AHIP 2026 FINAL EXAM 50 QUESTIONS WITH
VERIFIED ANSWERS
Mrs. Turner is comparing her employer's retiree insurance to Original Medicare and would li
zx zx zx zx zx zx zx zx zx zx zx zx zx
ke to know which of the following services Original Medicare will cover if the appropriate crit
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
eria are met. What could you tell her? - ans-Original Medicare covers ambulance services.
zx zx zx zx zx zx zx zx zx zx zx zx zx
Mrs. Duarte is enrolled in Original Medicare Parts A and B. She has recently reviewed her
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
Medicare Summary Notice (MSN) and disagrees with a determination that partially denied
zx zx zx zx zx zx zx zx zx zx zx zx
one of her claims for services. What advice would you give her? - ans-
zx zx zx zx zx zx zx zx zx zx zx zx zx
Mrs. Duarte should file an appeal of this initial determination within 120 days of the date she
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
received the MSN in the mail. zx zx zx zx zx
Mrs. Geisler's neighbor told her she should look at her Part D options during the annual Med
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
icare enrollment period because the features of Part D might have changed. Mrs. Geisler c
zx zx zx zx zx zx zx zx zx zx zx zx zx zx
an't remember what Part D is so she called you to ask what her neighbor was talking about.
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
What could you tell her? - ans- zx zx zx zx zx zx
Part D covers prescription drugs and she should look at her premiums, formulary, and cost-
zx zx zx zx zx zx zx zx zx zx zx zx zx zx
sharing among other factors to see if they have changed.
zx zx zx zx zx zx zx zx zx
Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What could you tell Mrs. Pa
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
rk that might be of assistance? - ans-
zx zx zx zx zx zx zx
She should contact her state Medicaid agency to see if she qualifies for one of several progr
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
ams that can help with Medicare costs for which she is responsible.
zx zx zx zx zx zx zx zx zx zx zx
Mrs. Quinn recently turned 66 and decided after many years of work to retire and begin rece
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
iving Social Security benefits. Shortly thereafter Mrs. Quinn received a letter informing her t
zx zx zx zx zx zx zx zx zx zx zx zx zx
hat she had been automatically enrolled in Medicare Part B. She wants to understand what
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
this means. What should you tell Mrs. Quinn? - ans-
zx zx zx zx zx zx zx zx zx
Part B primarily covers physician services. She will be paying a monthly premium and, exce
zx zx zx zx zx zx zx zx zx zx zx zx zx zx
pt for many preventive and screening tests, generally will have 20% co-
zx zx zx zx zx zx zx zx zx zx zx
payments for these services, in addition to an annual deductible. zx zx zx zx zx zx zx zx zx
Anita Magri will turn age 65 in August 2023. Anita intends to enroll in Original Medicare Part
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
A and Part B. She would also like to enroll in a Medicare Supplement (Medigap) plan. Anita'
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
s older neighbor Mel has told her about the Medigap Plan F in which he is enrolled. It not onl
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
y provides foreign travel emergency benefits but also covers his Medicare Part B deductibl
zx zx zx zx zx zx zx zx zx zx zx zx zx
e. Anita comes to you for advice. What should you tell her? - ans-
zx zx zx zx zx zx zx zx zx zx zx zx zx
You are sorry to disappoint Anita, but a Medigap F plan is no longer available to those who t
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
urn age 65 after January 1, 2020. Anita might instead consider other Medigap plans that off
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
er foreign travel benefits but do not cover the Part B deductible.
zx zx zx zx zx zx zx zx zx zx zx
, Mr. Singh would like drug coverage but does not want to be enrolled in a Medicare Advanta
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
ge plan. What should you tell him? - ans-Mr. Singh can enroll in a stand-
zx zx zx zx zx zx zx zx zx zx zx zx zx zx
alone prescription drug plan and continue to be covered for Part A and Part B services throu
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
gh Original Fee-for-Service Medicare.
zx zx zx
Mrs. Chen will be 65 soon, has been a citizen for twelve years, has been employed full time,
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
and paid taxes during that entire period. She is concerned that she will not qualify for covera
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
ge under part A because she was not born in the United States. What should you tell her? -
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
ans-
zx
Most individuals who are citizens and age 65 or over are covered under Part A by virtue of h
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
aving paid Medicare taxes while working, though some may be covered as a result of payin
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
g monthly premiums.
