctor recently prescribed several
expensive medications. Currently, she is enrolled in Original
Medicare and a standalone Part D plan. How would you advise Mrs.
Chi?
,Answer: Mrs. Chi may enroll in a MA MSA plan and remain in her
current standalone Part D prescription drug plan.
◉ Mrs. Lyons is in good health, uses a single prescription, and lives
independently in her own home. She is attracted by the idea of
maintaining control over a Medical Savings Account (MSA) but is not
sure if the plan associated with the account will fit her needs. What
specific piece of information about a Medicare MSA plan would it be
important for her to know, prior to enrolling in such a plan?
Answer: All MSAs cover Part A and Part B benefits, but not Part D
prescription drug benefits, which could be obtained by also
enrolling in a separate prescription drug plan.
◉ Mrs. Burton is a retiree with substantial income. She is enrolled in
an MA-PD plan and was disappointed with the service she received
from her primary care physician because she was told she would
have to wait five weeks to get an appointment when she was feeling
ill. She called you to ask what she could do so she would not have to
put up with such poor access to care. What could you tell her?
Answer: She could file a grievance with her plan to complain about
the lack of timeliness in getting an appointment.
◉ Mrs. Radford asks whether there are any special eligibility
requirements for Medicare Advantage. What should you tell her?
Answer: Mrs. Radford must be entitled to Part A and enrolled in Part
B to enroll in Medicare Advantage.
, ◉ Mr. Kelly wants to know whether he is eligible to sign up for a
private fee-for-service (PFFS) plan. What questions would you need
to ask to determine his eligibility?
Answer: You would need to ask Mr. Kelly if he is entitled to Part A,
enrolled in Part B, and if he lives in the PFFS plan's service area.
◉ Mr. Romero is 64, retiring soon, and considering enrollment in his
employer-sponsored retiree group health plan that includes drug
coverage with nominal copays. He heard about a neighbor's MA-PD
plan that you represent and because he takes numerous prescription
drugs, he is considering signing up for it. What should you tell him?
Answer: He should compare the benefits in his employer-sponsored
retiree group health plan with the benefits in his neighbor's MA-PD
plan to determine which one will provide sufficient coverage for his
prescription needs.
◉ Ms. Gibson recently lost her employer group health and drug
coverage and now she wants to enroll in a PPO that does not include
drug coverage. What should you tell her about obtaining drug
coverage?
Answer: She can enroll in the PPO, but she will not be able to
purchase a stand-alone Medicare Part D prescription drug plan.
◉ Dr. Elizabeth Brennan does not contract with the ABC PFFS plan
but accepts the plan's terms and conditions for payment. Mary
