AHIP 2026 EXAM READINESS GUIDE
Mr. Arias, a naturalized citizen, previously enrolled in Medicare Part B but has recently stopped paying his
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Part B premium. Mr. Arias is still covered by Part A. He would like to enroll in a Medicare Advantage (MA) plan
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and is still covered by Part A. What should you tell him? - correct answers He is not eligible to enroll in a
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Medicare Advantage plan until he re-enrolls in Medicare Part B.
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Mrs. Joy, age 65, is entitled to Part A but has not yet enrolled in Part B. She is considering enrolling in a
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Medicare Advantage plan (Part C). What should you advise her to do before she can enroll in a Medicare
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Advantage plan? - correct answers To join a Medicare Advantage plan, she also must enroll in Part B.
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Mr. Kumar is considering a Medicare Advantage HMO and has questions about his ability to access providers.
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What should you tell him? - correct answers In most Medicare Advantage HMOs, Mr. Kumar must generally
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obtain his services only from providers within the plan's network (except in an emergency or where care is
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unavailable within the network). A A A
Mrs. Robles is considering a Medicare Advantage PPO and has questions about which providers she can go to
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for her health care. What should you tell her? - correct answers Mrs. Robles can obtain care from any provider
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who participates in Original Medicare, but generally will have a higher cost-sharing amount if she sees a
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provider who/that is not a part of the PPO network.
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Mrs. Lester is age 75 and enjoys a comfortable but not extremely high-income level. She wishes to enroll in an
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MA MSA plan that she heard about from her neighbor. She also wants to have prescription drug coverage
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since her doctor recently prescribed several expensive medications. Currently, she is enrolled in Original
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Medicare and a standalone Part D plan. How would you advise Mrs. Lester? - correct answers Mrs. Lester may
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enroll in an MA MSA plan and remain in her current standalone Part D prescription drug plan.
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, Mr. Dalton is in excellent health, lives in his own home, and has a sizeable income from his investments. He
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has a friend enrolled in a Medicare Advantage Special Needs Plan (SNP). His friend has mentioned that the
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SNP charges very low cost-sharing amounts and Mr. Dalton would like to join that plan. What should you tell
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him? - correct answers SNPs limit enrollment to certain subpopulations of beneficiaries. Given his current
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situation, he is unlikely to qualify and would not be able to enroll in the SNP. A A A A A A A A A A A A A A A
Mr. Anderson wants to know whether he is eligible to sign up for a Private fee-for-service (PFFS) plan. What
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questions would you need to ask to determine his eligibility? - correct answers You would need to ask Mr.
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Anderson if he is entitled to Part A, enrolled in Part B, and if he lives in the PFFS plan's service area.
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Herber Noble is turning 65 next month, Herber legally entered the United States over twenty years ago but is
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not a citizen. Since his entry into the country, Herber has worked at Smallcap Incorporated and contributed to
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the Medicare system. Herber suffers from diabetes. He will soon retire and asks you if he can enroll in a
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Medicare Advantage plan that you represent. How would you respond? - correct answers Herber is eligible to
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enroll in Medicare Advantage as long as he is entitled to Part A and enrolled in Part B. Herber should go to the
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Social Security website to enroll in Medicare Part A and B if he has not done so already. Once he is enrolled, he
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can choose a Medicare Advantage plan.
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Which of the following individuals is most likely to be eligible to enroll in a Part D Plan? - correct answers Jose, a
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grandfather who was granted asylum and has worked in the United States for many years.
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Mrs. Castro has just turned 65, is in excellent health and has a relatively high income. She uses no medications
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and sees no reason to spend money on a Medicare prescription drug plan if she does not need the coverage.
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She currently does not have creditable coverage. What could you tell her about the implications of such a
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decision? - correct answers If she does not sign up for a Medicare prescription drug plan as soon as she is
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eligible to do so, and if she does sign up at a later date, her premium will be permanently increased by 1% of
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the national average premium for every month that she was not covered.
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Mr. Chen was still working when he first qualified for Medicare. At that time, he had employer group coverage
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that was creditable. During his initial Part D eligibility period, he decided not to enroll because he was satisfied
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with his drug coverage. It is now a year later and Mr. Chen has lost his employer group coverage within the last
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two weeks. How would you advise him? - correct answers Mr. Chen should enroll in a Part D plan before he has
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a 63-day break in coverage in order to avoid a premium penalty.