zx zx
Mr. Xi will soon turn age 65 and has come to you for advice as to what services are provided
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
under Original Medicare. What should you tell Mr. Xi that best describes the health coverag
zx zx zx zx zx zx zx zx zx zx zx zx zx zx
e provided to Medicare beneficiaries? - ans-
zx zx zx zx zx zx
Beneficiaries under Original Medicare have no cost-sharing for most preventive services. zx zx zx zx zx zx zx zx zx zx
Mr. Barker enjoys a comfortable retirement income. He recently had surgery and expected
zx zx zx zx zx zx zx zx zx zx zx zx zx
that he would have certain services and items covered by the plan with minimal out-of-
zx zx zx zx zx zx zx zx zx zx zx zx zx zx
pocket costs because his MA- zx zx zx zx
PD coverage has been very good. However, when he received the bill, he was surprised to
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
see large charges in excess of his maximum out-of-
zx zx zx zx zx zx zx zx
pocket limit that included some services and items he thought would be fully covered. He ca
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
lled you to ask what he could do? What could you tell him? - ans-
zx zx zx zx zx zx zx zx zx zx zx zx zx zx
You can offer to review the plans appeal process to help him ask the plan to review the cove
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
rage decision. zx
Mr. Lombardi is interested in a Medicare Advantage (MA) PPO plan that you represent. It is
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
one of three plans operated by the same organization in Mr. Lombardi's area. The MA PPO
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
plan does not include drug coverage, but the other two plans do. Mr. Lombardi likes the PP
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
O plan that does not include drug coverage and intends to obtain his drug coverage through
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
a stand-
zx zx
alone Medicare prescription drug plan. What should you tell him about this situation? - ans-
zx zx zx zx zx zx zx zx zx zx zx zx zx zx
He could enroll either in one of the MA plans that include prescription drug coverage or Origi
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
nal Medicare with a Medigap plan and standalone Part D prescription drug coverage, but h
zx zx zx zx zx zx zx zx zx zx zx zx zx zx
e cannot enroll in the MA-only PPO plan and a stand-alone prescription drug plan.
zx zx zx zx zx zx zx zx zx zx zx zx zx
Mr. Lopez has heard that he can sign up for a product called "Medicare Advantage" but is n
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
ot sure about what type of plan designs are available through this program. What should yo
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
u tell him about the types of health plans that are available through the Medicare Advantage
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
program? - ans-There are Medicare health plans such as HMOs, PPOs, PFFS, and MSAs.
zx zx zx zx zx zx zx zx zx zx zx zx zx zx
Mr. Kelly wants to know whether he is eligible to sign up for a private fee-for-
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
service (PFFS) plan. What questions would you need to ask to determine his eligibility? -
zx zx zx zx zx zx zx zx zx zx zx zx zx zx
ans-
zx
VERIFIED ANSWERS
Mrs. Turner is comparing her employer's retiree insurance to Original Medicare and would li
zx zx zx zx zx zx zx zx zx zx zx zx zx
ke to know which of the following services Original Medicare will cover if the appropriate crit
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
eria are met. What could you tell her? - ans-Original Medicare covers ambulance services.
zx zx zx zx zx zx zx zx zx zx zx zx zx
Mrs. Duarte is enrolled in Original Medicare Parts A and B. She has recently reviewed her
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
Medicare Summary Notice (MSN) and disagrees with a determination that partially denied
zx zx zx zx zx zx zx zx zx zx zx zx
one of her claims for services. What advice would you give her? - ans-
zx zx zx zx zx zx zx zx zx zx zx zx zx
Mrs. Duarte should file an appeal of this initial determination within 120 days of the date she
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
received the MSN in the mail. zx zx zx zx zx
Mrs. Geisler's neighbor told her she should look at her Part D options during the annual Med
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
icare enrollment period because the features of Part D might have changed. Mrs. Geisler c
zx zx zx zx zx zx zx zx zx zx zx zx zx zx
an't remember what Part D is so she called you to ask what her neighbor was talking about.
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
What could you tell her? - ans- zx zx zx zx zx zx
Part D covers prescription drugs and she should look at her premiums, formulary, and cost-
zx zx zx zx zx zx zx zx zx zx zx zx zx zx
sharing among other factors to see if they have changed.
zx zx zx zx zx zx zx zx zx
Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What could you tell Mrs. Pa
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
rk that might be of assistance? - ans-
zx zx zx zx zx zx zx
She should contact her state Medicaid agency to see if she qualifies for one of several progr
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
ams that can help with Medicare costs for which she is responsible.
