AHIP 2025–2026 Final Exam Test Bank | 120+ Real
Scenario-Based Questions & Verified Answers | 100%
Pass Guarantee
Thompson, a 68-year-old retiree, recently moved from Arizona to Florida to be
closer to her grandchildren. She had been enrolled in a Medicare Advantage (MA)
plan in Arizona for the last three years and was satisfied with her coverage.
However, after moving, she realized her current MA plan is not offered in her new
county of residence. She visits your insurance agency seeking help with
understanding her options. She is unsure whether she must stay with Medicare
Advantage or revert to Original Medicare, and she’s also concerned about
prescription drug coverage and continuity of care with her new doctor. She is
within 60 days of her move.
As a licensed and certified agent, what enrollment option is available to Mrs.
Thompson in this situation, and what would be the most appropriate guidance you
can offer to ensure she maintains continuous health coverage without penalties?
Answer:
Mrs. Thompson qualifies for a Special Enrollment Period (SEP) due to her
permanent move to a new service area where her current Medicare Advantage plan
is not offered. She can enroll in a new Medicare Advantage plan available in her
new Florida county or return to Original Medicare and, if desired, enroll in a
standalone Part D prescription drug plan. This SEP lasts for 2 full months after the
,month she moved, so she must act within that time frame to avoid a lapse in
coverage or late enrollment penalties for Part D. It is important to help her compare
MA plans available in her new area to ensure network compatibility and continued
medication coverage.
Question 2:
Mr. Jenkins is a 70-year-old Medicare beneficiary who has recently lost his
employer-sponsored retiree coverage due to company downsizing. He was
previously covered under a group plan that included both medical and prescription
benefits. Now that he no longer has this coverage, he is unsure what to do next. He
has not previously enrolled in any Medicare Part D plan, and he’s concerned about
coverage gaps and potential late enrollment penalties. Mr. Jenkins visits your office
10 days after his employer coverage ended and wants to know what steps he must
take to ensure continued coverage for both medical services and prescription drugs.
Answer:
Mr. Jenkins qualifies for a Special Enrollment Period (SEP) due to involuntary loss
of creditable drug coverage. He has two full months from the end of his employer-
sponsored plan to enroll in a Medicare Advantage plan with drug coverage
(MAPD) or a standalone Part D plan if he remains in Original Medicare. Enrolling
within this timeframe avoids a late enrollment penalty.
Question 3:
Ms. Nguyen is a 66-year-old Medicare beneficiary who enrolled in a Medicare
Advantage (MA) plan during the Annual Enrollment Period (AEP). Two months
later, she becomes dissatisfied with the network availability and wants to return to
,Original Medicare. She is unsure if she can switch plans and whether she needs a
prescription drug plan if she exits her MA coverage. She contacts you during
February, unsure of what to do next.
Answer:
Ms. Nguyen is eligible to use the Medicare Advantage Open Enrollment Period
(MA OEP), which runs from January 1 to March 31. During this time, she can
make a one-time switch from her current MA plan to another MA plan or disenroll
and return to Original Medicare. If she returns to Original Medicare, she must also
enroll in a Part D plan separately if she wants prescription drug coverage
Question 4:
Mr. Allen, age 72, recently watched a TV commercial advertising a Medicare
Advantage plan with zero-dollar premiums, vision and dental benefits, and free
transportation. He is currently enrolled in Original Medicare and a standalone Part
D plan but is interested in switching. He calls you on October 10 to ask if the
advertised plan is legitimate and whether he can switch to it immediately. He is not
enrolled in Medicaid or any other federal assistance program.
Answer:
Mr. Allen cannot switch immediately but may enroll in the new Medicare
Advantage plan during the Annual Enrollment Period (AEP), which runs from
October 15 to December 7. The effective date of the new plan would be January 1
of the following year. The commercial plan is legitimate but must be compared
carefully to his current coverage, particularly to ensure drug and provider network
needs are met.
, Question 5:
Mrs. Daniels is a Medicare beneficiary who has been receiving treatment for end-
stage renal disease (ESRD). She has always believed she was not eligible to enroll
in a Medicare Advantage plan due to her ESRD diagnosis. However, she recently
heard that rules have changed under the 21st Century Cures Act. She asks if she
can now consider enrolling in an MA plan and whether any restrictions apply.
Answer:
Yes, under the 21st Century Cures Act, effective January 1, 2021, individuals with
ESRD are eligible to enroll in Medicare Advantage plans. Mrs. Daniels may enroll
in an MA plan during applicable enrollment periods, such as AEP or a valid SEP.
She should ensure the MA plan meets her specialized care and dialysis network
needs.
Question 6:
You are meeting with a client who is dually eligible for Medicare and Medicaid.
They are interested in additional benefits such as dental, transportation, and over-
the-counter allowances. They are currently in a standard Medicare Advantage plan
and are unsure if they qualify for any special plans. They also frequently move
between care providers and want to minimize out-of-pocket costs.
Answer:
This client may be eligible for a Dual Eligible Special Needs Plan (D-SNP), which
offers coordinated care and extra benefits tailored for individuals enrolled in both
Medicare and Medicaid. D-SNPs can reduce out-of-pocket expenses and
streamline access to services. The client can change plans at any time through
Special Enrollment Periods available to dual-eligibles.
