AHIP 2026 module general Exam questions and well elaborated answers
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, AHIP 2026 module general Exam questions and well elaborated answers
1. 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
2. (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.
3. 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 ottered by private entities and she may enroll in one if it is available
in her area.
4. (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
5. 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
6. (W) Mrs. Billings enrolled in the ABC Medicare Advantage (MA)
plan several years ago. Her doctor recently confirmed a diagnosis of
end-stage renal dis- ease (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 suttering from ESRD if one is available in her area
7. 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).
8. 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.
9. 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
10. (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.
11. (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.
12. (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.
13. (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.
ACADEMIC WRITING & RESEARCH SERVICES
Professional | Original | Reliable
Academic Writing • Research & Analysis • Thesis & Dissertation Support
SERVICES OFFERED
Academic Writing
Research & Data Analysis
Thesis Writing Assistance
Dissertation Support
Assignment Help
Literature Reviews
Case Studies
Research Proposals
Editing & Proofreading
Referencing & Citations (APA, MLA, Harvard, Chicago)
Proctored exams
Why choose us?
High-Quality Work
Plagiarism-Free Content
Timely Delivery
Confidential & Professional
Well-Researched Academic Solutions
Contacts
Gmail:
WhatsApp: https://wa.me/254721933068?text=
Empowering Academic Success Through Professional Writing & Research Excellence
, AHIP 2026 module general Exam questions and well elaborated answers
1. 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
2. (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.
3. 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 ottered by private entities and she may enroll in one if it is available
in her area.
4. (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
5. 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
6. (W) Mrs. Billings enrolled in the ABC Medicare Advantage (MA)
plan several years ago. Her doctor recently confirmed a diagnosis of
end-stage renal dis- ease (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 suttering from ESRD if one is available in her area
7. 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).
8. 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.
9. 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
10. (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.
11. (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.
12. (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.
13. (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.
