A+ Graded Paper
AHIP Final Exam 2025&2026 - 200 Verified
Questions & A+ Answers
Questions and Mark scheme
Version: Final 1.1
, 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? - ✔✔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? - ✔✔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? - ✔✔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? - ✔✔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? - ✔✔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 Rodgers sees Dr. Brennan for treatment. How much may Dr. Brennan charge? - ✔✔Dr. Brennan can
charge Mary Rogers no more than the cost sharing specified in the PFFS plan's terms and condition of payment which
may include balance billing up to 15%of the Medicare rate.
Mrs. Kelly, age 65, is entitled to Part A but has not yet enrolled in Part B. She is considering enrollment in a Medicare
Advantage plan (Part C). What should you advise her to do before she can enroll in a Medicare Advantage plan? - ✔✔To
join a Medicare Advantage plan, she also must enroll in Part B.
Mr. Wells is trying to understand the difference between Original Medicare and Medicare Advantage. What would be
the correct description? - ✔✔Medicare Advantage is a way of covering all the Original Medicare benefits through private
health insurance companies.
Mr. Lombardi is interested in a Medicare Advantage (MA) PPO plan that you represent. It is one of three plans operated
by the same organization in Mr. Lombardi's area. The MA PPO plan does not include drug coverage, but the other two
AHIP Final Exam 2025&2026 - 200 Verified
Questions & A+ Answers
Questions and Mark scheme
Version: Final 1.1
, 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? - ✔✔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? - ✔✔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? - ✔✔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? - ✔✔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? - ✔✔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 Rodgers sees Dr. Brennan for treatment. How much may Dr. Brennan charge? - ✔✔Dr. Brennan can
charge Mary Rogers no more than the cost sharing specified in the PFFS plan's terms and condition of payment which
may include balance billing up to 15%of the Medicare rate.
Mrs. Kelly, age 65, is entitled to Part A but has not yet enrolled in Part B. She is considering enrollment in a Medicare
Advantage plan (Part C). What should you advise her to do before she can enroll in a Medicare Advantage plan? - ✔✔To
join a Medicare Advantage plan, she also must enroll in Part B.
Mr. Wells is trying to understand the difference between Original Medicare and Medicare Advantage. What would be
the correct description? - ✔✔Medicare Advantage is a way of covering all the Original Medicare benefits through private
health insurance companies.
Mr. Lombardi is interested in a Medicare Advantage (MA) PPO plan that you represent. It is one of three plans operated
by the same organization in Mr. Lombardi's area. The MA PPO plan does not include drug coverage, but the other two