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Ms. Ramos is enrolled in a Medicare Advantage plan that includes prescription drug plan (PDP) coverage. She
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is traveling and wishes to fill two of the prescriptions that she has lost. How would you advise her? - correct
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Mr. Arias, a naturalized citizen, previously enrolled in Medicare Part B but has recently stopped paying his
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Part B premium. Mr. Arias is still covered by Part A. He would like to enroll in a Medicare Advantage (MA) plan
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and is still covered by Part A. What should you tell him? - correct answers He is not eligible to enroll in a
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Medicare Advantage plan until he re-enrolls in Medicare Part B.
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Mrs. Joy, age 65, is entitled to Part A but has not yet enrolled in Part B. She is considering enrolling in a
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Medicare Advantage plan (Part C). What should you advise her to do before she can enroll in a Medicare
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Advantage plan? - correct answers To join a Medicare Advantage plan, she also must enroll in Part B.
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Mr. Kumar is considering a Medicare Advantage HMO and has questions about his ability to access providers.
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What should you tell him? - correct answers In most Medicare Advantage HMOs, Mr. Kumar must generally
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obtain his services only from providers within the plan's network (except in an emergency or where care is
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unavailable within the network). A A A
Mrs. Robles is considering a Medicare Advantage PPO and has questions about which providers she can go to
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for her health care. What should you tell her? - correct answers Mrs. Robles can obtain care from any provider
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who participates in Original Medicare, but generally will have a higher cost-sharing amount if she sees a
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provider who/that is not a part of the PPO network.
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Mrs. Lester is age 75 and enjoys a comfortable but not extremely high-income level. She wishes to enroll in an
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MA MSA plan that she heard about from her neighbor. She also wants to have prescription drug coverage
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since her doctor recently prescribed several expensive medications. Currently, she is enrolled in Original
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Medicare and a standalone Part D plan. How would you advise Mrs. Lester? - correct answers Mrs. Lester may
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enroll in an MA MSA plan and remain in her current standalone Part D prescription drug plan.
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, Mr. Dalton is in excellent health, lives in his own home, and has a sizeable income from his investments. He
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has a friend enrolled in a Medicare Advantage Special Needs Plan (SNP). His friend has mentioned that the
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SNP charges very low cost-sharing amounts and Mr. Dalton would like to join that plan. What should you tell
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him? - correct answers SNPs limit enrollment to certain subpopulations of beneficiaries. Given his current
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situation, he is unlikely to qualify and would not be able to enroll in the SNP. A A A A A A A A A A A A A A A
Mr. Anderson wants to know whether he is eligible to sign up for a Private fee-for-service (PFFS) plan. What
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questions would you need to ask to determine his eligibility? - correct answers You would need to ask Mr.
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Anderson if he is entitled to Part A, enrolled in Part B, and if he lives in the PFFS plan's service area.
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Herber Noble is turning 65 next month, Herber legally entered the United States over twenty years ago but is
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not a citizen. Since his entry into the country, Herber has worked at Smallcap Incorporated and contributed to
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the Medicare system. Herber suffers from diabetes. He will soon retire and asks you if he can enroll in a
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Medicare Advantage plan that you represent. How would you respond? - correct answers Herber is eligible to
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enroll in Medicare Advantage as long as he is entitled to Part A and enrolled in Part B. Herber should go to the
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Social Security website to enroll in Medicare Part A and B if he has not done so already. Once he is enrolled, he
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can choose a Medicare Advantage plan.
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Which of the following individuals is most likely to be eligible to enroll in a Part D Plan? - correct answers Jose, a
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grandfather who was granted asylum and has worked in the United States for many years.
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Mrs. Castro has just turned 65, is in excellent health and has a relatively high income. She uses no medications
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and sees no reason to spend money on a Medicare prescription drug plan if she does not need the coverage.
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She currently does not have creditable coverage. What could you tell her about the implications of such a
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decision? - correct answers If she does not sign up for a Medicare prescription drug plan as soon as she is
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eligible to do so, and if she does sign up at a later date, her premium will be permanently increased by 1% of
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the national average premium for every month that she was not covered.
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Mr. Chen was still working when he first qualified for Medicare. At that time, he had employer group coverage
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that was creditable. During his initial Part D eligibility period, he decided not to enroll because he was satisfied
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with his drug coverage. It is now a year later and Mr. Chen has lost his employer group coverage within the last
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two weeks. How would you advise him? - correct answers Mr. Chen should enroll in a Part D plan before he has
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a 63-day break in coverage in order to avoid a premium penalty.
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Ms. Ramos is enrolled in a Medicare Advantage plan that includes prescription drug plan (PDP) coverage. She
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is traveling and wishes to fill two of the prescriptions that she has lost. How would you advise her? - correct
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