AHIP Final Exam
AHIP FINAL EXAM NEWEST 2025/2026 COMPLETE ALL 150
QUESTIONS AND CORRECT DETAILED ANSWERS |ALREADY
GRADED A+||ALREADY GRADED A+
Anthony Boniface turned 65 in 2023. He was not receiving Social Security or
Railroad Retirement Benefits on his 65th birthday. He was interested in obtaining
Medicare coverage and is eligible for premium-free Part A. Before he could enroll
in Medicare, his entire area was impacted by a hurricane causing massive flooding
and severe wind damage. The Federal government declared this to be a natural
disaster which has recently ended. During this period Anthony's initial enrollment
period expired. Anthony asks you how he can now obtain Medicare coverage.
What should you say? - ANSWER-Anthony is eligible for a special enrollment
period (SEP) because he missed an enrollment period due to the impact of the
Federally declared disaster. This SEP will allow Anthony to enroll in Part B up to six
months after the end of the emergency declaration. Anthony may enroll in
premium-free Part A at any time and his Part A coverage will be retroactive for up
to 6 months.
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.
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? -
ANSWER-Mrs. Ramos can obtain care from any provider who participates in
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, AHIP Final Exam
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. 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.
Mr. Sinclair has diabetes and heart trouble and is generally satisfied with the care
he has received under Original Medicare, but he would like to know more about
Medicare Advantage Special Needs Plans (SNPs). What could you tell him? -
ANSWER-SNPs have special programs for enrollees with chronic conditions, like
Mr. Sinclair, and they provide prescription drug coverage that could be very
helpful as well.
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.
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? - ANSWER-He
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, AHIP Final Exam
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.
Juan Hernandez is turning 65 next month, Juan legally entered the United States
over twenty years ago but is not a citizen. Since his entry into the country, Juan
has worked at Smallcap Incorporated and contributed to the Medicare system.
Juan 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? -
ANSWER-Juan is eligible to enroll in a Medicare Advantage as long as he is entitled
to Part A and enrolled in Part B. Juan 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.
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. Barker enjoys a comfortable retirement income. He recently had surgery and
expected that he would have certain services and items covered by the plan with
minimal out-of-pocket costs because his MA-PD coverage has been very good.
However, when he received the bill, he was surprised to see large charges in
excess of his maximum out-of-pocket limit that included some services and items
he thought would be fully covered. He called you to ask what he could do? What
could you tell him? - ANSWER-You can offer to review the plans appeal process to
help him ask the plan to review the coverage decision.
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, AHIP Final 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.
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
Mr. Greco 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. Greco would like to join that plan. What should you tell
him? - ANSWER-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.
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AHIP FINAL EXAM NEWEST 2025/2026 COMPLETE ALL 150
QUESTIONS AND CORRECT DETAILED ANSWERS |ALREADY
GRADED A+||ALREADY GRADED A+
Anthony Boniface turned 65 in 2023. He was not receiving Social Security or
Railroad Retirement Benefits on his 65th birthday. He was interested in obtaining
Medicare coverage and is eligible for premium-free Part A. Before he could enroll
in Medicare, his entire area was impacted by a hurricane causing massive flooding
and severe wind damage. The Federal government declared this to be a natural
disaster which has recently ended. During this period Anthony's initial enrollment
period expired. Anthony asks you how he can now obtain Medicare coverage.
What should you say? - ANSWER-Anthony is eligible for a special enrollment
period (SEP) because he missed an enrollment period due to the impact of the
Federally declared disaster. This SEP will allow Anthony to enroll in Part B up to six
months after the end of the emergency declaration. Anthony may enroll in
premium-free Part A at any time and his Part A coverage will be retroactive for up
to 6 months.
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.
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? -
ANSWER-Mrs. Ramos can obtain care from any provider who participates in
1|Page
, AHIP Final Exam
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. 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.
Mr. Sinclair has diabetes and heart trouble and is generally satisfied with the care
he has received under Original Medicare, but he would like to know more about
Medicare Advantage Special Needs Plans (SNPs). What could you tell him? -
ANSWER-SNPs have special programs for enrollees with chronic conditions, like
Mr. Sinclair, and they provide prescription drug coverage that could be very
helpful as well.
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.
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? - ANSWER-He
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, AHIP Final Exam
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.
Juan Hernandez is turning 65 next month, Juan legally entered the United States
over twenty years ago but is not a citizen. Since his entry into the country, Juan
has worked at Smallcap Incorporated and contributed to the Medicare system.
Juan 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? -
ANSWER-Juan is eligible to enroll in a Medicare Advantage as long as he is entitled
to Part A and enrolled in Part B. Juan 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.
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. Barker enjoys a comfortable retirement income. He recently had surgery and
expected that he would have certain services and items covered by the plan with
minimal out-of-pocket costs because his MA-PD coverage has been very good.
However, when he received the bill, he was surprised to see large charges in
excess of his maximum out-of-pocket limit that included some services and items
he thought would be fully covered. He called you to ask what he could do? What
could you tell him? - ANSWER-You can offer to review the plans appeal process to
help him ask the plan to review the coverage decision.
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, AHIP Final 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.
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
Mr. Greco 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. Greco would like to join that plan. What should you tell
him? - ANSWER-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.
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