AHIP Exam Study Guide –
Practice Questions with
Verified Answers. GRADED A+.
Latest 2026/2027 Update
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✔✔-
They are Medicare health plans such as HMOs, PPOs, PFFS, SNPs, and MSAs
(W) Mr. Wells is trying to understand the difference between Original Medicare
and Medicare Advantage. What would be a correct description? - Answer✔✔-
Medicare Advantage is a way of covering all of the Original Medicare benefits
through private health insurance companies.
During a sales presentation in Ms. Sullivan's home, she tells you that she has
heard about a type of Medicare health plan known as Private Fee-for-Service
(PFFS). She wants to know if this would be available to her. What should you
tell her about PFFS plans? - Answer✔✔-A PFFS plan is one of various types of
Medicare Advantage plans offered by private entities and she may enroll in one
if it is available in her area.
,(W) 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
Mr. Castillo, a naturalized citizen, previously enrolled in Medicare Part B but has
recently stopped paying his Part B premium. He would like to enroll in a
Medicare Advantage (MA) plan and is still covered by Part A. What should you
tell him? - Answer✔✔-He is not eligible to enroll in a Medicare Advantage plan
until he re-enrolls in Medicare Part B
(W) Mrs. Billings enrolled in the ABC Medicare Advantage (MA) plan several
years ago. Her doctor recently confirmed a diagnosis of end-stage renal disease
(ESRD). What options does Mrs. Billings have in regard to her MA plan during
the next open enrollment season? - Answer✔✔-She may remain in her ABC
MA plan or enroll in a Special Needs Plan (SNP) for individuals suffering from
ESRD if one is available in her area
Mr. Kumar is considering a Medicare Advantage HMO and has questions about
his ability to access providers. What should you tell him? - Answer✔✔-In most
Medicare Advantage HMOs, Mr. Kumar must obtain his services only from
providers who have a contractual relationship with the plan (except in an
emergency).
Mrs. Ramos 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? -
Answer✔✔-Mrs. Ramos can obtain care from any provider who participates in
Original Medicare, but generally will be charged a lower co-payment if she goes
to one of the plan's preferred providers.
,Mr. Sinclair has diabetes and heart trouble and is generally satisfied with the
care he has received under Original Medicare, but he would like to know more
about Medicare Advantage Special Needs Plans (SNPs). What could you tell
him? - Answer✔✔-SNPs have special programs for enrollees with chronic
conditions, like Mr. Sinclair, and they provide prescription drug coverage that
could be very helpful as well
(W) Mr. Greco 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. Greco would like to join that plan. What
should you tell him? - Answer✔✔-SNPs limit enrollment to certain sub-
populations of beneficiaries. Given his current situation, he is unlikely to qualify
and would not be able to enroll in the SNP.
(W) Mrs. Chen will be 65 soon, has been a citizen for twelve years, has been
employed full time, and paid taxes during that entire period. She is concerned
that she will not qualify for coverage under part A because she was not born in
the United States. What should you tell her? - Answer✔✔-Most individuals
who are citizens and over age 65 are covered under Part A by virtue of having
paid Medicare taxes while working, though some may be covered as a result of
paying monthly premiums.
(W) Mr. Bauer is 49 years old, but eighteen months ago he was declared
disabled by the Social Security Administration and has been receiving disability
payments. He is wondering whether he can obtain coverage under Medicare.
What should you tell him? - Answer✔✔-After receiving such disability
payments for 24 months, he will be automatically enrolled in Medicare,
regardless of age.
, (W) Mr. Davis is 49 years old and has been receiving disability benefits from the
Social Security Administration for 12 months. Can you sell him a Medicare
Advantage or Part D Prescription Drug policy? - Answer✔✔-No, he cannot
purchase a Medicare Advantage or Part D policy because he has not received
Social Security or Railroad Retirement disability benefits for 24 months.
(W) Ms. Henderson believes that she will qualify for Medicare coverage when
she turns 65, without paying any premiums, because she has been working for
40 years and paying Medicare taxes. What should you tell her? - Answer✔✔-In
order to obtain Part B coverage, she must pay a standard monthly premium,
though it is higher for individuals with higher incomes
(W) 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? -
Answer✔✔-Mr. Diaz will not pay any penalty because he had continuous
coverage under his employer's plan.
(W) Mrs. Peňa is 66 years old, has coverage under an employer plan and will
retire next year. She heard she must enroll in Part B at the beginning of the
year to ensure no gap in coverage. What can you tell her? - Answer✔✔-She
may enroll at any time while she is covered under her employer plan, but she
will have a special eight-month enrollment period that differs from the
standard general enrollment period, during which she may enroll in Medicare
Part B
(W) Mrs. Kelly is entitled to Part A, but is not yet enrolled in Part B. She is
considering enrollment in a Medicare health plan. What should you advise her
to do before she will be able to enroll into a Medicare health plan? -
Practice Questions with
Verified Answers. GRADED A+.
