AHIP Final Exam Newest 2025 Exam
AHIP FINAL EXAM NEWEST 2025 EXAM COMPLETE QUESTIONS
AND CORRECT DETAILED ANSWERS (VERIFIED ANSWERS)
|ALREADY GRADED A+
Mr. Diaz continued working with his company and was insured under his employer's group plan
until he reached age 68. He has heard that there is a premium penalty for those who did not
sign up for Part B when first eligible and wants to know how much he will have to pay. What
should you tell him? - ANSWER-Mr. Diaz will not pay any penalty because he had continuous
coverage under his employer's plan.
Anita Magri will turn age 65 in August 2023. Anita intends to enroll in Original Medicare Part A
and Part B. She would also like to enroll in a Medicare Supplement (Medigap) plan. Anita's older
neighbor Mel has told her about the Medigap Plan F in which he is enrolled. It not only provides
foreign travel emergency benefits but also covers his Medicare Part B deductible. Anita comes
to you for advice. What should you tell her? - ANSWER-You are sorry to disappoint Anita, but a
Medigap F plan is no longer available to those who turn age 65 after January 1, 2020. Anita
might instead consider other Medigap plans that offer foreign travel benefits but do not cover
the Part B deductible.
Hank's Fish Store, Inc. is a small company with just 15 employees located in Florida. Hank, the
store owner, has provided excellent health benefits to the store's workforce. William, one of the
store's long-time employees, will soon be reaching age 65 and eligible for Medicare. William is
in good health. He intends to remain an active full-time employee, working several years after
becoming eligible for Medicare. What type(s) of retiree health benefit will Hank's Fish Store be
able to offer William? - ANSWER-Hank's can continue to offer William the same employee
health benefit plan, or, if William enrolls in Medicare Part B, it can enroll him in a Medicare
Advantage plan that is offered to the public.
Mr. Sanchez has just turned 65 and is entitled to Part A but has not enrolled in Part B because
he has coverage through an employer plan. If he wants to enroll in a Medicare Advantage plan,
what will he have to do? - ANSWER-He will have to enroll in Part B.
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, AHIP Final Exam Newest 2025 Exam
Mrs. Velasquez cares for her frail elderly mother, Maria, who lives in North Carolina. She is
worried that without additional support, her mother will need to go into a nursing home. Mrs.
Velasquez asks you if there is any Medicare plan that might allow her mother to remain in the
community rather than going into a nursing home. How should you advise Mrs. Velasquez? -
ANSWER-There are Programs of All-Inclusive Care for the Elderly (PACE) for frail elderly
beneficiaries certified as needing a nursing home level of care but are able to live safely in the
community at the time of enrolment.
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.
2|Page
, AHIP Final Exam Newest 2025 Exam
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 Rodgers sees Dr. Brennan for treatment. How much may Dr.
Brennan charge? - ANSWER-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.
3|Page
AHIP FINAL EXAM NEWEST 2025 EXAM COMPLETE QUESTIONS
AND CORRECT DETAILED ANSWERS (VERIFIED ANSWERS)
|ALREADY GRADED A+
Mr. Diaz continued working with his company and was insured under his employer's group plan
until he reached age 68. He has heard that there is a premium penalty for those who did not
sign up for Part B when first eligible and wants to know how much he will have to pay. What
should you tell him? - ANSWER-Mr. Diaz will not pay any penalty because he had continuous
coverage under his employer's plan.
Anita Magri will turn age 65 in August 2023. Anita intends to enroll in Original Medicare Part A
and Part B. She would also like to enroll in a Medicare Supplement (Medigap) plan. Anita's older
neighbor Mel has told her about the Medigap Plan F in which he is enrolled. It not only provides
foreign travel emergency benefits but also covers his Medicare Part B deductible. Anita comes
to you for advice. What should you tell her? - ANSWER-You are sorry to disappoint Anita, but a
Medigap F plan is no longer available to those who turn age 65 after January 1, 2020. Anita
might instead consider other Medigap plans that offer foreign travel benefits but do not cover
the Part B deductible.
Hank's Fish Store, Inc. is a small company with just 15 employees located in Florida. Hank, the
store owner, has provided excellent health benefits to the store's workforce. William, one of the
store's long-time employees, will soon be reaching age 65 and eligible for Medicare. William is
in good health. He intends to remain an active full-time employee, working several years after
becoming eligible for Medicare. What type(s) of retiree health benefit will Hank's Fish Store be
able to offer William? - ANSWER-Hank's can continue to offer William the same employee
health benefit plan, or, if William enrolls in Medicare Part B, it can enroll him in a Medicare
Advantage plan that is offered to the public.
Mr. Sanchez has just turned 65 and is entitled to Part A but has not enrolled in Part B because
he has coverage through an employer plan. If he wants to enroll in a Medicare Advantage plan,
what will he have to do? - ANSWER-He will have to enroll in Part B.
1|Page
, AHIP Final Exam Newest 2025 Exam
Mrs. Velasquez cares for her frail elderly mother, Maria, who lives in North Carolina. She is
worried that without additional support, her mother will need to go into a nursing home. Mrs.
Velasquez asks you if there is any Medicare plan that might allow her mother to remain in the
community rather than going into a nursing home. How should you advise Mrs. Velasquez? -
ANSWER-There are Programs of All-Inclusive Care for the Elderly (PACE) for frail elderly
beneficiaries certified as needing a nursing home level of care but are able to live safely in the
community at the time of enrolment.
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.
2|Page
, AHIP Final Exam Newest 2025 Exam
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 Rodgers sees Dr. Brennan for treatment. How much may Dr.
Brennan charge? - ANSWER-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.
3|Page
