NURSING 412 AHIP Final Exam Questions
with 100% Correct Detailed Verified Answers
2025/2026
Introduction:
This document provides the complete Nursing 412 AHIP Final Exam
for the academic year 2025/2026, including all questions with
100% correct, verified, and detailed answers. It covers a wide
range of exam-relevant topics such as Medicare, Medicaid, AHIP
compliance, health insurance policies, patient rights, managed care,
and healthcare ethics. The material is designed to help nursing
students prepare thoroughly and succeed in their AHIP final exam.
,Exam Questions and Answers:
Mr. Castillo, a naturalized citizen, previously enrolled in Medicare
Part B but has recently stopped paying his Part B premium. Mr.
Castillo is still covered by Part A. 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.
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? --- correct 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.
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? --- correct 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.
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? --- correct answer ---She can enroll in the PPO, but she
will not be able to purchase a stand-alone Medicare Part D
prescription drug plan.
Mr. Gomez notes that a Private Fee-for-Service (PFFS) plan
available in his area has an attractive premium. He wants to know
if he must use doctors in a network as his current HMO plan
requires him to do. What should you tell him? --- correct answer ---
He may receive health care services from any doctor allowed to bill
Medicare, as long as he shows the doctor the plan's identification
card and the doctor agrees to accept the PFFS plan's payment terms
and conditions, which could include balance billing.
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 have a higher cost-sharing amount if
she sees a provider who/that is not a part of the PPO network.
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? --- correct 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.
Which of the following statement(s) is/are correct about a
Medicare Savings Account (MSA) Plans? --- correct answer ---MSAs
may have either a partial network, full network, or no network of
providers. MSA plans cover Part A and Part B benefits but not Part
D prescription drug benefits. Non-network providers must accept
the same amount that Original Medicare would pay them as
payment in full.
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.
Mrs. Wang wants to know generally how the benefits under
Original Medicare might compare to the benefits package of a
Medicare Advantage Plan before she starts looking at specific plans.
What could you tell her? --- correct answer ---Medicare Advantage
Plans do not necessarily have to cover all of the Original Medicare
Part A and Part B services but must include a maximum out-of-
pocket limit.
with 100% Correct Detailed Verified Answers
2025/2026
Introduction:
This document provides the complete Nursing 412 AHIP Final Exam
for the academic year 2025/2026, including all questions with
100% correct, verified, and detailed answers. It covers a wide
range of exam-relevant topics such as Medicare, Medicaid, AHIP
compliance, health insurance policies, patient rights, managed care,
and healthcare ethics. The material is designed to help nursing
students prepare thoroughly and succeed in their AHIP final exam.
,Exam Questions and Answers:
Mr. Castillo, a naturalized citizen, previously enrolled in Medicare
Part B but has recently stopped paying his Part B premium. Mr.
Castillo is still covered by Part A. 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.
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? --- correct 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.
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? --- correct 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.
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? --- correct answer ---She can enroll in the PPO, but she
will not be able to purchase a stand-alone Medicare Part D
prescription drug plan.
Mr. Gomez notes that a Private Fee-for-Service (PFFS) plan
available in his area has an attractive premium. He wants to know
if he must use doctors in a network as his current HMO plan
requires him to do. What should you tell him? --- correct answer ---
He may receive health care services from any doctor allowed to bill
Medicare, as long as he shows the doctor the plan's identification
card and the doctor agrees to accept the PFFS plan's payment terms
and conditions, which could include balance billing.
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 have a higher cost-sharing amount if
she sees a provider who/that is not a part of the PPO network.
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? --- correct 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.
Which of the following statement(s) is/are correct about a
Medicare Savings Account (MSA) Plans? --- correct answer ---MSAs
may have either a partial network, full network, or no network of
providers. MSA plans cover Part A and Part B benefits but not Part
D prescription drug benefits. Non-network providers must accept
the same amount that Original Medicare would pay them as
payment in full.
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.
Mrs. Wang wants to know generally how the benefits under
Original Medicare might compare to the benefits package of a
Medicare Advantage Plan before she starts looking at specific plans.
What could you tell her? --- correct answer ---Medicare Advantage
Plans do not necessarily have to cover all of the Original Medicare
Part A and Part B services but must include a maximum out-of-
pocket limit.
