AHIP Exam Questions
and Answers
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,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? - Correct Answer: They are
Medicare health plans such as HMOs, PPOs, PFFS, SNPs, and MSAs
(W) Mr. Wells is trying to understand the difference between Original Medicare and Medicare
Advantage. What would be a correct description? - Correct Answer: Medicare Advantage is a way of
covering all of the Original Medicare benefits through private health insurance companies.
During a sales presentation in Ms. Sullivan's home, she tells you that she has heard about a type of
Medicare health plan known as Private Fee-for-Service (PFFS). She wants to know if this would be
available to her. What should you tell her about PFFS plans? - Correct Answer: A PFFS plan is one of
various types of Medicare Advantage plans offered by private entities and she may enroll in one if it is
available in her area.
(W) Mrs. Radford asks whether there are any special eligibility requirements for Medicare Advantage.
What should you tell her? - Correct Answer: Mrs. Radford must be entitled to Part A and enrolled in Part
B to enroll in Medicare Advantage
Mr. Castillo, a naturalized citizen, previously enrolled in Medicare Part B but has recently stopped paying
his Part B premium. He would like to enroll in a Medicare Advantage (MA) plan and is still covered by
Part A. What should you tell him? - Correct Answer: He is not eligible to enroll in a Medicare Advantage
plan until he re-enrolls in Medicare Part B
(W) 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? - Correct Answer: 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
Mr. Kumar is considering a Medicare Advantage HMO and has questions about his ability to access
providers. What should you tell him? - Correct Answer: 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).
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? - Correct Answer: Mrs. Ramos can obtain care from
, any provider who participates in Original Medicare, but generally will be charged a lower co-payment if
she goes to one of the plan's preferred providers.
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? - Correct Answer: 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
(W) 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? - Correct Answer: 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.
(W) Mrs. Chen will be 65 soon, has been a citizen for twelve years, has been employed full time, and
paid taxes during that entire period. She is concerned that she will not qualify for coverage under part A
because she was not born in the United States. What should you tell her? - Correct Answer: Most
individuals who are citizens and over age 65 are covered under Part A by virtue of having paid Medicare
taxes while working, though some may be covered as a result of paying monthly premiums.
(W) Mr. Bauer is 49 years old, but eighteen months ago he was declared disabled by the Social Security
Administration and has been receiving disability payments. He is wondering whether he can obtain
coverage under Medicare. What should you tell him? - Correct Answer: After receiving such disability
payments for 24 months, he will be automatically enrolled in Medicare, regardless of age.
(W) Mr. Davis is 49 years old and has been receiving disability benefits from the Social Security
Administration for 12 months. Can you sell him a Medicare Advantage or Part D Prescription Drug
policy? - Correct Answer: No, he cannot purchase a Medicare Advantage or Part D policy because he has
not received Social Security or Railroad Retirement disability benefits for 24 months.
(W) Ms. Henderson believes that she will qualify for Medicare coverage when she turns 65, without
paying any premiums, because she has been working for 40 years and paying Medicare taxes. What
should you tell her? - Correct Answer: In order to obtain Part B coverage, she must pay a standard
monthly premium, though it is higher for individuals with higher incomes
and Answers
User [Date] [Course title]
, ACADEMIC SUPPORT SERVICES
Our Services:
Proctored Exam Assistance
Online Class Management (Full Course Support)
Exam Preparation & Study Materials
Assignments and Coursework Support
Essay and Research Paper Writing
Discussion Posts & Responses
Editing and Proofreading
Confidential Academic Consultation
Contact Information:
Email:
WhatsApp: https://wa.me/254790523088
Your success is our priority. 100% Confidentiality Guaranteed.
,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? - Correct Answer: They are
Medicare health plans such as HMOs, PPOs, PFFS, SNPs, and MSAs
(W) Mr. Wells is trying to understand the difference between Original Medicare and Medicare
Advantage. What would be a correct description? - Correct Answer: Medicare Advantage is a way of
covering all of the Original Medicare benefits through private health insurance companies.
During a sales presentation in Ms. Sullivan's home, she tells you that she has heard about a type of
Medicare health plan known as Private Fee-for-Service (PFFS). She wants to know if this would be
available to her. What should you tell her about PFFS plans? - Correct Answer: A PFFS plan is one of
various types of Medicare Advantage plans offered by private entities and she may enroll in one if it is
available in her area.
(W) Mrs. Radford asks whether there are any special eligibility requirements for Medicare Advantage.
What should you tell her? - Correct Answer: Mrs. Radford must be entitled to Part A and enrolled in Part
B to enroll in Medicare Advantage
Mr. Castillo, a naturalized citizen, previously enrolled in Medicare Part B but has recently stopped paying
his Part B premium. He would like to enroll in a Medicare Advantage (MA) plan and is still covered by
Part A. What should you tell him? - Correct Answer: He is not eligible to enroll in a Medicare Advantage
plan until he re-enrolls in Medicare Part B
(W) 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? - Correct Answer: 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
Mr. Kumar is considering a Medicare Advantage HMO and has questions about his ability to access
providers. What should you tell him? - Correct Answer: 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).
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? - Correct Answer: Mrs. Ramos can obtain care from
, any provider who participates in Original Medicare, but generally will be charged a lower co-payment if
she goes to one of the plan's preferred providers.
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? - Correct Answer: 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
(W) 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? - Correct Answer: 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.
(W) Mrs. Chen will be 65 soon, has been a citizen for twelve years, has been employed full time, and
paid taxes during that entire period. She is concerned that she will not qualify for coverage under part A
because she was not born in the United States. What should you tell her? - Correct Answer: Most
individuals who are citizens and over age 65 are covered under Part A by virtue of having paid Medicare
taxes while working, though some may be covered as a result of paying monthly premiums.
(W) Mr. Bauer is 49 years old, but eighteen months ago he was declared disabled by the Social Security
Administration and has been receiving disability payments. He is wondering whether he can obtain
coverage under Medicare. What should you tell him? - Correct Answer: After receiving such disability
payments for 24 months, he will be automatically enrolled in Medicare, regardless of age.
(W) Mr. Davis is 49 years old and has been receiving disability benefits from the Social Security
Administration for 12 months. Can you sell him a Medicare Advantage or Part D Prescription Drug
policy? - Correct Answer: No, he cannot purchase a Medicare Advantage or Part D policy because he has
not received Social Security or Railroad Retirement disability benefits for 24 months.
(W) Ms. Henderson believes that she will qualify for Medicare coverage when she turns 65, without
paying any premiums, because she has been working for 40 years and paying Medicare taxes. What
should you tell her? - Correct Answer: In order to obtain Part B coverage, she must pay a standard
monthly premium, though it is higher for individuals with higher incomes