zx zx zx zx zx zx zx zx zx zx zx
Mrs. Quinn recently turned 66 and decided after many years of work to retire and begin rece
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
iving Social Security benefits. Shortly thereafter Mrs. Quinn received a letter informing her t
zx zx zx zx zx zx zx zx zx zx zx zx zx
hat she had been automatically enrolled in Medicare Part B. She wants to understand what
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
this means. What should you tell Mrs. Quinn? - ans-
zx zx zx zx zx zx zx zx zx
Part B primarily covers physician services. She will be paying a monthly premium and, exce
zx zx zx zx zx zx zx zx zx zx zx zx zx zx
pt for many preventive and screening tests, generally will have 20% co-
zx zx zx zx zx zx zx zx zx zx zx
payments for these services, in addition to an annual deductible. zx zx zx zx zx zx zx zx zx
Anita Magri will turn age 65 in August 2023. Anita intends to enroll in Original Medicare Part
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
A and Part B. She would also like to enroll in a Medicare Supplement (Medigap) plan. Anita'
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
s older neighbor Mel has told her about the Medigap Plan F in which he is enrolled. It not onl
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
y provides foreign travel emergency benefits but also covers his Medicare Part B deductibl
zx zx zx zx zx zx zx zx zx zx zx zx zx
e. Anita comes to you for advice. What should you tell her? - ans-
zx zx zx zx zx zx zx zx zx zx zx zx zx
You are sorry to disappoint Anita, but a Medigap F plan is no longer available to those who t
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
urn age 65 after January 1, 2020. Anita might instead consider other Medigap plans that off
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
er foreign travel benefits but do not cover the Part B deductible.
zx zx zx zx zx zx zx zx zx zx zx
, Mr. Singh would like drug coverage but does not want to be enrolled in a Medicare Advanta
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
ge plan. What should you tell him? - ans-Mr. Singh can enroll in a stand-
zx zx zx zx zx zx zx zx zx zx zx zx zx zx
alone prescription drug plan and continue to be covered for Part A and Part B services throu
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
gh Original Fee-for-Service Medicare.
zx zx zx
Mrs. Chen will be 65 soon, has been a citizen for twelve years, has been employed full time,
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
and paid taxes during that entire period. She is concerned that she will not qualify for covera
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
ge under part A because she was not born in the United States. What should you tell her? -
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
ans-
zx
Most individuals who are citizens and age 65 or over are covered under Part A by virtue of h
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
aving paid Medicare taxes while working, though some may be covered as a result of payin
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
g monthly premiums.
zx zx
Mr. Xi will soon turn age 65 and has come to you for advice as to what services are provided
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
under Original Medicare. What should you tell Mr. Xi that best describes the health coverag
zx zx zx zx zx zx zx zx zx zx zx zx zx zx
e provided to Medicare beneficiaries? - ans-
zx zx zx zx zx zx
Beneficiaries under Original Medicare have no cost-sharing for most preventive services. zx zx zx zx zx zx zx zx zx zx
Mr. Barker enjoys a comfortable retirement income. He recently had surgery and expected
zx zx zx zx zx zx zx zx zx zx zx zx zx
that he would have certain services and items covered by the plan with minimal out-of-
zx zx zx zx zx zx zx zx zx zx zx zx zx zx
pocket costs because his MA- zx zx zx zx
PD coverage has been very good. However, when he received the bill, he was surprised to
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
see large charges in excess of his maximum out-of-
zx zx zx zx zx zx zx zx
pocket limit that included some services and items he thought would be fully covered. He ca
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
lled you to ask what he could do? What could you tell him? - ans-
zx zx zx zx zx zx zx zx zx zx zx zx zx zx
You can offer to review the plans appeal process to help him ask the plan to review the cove
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
rage decision. zx
Mr. Lombardi is interested in a Medicare Advantage (MA) PPO plan that you represent. It is
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
one of three plans operated by the same organization in Mr. Lombardi's area. The MA PPO
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
plan does not include drug coverage, but the other two plans do. Mr. Lombardi likes the PP
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
O plan that does not include drug coverage and intends to obtain his drug coverage through
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
a stand-
zx zx
alone Medicare prescription drug plan. What should you tell him about this situation? - ans-
zx zx zx zx zx zx zx zx zx zx zx zx zx zx
He could enroll either in one of the MA plans that include prescription drug coverage or Origi
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
nal Medicare with a Medigap plan and standalone Part D prescription drug coverage, but h
zx zx zx zx zx zx zx zx zx zx zx zx zx zx
e cannot enroll in the MA-only PPO plan and a stand-alone prescription drug plan.
zx zx zx zx zx zx zx zx zx zx zx zx zx
Mr. Lopez has heard that he can sign up for a product called "Medicare Advantage" but is n
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
ot sure about what type of plan designs are available through this program. What should yo
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
u tell him about the types of health plans that are available through the Medicare Advantage
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
program? - ans-There are Medicare health plans such as HMOs, PPOs, PFFS, and MSAs.
zx zx zx zx zx zx zx zx zx zx zx zx zx zx
Mr. Kelly wants to know whether he is eligible to sign up for a private fee-for-
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
service (PFFS) plan. What questions would you need to ask to determine his eligibility? -
zx zx zx zx zx zx zx zx zx zx zx zx zx zx
ans-
zx
