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AHIP 2026 Final Exam Questions and Answers (2026)
(Verified Answers)||Verified Exam!!!
Mr. Lopez has heard that he can sign up for a product
called "Medicare Advantage" but is not sure about what
type of plan designs are available through this program.
What should you tell him about the types of health plans
that are available through the Medicare Advantage
program? - Answer-There are Medicare health plans such
as HMOs, PPOs, PFFS, and MSAs.
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. Wells is trying to understand the difference between
Original Medicare and Medicare Advantage. What would
be the correct description? - Answer-Medicare Advantage
is a way of covering all the Original Medicare benefits
through private health insurance companies.
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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. Chou likes a Private Fee-for-Service (PFFS) plan
available in her area that does not include drug coverage.
She wants to enroll in the plan and enroll in a stand-alone
prescription drug plan. What should you tell her? - Answer-
She could enroll in a PFFS plan and a stand-alone
Medicare prescription drug 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.
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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.
Mrs. Lopez is enrolled in a cost plan for her Medicare
benefits. She has recently lost creditable coverage
previously available through her husband's employer. She
is interested in enrolling in a Medicare Part D prescription
drug plan (PDP). What should you tell her? - Answer-If a
Part D benefit is offered through her plan she may choose
to enroll in that plan or a standalone PDP.
Mr. Shapiro gets by on a very small amount of fixed
income. He has heard there may be extra help paying for
Part D prescription drugs for Medicare beneficiaries with
limited income. He wants to know whether he might
qualify. What should you tell him? - Answer-The extra help
is available to beneficiaries whose income and assets do
not exceed annual limits specified by the government.
AHIP 2026 Final Exam Questions and Answers (2026)
(Verified Answers)||Verified Exam!!!
Mr. Lopez has heard that he can sign up for a product
called "Medicare Advantage" but is not sure about what
type of plan designs are available through this program.
What should you tell him about the types of health plans
that are available through the Medicare Advantage
program? - Answer-There are Medicare health plans such
as HMOs, PPOs, PFFS, and MSAs.
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. Wells is trying to understand the difference between
Original Medicare and Medicare Advantage. What would
be the correct description? - Answer-Medicare Advantage
is a way of covering all the Original Medicare benefits
through private health insurance companies.
,2|Page
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. Chou likes a Private Fee-for-Service (PFFS) plan
available in her area that does not include drug coverage.
She wants to enroll in the plan and enroll in a stand-alone
prescription drug plan. What should you tell her? - Answer-
She could enroll in a PFFS plan and a stand-alone
Medicare prescription drug 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.
, 3|Page
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.
Mrs. Lopez is enrolled in a cost plan for her Medicare
benefits. She has recently lost creditable coverage
previously available through her husband's employer. She
is interested in enrolling in a Medicare Part D prescription
drug plan (PDP). What should you tell her? - Answer-If a
Part D benefit is offered through her plan she may choose
to enroll in that plan or a standalone PDP.
Mr. Shapiro gets by on a very small amount of fixed
income. He has heard there may be extra help paying for
Part D prescription drugs for Medicare beneficiaries with
limited income. He wants to know whether he might
qualify. What should you tell him? - Answer-The extra help
is available to beneficiaries whose income and assets do
not exceed annual limits specified by the government.