Scenario-Based Questions & Verified Answers | 100%
Pass Guarantee
Thompson, a 68-year-old retiree, recently moved from Arizona to Florida to be
closer to her grandchildren. She had been enrolled in a Medicare Advantage (MA)
plan in Arizona for the last three years and was satisfied with her coverage.
However, after moving, she realized her current MA plan is not offered in her new
county of residence. She visits your insurance agency seeking help with
understanding her options. She is unsure whether she must stay with Medicare
Advantage or revert to Original Medicare, and she’s also concerned about
prescription drug coverage and continuity of care with her new doctor. She is
within 60 days of her move.
As a licensed and certified agent, what enrollment option is available to Mrs.
Thompson in this situation, and what would be the most appropriate guidance you
can offer to ensure she maintains continuous health coverage without penalties?
Answer:
Mrs. Thompson qualifies for a Special Enrollment Period (SEP) due to her
permanent move to a new service area where her current Medicare Advantage plan
is not offered. She can enroll in a new Medicare Advantage plan available in her
new Florida county or return to Original Medicare and, if desired, enroll in a
standalone Part D prescription drug plan. This SEP lasts for 2 full months after the
,month she moved, so she must act within that time frame to avoid a lapse in
coverage or late enrollment penalties for Part D. It is important to help her compare
MA plans available in her new area to ensure network compatibility and continued
medication coverage.
Question 2:
Mr. Jenkins is a 70-year-old Medicare beneficiary who has recently lost his
employer-sponsored retiree coverage due to company downsizing. He was
previously covered under a group plan that included both medical and prescription
benefits. Now that he no longer has this coverage, he is unsure what to do next. He
has not previously enrolled in any Medicare Part D plan, and he’s concerned about
coverage gaps and potential late enrollment penalties. Mr. Jenkins visits your office
10 days after his employer coverage ended and wants to know what steps he must
take to ensure continued coverage for both medical services and prescription drugs.
Answer:
Mr. Jenkins qualifies for a Special Enrollment Period (SEP) due to involuntary loss
of creditable drug coverage. He has two full months from the end of his employer-
sponsored plan to enroll in a Medicare Advantage plan with drug coverage
(MAPD) or a standalone Part D plan if he remains in Original Medicare. Enrolling
within this timeframe avoids a late enrollment penalty.
Question 3:
Ms. Nguyen is a 66-year-old Medicare beneficiary who enrolled in a Medicare
Advantage (MA) plan during the Annual Enrollment Period (AEP). Two months
later, she becomes dissatisfied with the network availability and wants to return to
,Original Medicare. She is unsure if she can switch plans and whether she needs a
prescription drug plan if she exits her MA coverage. She contacts you during
February, unsure of what to do next.
Answer:
Ms. Nguyen is eligible to use the Medicare Advantage Open Enrollment Period
(MA OEP), which runs from January 1 to March 31. During this time, she can
make a one-time switch from her current MA plan to another MA plan or disenroll
and return to Original Medicare. If she returns to Original Medicare, she must also
enroll in a Part D plan separately if she wants prescription drug coverage
Question 4:
Mr. Allen, age 72, recently watched a TV commercial advertising a Medicare
Advantage plan with zero-dollar premiums, vision and dental benefits, and free
transportation. He is currently enrolled in Original Medicare and a standalone Part
D plan but is interested in switching. He calls you on October 10 to ask if the
advertised plan is legitimate and whether he can switch to it immediately. He is not
enrolled in Medicaid or any other federal assistance program.
Answer:
Mr. Allen cannot switch immediately but may enroll in the new Medicare
Advantage plan during the Annual Enrollment Period (AEP), which runs from
October 15 to December 7. The effective date of the new plan would be January 1
of the following year. The commercial plan is legitimate but must be compared
carefully to his current coverage, particularly to ensure drug and provider network
needs are met.
, Question 5:
Mrs. Daniels is a Medicare beneficiary who has been receiving treatment for end-
stage renal disease (ESRD). She has always believed she was not eligible to enroll
in a Medicare Advantage plan due to her ESRD diagnosis. However, she recently
heard that rules have changed under the 21st Century Cures Act. She asks if she
can now consider enrolling in an MA plan and whether any restrictions apply.
Answer:
Yes, under the 21st Century Cures Act, effective January 1, 2021, individuals with
ESRD are eligible to enroll in Medicare Advantage plans. Mrs. Daniels may enroll
in an MA plan during applicable enrollment periods, such as AEP or a valid SEP.
She should ensure the MA plan meets her specialized care and dialysis network
needs.
Question 6:
You are meeting with a client who is dually eligible for Medicare and Medicaid.
They are interested in additional benefits such as dental, transportation, and over-
the-counter allowances. They are currently in a standard Medicare Advantage plan
and are unsure if they qualify for any special plans. They also frequently move
between care providers and want to minimize out-of-pocket costs.
Answer:
This client may be eligible for a Dual Eligible Special Needs Plan (D-SNP), which
offers coordinated care and extra benefits tailored for individuals enrolled in both
Medicare and Medicaid. D-SNPs can reduce out-of-pocket expenses and
streamline access to services. The client can change plans at any time through
Special Enrollment Periods available to dual-eligibles.
