AHIP - Final examination Questions and Answers Updated 2026

AHIP - Final examination
Questions and Answers
Updated 2026
Mr.BZachowBhasBaBconditionBforBwhichBthreeBdrugsBareBavailable.BHeBhasBtriedBtwoB
butBhadBanBallergicBreactionBtoBthem.BOnlyBtheBthirdBdrugBworksBforBhimBandBitBisB
notBonBhisBPartBDBplan'sBformulary.BWhatBcouldByouBtellBhimBtoBdo?B-
BAnswerBMr.BZachowBhasBaBrightBtoBrequestBaBformularyBexceptionBtoBobtainBcovera
geBforBhisBPartBDBdrug.BHeBorBhisBphysicianBcouldBobtainBtheBstandardizedBrequestBf
ormBonBtheBplan'sBwebsite,BfillBitBout,BandBsubmitBitBtoBhisBplan.



Mr.BPolanskiBlikesBtheBcostBofBanBHMOBplanBavailableBinBhisBarea,BbutBwouldBlikeBto
BbeBableBtoBvisitBoneBorBtwoBdoctorsBwhoBaren'tBparticipatingBproviders.BHeBwantsB
toBknowBifBtheBPointBofBServiceB(POS)BoptionBavailableBwithBsomeBHMOsBwillBbeBof
BanyBhelpBinBthisBsituation.BWhatBshouldByouBtellBhim?B-
BAnswerBTheBPOSBoptionBmightBbeBaBgoodBsolutionBforBhimBasBitBwillBallowBhimBto
BvisitBout-of-
networkBproviders,BgenerallyBwithoutBpriorBapproval.BHowever,BheBshouldBbeBawareBt
hatBitBisBlikelyBheBwillBhaveBtoBpayBhigherBcost-sharingBforBservicesBfromBout-of-
networkBproviders.



Mr.BBarkerBhadBsurgeryBrecentlyBandBexpectedBthatBheBwouldBhaveBcertainBservicesB
andBitemsBcoveredBbyBtheBplanBwithBminimalBout-of-pocketBcostsBbecauseBhisBMA-
PDBcoverageBhasBbeenBveryBgood.BHowever,BwhenBheBreceivedBtheBbill,BheBwasBsurp
risedBtoBseeBlargeBchargesBinBexcessBofBhisBmaximumBout-of-
pocketBlimitBthatBincludedBaBnumberBofBservicesBandBitemsBheBthoughtBwouldBbeBfu
llyBcovered.BHeBcalledByouBtoBaskBwhatBheBcouldBdo?BWhatBcouldByouBtellBhim?B-
BAnswerBYouBcanBofferBtoBreviewBtheBplansBappealBprocessBtoBhelpBhimBaskBtheBpla
nBtoBreviewBtheBcoverageBdecision.



Ms.BStuartBhasBheardBaboutBaBspecialBneedsBplanB(SNP)BthatBoneBofBherBfriendsBisB
enrolledBinBandBisBinterestedBinBthatBproduct.BSheBwantsBtoBbeBsureBsheBalsoBhasBc
overageBforBprescriptionBdrugs.BWouldBsheBbeBableBtoBobtainBdrugBcoverageBifBsheB
enrolledBinBtheBSNP?B-

, BAnswerBa.BYes.BAllBSNPsBareBrequiredBtoBprovideBPartBDBcoverageBforBprescriptionB
drugs.

b.BYes,BbutBonlyBifBsheBqualifiesBforBPartBDBprescriptionBdrugBcoverageBunderBherBst
ateBMedicaidBprogram.

c.BNo.BMedicareBbeneficiariesBwhoBenrollBinBanBSNPBmustBalwaysBobtainBtheirBdrugB
coverageBthroughBaBstand-
aloneBPartBDBMedicareBprescriptionBdrugBplanBthatBtheyBsignBupBforBindependentBof
BtheirBenrollmentBinBtheBSNP.

d.BMaybe.BSomeBSNPsBofferBPartBDBcoverageBforBprescriptionBdrugsBandBsomeBdoBn
ot.

=B?????



PhionaBworksBinBtheBITBDepartmentBofBBestCareBHealthBPlan.BPhionaBisBplacedBinBch
argeBofBBestCare'sBeffortsBtoBfacilitateBelectronicBenrollmentBinBitsBMedicareBAdvanta
geBplans.BInBsettingBupBtheBenrollmentBsite,BwhichBofBtheBfollowingBmustBPhionaBco
nsider?B-
BAnswerBII.BAllBdataBelementsBrequiredBtoBcompleteBanBenrollmentBrequestBmustBbe
Bcaptured.

III.BTheBprocessBmustBincludeBaBclearBandBdistinctBstepBthatBrequiresBtheBapplicantBt
oBactivateBanB"EnrollBNow"BorB"IBAgree"BtypeBofBbuttonBorBtool.



Ms.BLewisBunderstandsBthatBMedicareBprescriptionBdrugBplansBmayBuseBvariousBmeth
odsBtoBcontrolBtheBuseBofBspecificBdrugs.BSheBhasBheardBaboutBaBtechniqueBcalledB"
stepBtherapy"BandBisBwonderingBifByouBcanBexplainBwhatBthatBis.BWhatBshouldByouBt
ellBher?B-
BAnswerBStepBtherapyBinvolvesBusingBoneBorBmoreBlowerBpricedBdrugsBbeforeBtrying
BaBmoreBexpensiveBdrugBwhenBallBareBusedBtoBtreatBtheBsameBcondition.



Mr.BGomezBnotesBthatBaBPrivateBFee-for-
ServiceB(PFFS)BplanBavailableBinBhisBareaBhasBanBattractiveBpremium.BHeBwantsBtoBkn
owBifBheBmustBuseBdoctorsBinBaBnetworkBasBhisBcurrentBHMOBplanBrequiresBhimBto
Bdo.BWhatBshouldByouBtellBhim?B-
BAnswerBHeBmayBreceiveBhealthBcareBservicesBfromBANYBdoctorBallowedBtoBbillBMed
icare,BasBlongBasBheBshowsBtheBdoctorBtheBplan'sBidentificationBcardBandBtheBdoctor
BagreesBtoBacceptBtheBPFFSBplan'sBpaymentBtermsBandBconditions,BwhichBcouldBinclu
deBbalanceBbilling.