1
AHIP EXAM NEWEST VERSION -2025/2026- 100+ QUESTIONS
AND VERIFIED ANSWERS 100% CORRECT GUARANTEED
SUCCESS
Mrs. Lester is age 75 and enjoys a comfortable but not extremely high-income
level. She wishes to enroll in an 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.
Lester?
Mrs. Lester may enroll in an MA MSA plan and remain in her current standalone
Part D prescription drug plan.
Mr. Kumar is considering a Medicare Advantage HMO and has questions about his
ability to access providers. What should you tell him?
In most Medicare Advantage HMOs, Mr. Kumar must generally obtain his services
only from providers within the plan's network (except in an emergency or where
care is unavailable within the network).
Mrs. Robles 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?
Mrs. Robles 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.
Mr. Dalton 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. Dalton would like to join that plan. What should you tell
him?
, 2
SNPs limit enrollment to certain subpopulations of beneficiaries. Given his current
situation, he is unlikely to qualify and would not be able to enroll in the SNP.
Mr. Anderson 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. Anderson if he is entitled to Part A, enrolled in Part B,
and if he lives in the PFFS plan's service area.
Herber Noble is turning 65 next month, Herber legally entered the United States
over twenty years ago but is not a citizen. Since his entry into the country, Herber
has worked at Smallcap Incorporated and contributed to the Medicare system.
Herber suffers from diabetes. He will soon retire and asks you if he can enroll in a
Medicare Advantage plan that you represent. How would you respond?
Herber is eligible to enroll in Medicare Advantage as long as he is entitled to Part
A and enrolled in Part B. Herber should go to the Social Security website to enroll
in Medicare Part A and B if he has not done so already. Once he is enrolled, he can
choose a Medicare Advantage plan.
Which of the following individuals is most likely to be eligible to enroll in a Part D
Plan?
Jose, a grandfather who was granted asylum and has worked in the United States
for many years.
Mrs. Castro has just turned 65, is in excellent health and has a relatively high
income. She uses no medications and sees no reason to spend money on a
Medicare prescription drug plan if she does not need the coverage. She currently
does not have creditable coverage. What could you tell her about the implications
of such a decision?
If she does not sign up for a Medicare prescription drug plan as soon as she is
eligible to do so, and if she does sign up at a later date, her premium will be
permanently increased by 1% of the national average premium for every month
that she was not covered.
, 3
Mr. Chen was still working when he first qualified for Medicare. At that time, he
had employer group coverage that was creditable. During his initial Part D
eligibility period, he decided not to enroll because he was satisfied with his drug
coverage. It is now a year later and Mr. Chen has lost his employer group coverage
within the last two weeks. How would you advise him?
Mr. Chen should enroll in a Part D plan before he has a 63-day break in coverage in
order to avoid a premium penalty.
Ms. Ramos is enrolled in a Medicare Advantage plan that includes prescription
drug plan (PDP) coverage. She is traveling and wishes to fill two of the
prescriptions that she has lost. How would you advise her?
She may fill prescriptions for covered drugs at non-network pharmacies, but likely
at a higher cost than paid at an in-network pharmacy.
What types of tools can Medicare Part D prescription drug plans use that affect
the way their enrollees can access medications?
Part D plans do not have to cover all medications. As a result, their formularies, or
lists of covered drugs, will vary from plan to plan. In addition, they can use cost
containment techniques such as tiered co-payments and step therapy.
Mrs. Esmeralda Avila is a Medicare beneficiary enrolled in a MA-PD plan you
represent. Her neighbor recently suffered from a painful case of shingles. Mrs.
Avila hopes to avoid such an illness through vaccination. She asks you whether the
cost of the shingles vaccination will be covered under the plan you represent.
What should you say?
Yes, there is no cost sharing for the shingles vaccine even in the deductible phase
of her prescription drug plan because it is an adult vaccine recommended by the
Advisory Committee on Immunization Practices (AICP).
