AHIP Final Exam (2026/2027) – America’s
Health Insurance Plans Medicare
Certification | Verified Multiple-Choice
Questions with Rationales|| PASS!!
Mr. Diaz continued working with his company and was insured under
his employer's group plan until he reached age 68. He has heard that
there is a premium penalty for those who did not sign up for Part B
when first eligible and wants to know how much he will have to pay.
What should you tell him? - ANSWERS-The penalty will be a permanent
10% increase in his Part B premium for every 12-month period that
passed during which he could have enrolled and did not.
Ms. Moore plans to retire when she turns 65 in a few months. She is in
excellent health and will have considerable income when she retires.
She is concerned that her income will make it impossible for her to
qualify for Medicare. What could you tell her to address her concern? -
ANSWERS-Medicare is a program for people age 65 or older and those
under age 65 with certain disabilities, end-stage renal disease, and
Lou Gehrig's disease so she will be eligible for Medicare.
Mildred Savage enrolled in Allcare Medicare Advantage plan several
years ago. Mildred recently learned that she is suffering from
inoperable cancer and has just a few months to live. She would like to
spend these final months in hospice care. Mildred's family asks you
whether hospice benefits will be paid for under the Allcare Medicare
Advantage plan. What should you say? - ANSWERS-Mildred may remain
, enrolled in Allcare and make a hospice election. Hospice benefits will
be paid for by Original Medicare under Part A and Allcare will continue
to pay for any non-hospice services.
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? - ANSWERS-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.
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? - ANSWERS-You would need to ask Mr. Kelly if
he is enrolled in Part A and Part B and if he lives in the PFFS plan's
service area.
Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What
could you tell Mrs. Park that might be of assistance? - ANSWERS-She
should contact her state Medicaid agency to see if she qualifies
forprograms that can help with Medicare costs for which she is
responsible.
Madeline Martinez was widowed several years ago. Her husband
worked for many years and contributed into the Medicare system. He
also left a substantial estate which provides Madeline with an annual
income of approximately $130,000. Madeline, who has only worked
part-time for the last three years, will soon turn age 65 and hopes to
enroll in Original Medicare. She comes to you for advice. What should
Health Insurance Plans Medicare
Certification | Verified Multiple-Choice
Questions with Rationales|| PASS!!
Mr. Diaz continued working with his company and was insured under
his employer's group plan until he reached age 68. He has heard that
there is a premium penalty for those who did not sign up for Part B
when first eligible and wants to know how much he will have to pay.
What should you tell him? - ANSWERS-The penalty will be a permanent
10% increase in his Part B premium for every 12-month period that
passed during which he could have enrolled and did not.
Ms. Moore plans to retire when she turns 65 in a few months. She is in
excellent health and will have considerable income when she retires.
She is concerned that her income will make it impossible for her to
qualify for Medicare. What could you tell her to address her concern? -
ANSWERS-Medicare is a program for people age 65 or older and those
under age 65 with certain disabilities, end-stage renal disease, and
Lou Gehrig's disease so she will be eligible for Medicare.
Mildred Savage enrolled in Allcare Medicare Advantage plan several
years ago. Mildred recently learned that she is suffering from
inoperable cancer and has just a few months to live. She would like to
spend these final months in hospice care. Mildred's family asks you
whether hospice benefits will be paid for under the Allcare Medicare
Advantage plan. What should you say? - ANSWERS-Mildred may remain
, enrolled in Allcare and make a hospice election. Hospice benefits will
be paid for by Original Medicare under Part A and Allcare will continue
to pay for any non-hospice services.
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? - ANSWERS-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.
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? - ANSWERS-You would need to ask Mr. Kelly if
he is enrolled in Part A and Part B and if he lives in the PFFS plan's
service area.
Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What
could you tell Mrs. Park that might be of assistance? - ANSWERS-She
should contact her state Medicaid agency to see if she qualifies
forprograms that can help with Medicare costs for which she is
responsible.
Madeline Martinez was widowed several years ago. Her husband
worked for many years and contributed into the Medicare system. He
also left a substantial estate which provides Madeline with an annual
income of approximately $130,000. Madeline, who has only worked
part-time for the last three years, will soon turn age 65 and hopes to
enroll in Original Medicare. She comes to you for advice. What should