Latest 2026/2027 Update
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✔✔-
They are Medicare health plans such as HMOs, PPOs, PFFS, SNPs, and MSAs
(W) Mr. Wells is trying to understand the difference between Original Medicare
and Medicare Advantage. What would be a correct description? - Answer✔✔-
Medicare Advantage is a way of covering all of the Original Medicare benefits
through private health insurance companies.
During a sales presentation in Ms. Sullivan's home, she tells you that she has
heard about a type of Medicare health plan known as Private Fee-for-Service
(PFFS). She wants to know if this would be available to her. What should you
tell her about PFFS plans? - Answer✔✔-A PFFS plan is one of various types of
Medicare Advantage plans offered by private entities and she may enroll in one
if it is available in her area.
,(W) 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
Mr. Castillo, a naturalized citizen, previously enrolled in Medicare Part B but has
recently stopped paying his Part B premium. He would like to enroll in a
Medicare Advantage (MA) plan and is still covered by Part A. What should you
tell him? - Answer✔✔-He is not eligible to enroll in a Medicare Advantage plan
until he re-enrolls in Medicare Part B
(W) Mrs. Billings enrolled in the ABC Medicare Advantage (MA) plan several
years ago. Her doctor recently confirmed a diagnosis of end-stage renal disease
(ESRD). What options does Mrs. Billings have in regard to her MA plan during
the next open enrollment season? - Answer✔✔-She may remain in her ABC
MA plan or enroll in a Special Needs Plan (SNP) for individuals suffering from
ESRD if one is available in her area
Mr. Kumar is considering a Medicare Advantage HMO and has questions about
his ability to access providers. What should you tell him? - Answer✔✔-In most
Medicare Advantage HMOs, Mr. Kumar must obtain his services only from
providers who have a contractual relationship with the plan (except in an
emergency).
Mrs. Ramos 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? -
Answer✔✔-Mrs. Ramos can obtain care from any provider who participates in
Original Medicare, but generally will be charged a lower co-payment if she goes
to one of the plan's preferred providers.
,Mr. Sinclair has diabetes and heart trouble and is generally satisfied with the
care he has received under Original Medicare, but he would like to know more
about Medicare Advantage Special Needs Plans (SNPs). What could you tell
him? - Answer✔✔-SNPs have special programs for enrollees with chronic
conditions, like Mr. Sinclair, and they provide prescription drug coverage that
could be very helpful as well
(W) Mr. Greco 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. Greco would like to join that plan. What
should you tell him? - Answer✔✔-SNPs limit enrollment to certain sub-
populations of beneficiaries. Given his current situation, he is unlikely to qualify
and would not be able to enroll in the SNP.
(W) Mrs. Chen will be 65 soon, has been a citizen for twelve years, has been
employed full time, and paid taxes during that entire period. She is concerned
that she will not qualify for coverage under part A because she was not born in
the United States. What should you tell her? - Answer✔✔-Most individuals
who are citizens and over age 65 are covered under Part A by virtue of having
paid Medicare taxes while working, though some may be covered as a result of
paying monthly premiums.
(W) Mr. Bauer is 49 years old, but eighteen months ago he was declared
disabled by the Social Security Administration and has been receiving disability
payments. He is wondering whether he can obtain coverage under Medicare.
What should you tell him? - Answer✔✔-After receiving such disability
payments for 24 months, he will be automatically enrolled in Medicare,
regardless of age.
, (W) Mr. Davis is 49 years old and has been receiving disability benefits from the
Social Security Administration for 12 months. Can you sell him a Medicare
Advantage or Part D Prescription Drug policy? - Answer✔✔-No, he cannot
purchase a Medicare Advantage or Part D policy because he has not received
Social Security or Railroad Retirement disability benefits for 24 months.
(W) Ms. Henderson believes that she will qualify for Medicare coverage when
she turns 65, without paying any premiums, because she has been working for
40 years and paying Medicare taxes. What should you tell her? - Answer✔✔-In
order to obtain Part B coverage, she must pay a standard monthly premium,
though it is higher for individuals with higher incomes
(W) 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? -
Answer✔✔-Mr. Diaz will not pay any penalty because he had continuous
coverage under his employer's plan.
(W) Mrs. Peňa is 66 years old, has coverage under an employer plan and will
retire next year. She heard she must enroll in Part B at the beginning of the
year to ensure no gap in coverage. What can you tell her? - Answer✔✔-She
may enroll at any time while she is covered under her employer plan, but she
will have a special eight-month enrollment period that differs from the
standard general enrollment period, during which she may enroll in Medicare
Part B
(W) Mrs. Kelly is entitled to Part A, but is not yet enrolled in Part B. She is
considering enrollment in a Medicare health plan. What should you advise her
to do before she will be able to enroll into a Medicare health plan? -