Mrs. Strickland is a new Medicare beneficiary who has just retired from retail
work. She is interested in selecting a Medicare Part D prescription drug plan. She
takes several medications and is concerned that she has not been able to identify
a plan that covers all of her medications. She does not want to make an abrupt
AHIP EXAM NEWEST VERSION -2025/2026- 100+ QUESTIONS
AND VERIFIED ANSWERS 100% CORRECT GUARANTEED
SUCCESS
Mrs. Lester is age 75 and enjoys a comfortable but not extremely high-income
level. She wishes to enroll in an 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.
Lester?
Mrs. Lester may enroll in an MA MSA plan and remain in her current standalone
Part D prescription drug plan.
Mr. Kumar is considering a Medicare Advantage HMO and has questions about his
ability to access providers. What should you tell him?
In most Medicare Advantage HMOs, Mr. Kumar must generally obtain his services
only from providers within the plan's network (except in an emergency or where
care is unavailable within the network).
Mrs. Robles 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?
Mrs. Robles 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.
Mr. Dalton 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. Dalton would like to join that plan. What should you tell
him?
, 2
SNPs limit enrollment to certain subpopulations of beneficiaries. Given his current
situation, he is unlikely to qualify and would not be able to enroll in the SNP.
Mr. Anderson 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. Anderson if he is entitled to Part A, enrolled in Part B,
and if he lives in the PFFS plan's service area.
Herber Noble is turning 65 next month, Herber legally entered the United States
over twenty years ago but is not a citizen. Since his entry into the country, Herber
has worked at Smallcap Incorporated and contributed to the Medicare system.
Herber suffers from diabetes. He will soon retire and asks you if he can enroll in a
Medicare Advantage plan that you represent. How would you respond?
Herber is eligible to enroll in Medicare Advantage as long as he is entitled to Part
A and enrolled in Part B. Herber should go to the Social Security website to enroll
in Medicare Part A and B if he has not done so already. Once he is enrolled, he can
choose a Medicare Advantage plan.
Which of the following individuals is most likely to be eligible to enroll in a Part D
Plan?
Jose, a grandfather who was granted asylum and has worked in the United States
for many years.
Mrs. Castro has just turned 65, is in excellent health and has a relatively high
income. She uses no medications and sees no reason to spend money on a
Medicare prescription drug plan if she does not need the coverage. She currently
does not have creditable coverage. What could you tell her about the implications
of such a decision?
If she does not sign up for a Medicare prescription drug plan as soon as she is
eligible to do so, and if she does sign up at a later date, her premium will be
permanently increased by 1% of the national average premium for every month
that she was not covered.
, 3
Mr. Chen was still working when he first qualified for Medicare. At that time, he
had employer group coverage that was creditable. During his initial Part D
eligibility period, he decided not to enroll because he was satisfied with his drug
coverage. It is now a year later and Mr. Chen has lost his employer group coverage
within the last two weeks. How would you advise him?
Mr. Chen should enroll in a Part D plan before he has a 63-day break in coverage in
order to avoid a premium penalty.
Ms. Ramos is enrolled in a Medicare Advantage plan that includes prescription
drug plan (PDP) coverage. She is traveling and wishes to fill two of the
prescriptions that she has lost. How would you advise her?
She may fill prescriptions for covered drugs at non-network pharmacies, but likely
at a higher cost than paid at an in-network pharmacy.
What types of tools can Medicare Part D prescription drug plans use that affect
the way their enrollees can access medications?
Part D plans do not have to cover all medications. As a result, their formularies, or
lists of covered drugs, will vary from plan to plan. In addition, they can use cost
containment techniques such as tiered co-payments and step therapy.
Mrs. Esmeralda Avila is a Medicare beneficiary enrolled in a MA-PD plan you
represent. Her neighbor recently suffered from a painful case of shingles. Mrs.
Avila hopes to avoid such an illness through vaccination. She asks you whether the
cost of the shingles vaccination will be covered under the plan you represent.
What should you say?
Yes, there is no cost sharing for the shingles vaccine even in the deductible phase
of her prescription drug plan because it is an adult vaccine recommended by the
Advisory Committee on Immunization Practices (AICP).
Mrs. Strickland is a new Medicare beneficiary who has just retired from retail
work. She is interested in selecting a Medicare Part D prescription drug plan. She
takes several medications and is concerned that she has not been able to identify
a plan that covers all of her medications. She does not want to make an abrupt
