AHIP 2026 FINAL EXAM QUESTIONS AND ANSWERS
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Mr. Arias, a naturalized citizen, previously enrolled in Medicare Part B but has
recently stopped paying his Part B premium. Mr. Arias is still covered by Part A. He
would like to enrol in a Medicare Advantage (MA) plan and is still covered by Part
A. What should you tell him? ANS >> He is not eligible to enrol in a Medicare
Advantage plan until he re-enrols in Medicare Part B.
Mrs. Joy, age 65, is entitled to Part A but has not yet enrolled in Part B. She is
considering enrolling in a Medicare Advantage plan (Part C). What should you
advise her to do before she can enrol in a Medicare Advantage plan? ANS >> To
join a Medicare Advantage plan, she also must enrol in Part B.
Mr. Kumar is considering a Medicare Advantage HMO and has questions about his
ability to access providers. What should you tell him? ANS >> 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).
, AHIP 2026
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? ANS
>> 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.
Mrs. Lester is age 75 and enjoys a comfortable but not extremely high-income
level. She wishes to enrol in an MA MSA plan that she heard about from her
neighbour. 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? ANS >> Mrs. Lester may enrol in an MA MSA plan and remain in her
current standalone Part D prescription drug plan.
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? ANS >> SNPs limit enrolment to certain subpopulations of beneficiaries.
Given his current situation, he is unlikely to qualify and would not be able to enrol
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? ANS >> 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