AHIP 2026 FINAL EXAM QUESTIONS AND
ACCURATE ANSWERS
1. 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 enroll in a Medicare Advantage (MA)
plan and is still covered by Part A. What should you tell him?: He is not eligible to
enroll in a Medicare Advantage plan until he re-enrolls in Medicare Part B.
2. 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 enroll in a Medicare
Advantage plan?: To join a Medicare Advantage plan, she also must enroll in Part B.
3. Mr. Kumar is considering a Medicare Advantage HMO and has questions
about his ability to access providers. What should you tell him?: 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).
4. 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?: 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.
5. Mrs. Lester is age 75 and enjoys a comfortable but not extremely
high-in-come level. She wishes to enroll in an MA MSA plan that she
heard about from her neighbor. 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?: Mrs. Lester may
enroll in an MA MSA plan and remain in her current standalone Part D prescription drug plan.
6. Mr. Dalton is in excellent health, lives in his own home, and has a
sizeable in-come 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?: SNPs limit enrollment to certain
subpopulations of beneficiaries. Given his current situation, he is unlikely to qualify and would not
be able to enroll in the SNP.
,AHIP 2026 FINAL EXAM QUESTIONS AND
ACCURATE ANSWERS
7. 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 deter-
, AHIP 2026 FINAL EXAM QUESTIONS AND
ACCURATE ANSWERS
mine his eligibility?: 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.
8. 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 has worked at Smallcap Incorporated and
contributed to the Medicare system. Herber suffers from diabetes. He will
soon retire and asks you if he can enroll in a Medicare Advantage plan that
you represent. How would you respond?: Herber is eligible to enroll in Medicare
Advantage as long as he is entitled to Part A and enrolled in Part B. Herber should go to the Social
Security website to enroll in Medicare Part A and B if he has not done so already. Once he is enrolled,
he can choose a Medicare Advantage plan.
9. Which of the following individuals is most likely to be eligible to enroll in
a Part D Plan?: Jose, a grandfather who was granted asylum and has worked in the United States for
many years.
10. Mrs. Castro has just turned 65, is in excellent health and has a
relatively high income. She uses no medications and sees no reason to
spend money on a Medicare prescription drug plan if she does not need
the coverage. She currently does not have creditable coverage. What
could you tell her about the implications of such a decision?: If she does not sign up
for a Medicare prescription drug plan as soon as she is eligible to do so, and if she does sign up
at a later date, her premium will be permanently increased
by 1% of the national average premium for every month that she was not covered.
11. Mr. Chen was still working when he first qualified for Medicare. At
that time, he had employer group coverage that was creditable. During
his initial Part D eligibility period, he decided not to enroll because he was
satisfied with his drug coverage. It is now a year later and Mr. Chen has
lost his employer group coverage within the last two weeks. How would
you advise him?: Mr. Chen should enroll in a Part D plan before he has a 63-day break in
coverage in order to avoid a premium penalty.
12. Ms. Ramos is enrolled in a Medicare Advantage plan that includes
prescrip-tion drug plan (PDP) coverage. She is traveling and wishes to fill
two of the prescriptions that she has lost. How would you advise her?: She
ACCURATE ANSWERS
1. 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 enroll in a Medicare Advantage (MA)
plan and is still covered by Part A. What should you tell him?: He is not eligible to
enroll in a Medicare Advantage plan until he re-enrolls in Medicare Part B.
2. 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 enroll in a Medicare
Advantage plan?: To join a Medicare Advantage plan, she also must enroll in Part B.
3. Mr. Kumar is considering a Medicare Advantage HMO and has questions
about his ability to access providers. What should you tell him?: 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).
4. 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?: 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.
5. Mrs. Lester is age 75 and enjoys a comfortable but not extremely
high-in-come level. She wishes to enroll in an MA MSA plan that she
heard about from her neighbor. 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?: Mrs. Lester may
enroll in an MA MSA plan and remain in her current standalone Part D prescription drug plan.
6. Mr. Dalton is in excellent health, lives in his own home, and has a
sizeable in-come 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?: SNPs limit enrollment to certain
subpopulations of beneficiaries. Given his current situation, he is unlikely to qualify and would not
be able to enroll in the SNP.
,AHIP 2026 FINAL EXAM QUESTIONS AND
ACCURATE ANSWERS
7. 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 deter-
, AHIP 2026 FINAL EXAM QUESTIONS AND
ACCURATE ANSWERS
mine his eligibility?: 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.
8. 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 has worked at Smallcap Incorporated and
contributed to the Medicare system. Herber suffers from diabetes. He will
soon retire and asks you if he can enroll in a Medicare Advantage plan that
you represent. How would you respond?: Herber is eligible to enroll in Medicare
Advantage as long as he is entitled to Part A and enrolled in Part B. Herber should go to the Social
Security website to enroll in Medicare Part A and B if he has not done so already. Once he is enrolled,
he can choose a Medicare Advantage plan.
9. Which of the following individuals is most likely to be eligible to enroll in
a Part D Plan?: Jose, a grandfather who was granted asylum and has worked in the United States for
many years.
10. Mrs. Castro has just turned 65, is in excellent health and has a
relatively high income. She uses no medications and sees no reason to
spend money on a Medicare prescription drug plan if she does not need
the coverage. She currently does not have creditable coverage. What
could you tell her about the implications of such a decision?: If she does not sign up
for a Medicare prescription drug plan as soon as she is eligible to do so, and if she does sign up
at a later date, her premium will be permanently increased
by 1% of the national average premium for every month that she was not covered.
11. Mr. Chen was still working when he first qualified for Medicare. At
that time, he had employer group coverage that was creditable. During
his initial Part D eligibility period, he decided not to enroll because he was
satisfied with his drug coverage. It is now a year later and Mr. Chen has
lost his employer group coverage within the last two weeks. How would
you advise him?: Mr. Chen should enroll in a Part D plan before he has a 63-day break in
coverage in order to avoid a premium penalty.
12. Ms. Ramos is enrolled in a Medicare Advantage plan that includes
prescrip-tion drug plan (PDP) coverage. She is traveling and wishes to fill
two of the prescriptions that she has lost. How would you advise her?: She
