AHIP Medicare Coverage Options 2026–2027
|Questions & Verified Answers | Medicare Certification
Exam Prep
1. If a beneficiary enrolled in a Medicare Advantage plan wants to
continue treatment with a non-network provider, what steps should they
consider?
They should switch back to Original Medicare to avoid network
restrictions.
They must immediately stop treatment with the non-network
provider.
They can continue treatment without any changes to their
coverage.
They should check if their plan covers out-of-network services
and understand any additional costs involved.
2. What is a key consideration for Avery regarding drug coverage after
losing her employer's health plan?
She needs to enroll in a separate Part D plan for drug
coverage.
She must wait until the next open enrollment period.
She is automatically enrolled in drug coverage.
She can rely on her PPO for drug coverage.
3. 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?
All individuals who are citizens and age 65 or over will be
covered under Part A.
,Most individuals who are citizens and age 65 or over and are
, covered under Part A must pay a monthly premium for that
coverage.
Most individuals who are citizens and age 65 or over and wish to
be covered under Part A must enroll in a Medicare Advantage
Plan.
Most individuals who are citizens and age 65 or over 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.
4. Dakota is 67 and recently retired. Upon retirement, they lost their group
health insurance. Dakota is now eligible for ____, which will provide health
care due to their age.
Medicaid
Social Security
Medicare
COBRA
5. If Mr. Church is considering switching from his HMO plan to a PFFS plan,
what should he evaluate regarding his current healthcare providers?
He should check if his current doctors accept the payment
terms of the PFFS plan.
He should ensure that all his doctors are in the PFFS network.
He should find out if he needs referrals to see specialists.
He should confirm that his current plan has lower premiums.
6. Mr. Wu is eligible for Medicare. He has limited financial resources but
failed to qualify for the Part D low-income subsidy. Where might he turn
for help with his prescription drug costs?
, Mr. Wu may still qualify for help in paying for Part D costs
through the local Office of the Aging.
Mr. Wu may still qualify for help in paying Part D costs through
his State Pharmaceutical Assistance Program.
Mr. Wu has no alternative but to liquidate his remaining assets
and apply for coverage through his state's Medicaid program.
Mr. Wu may still qualify for help in paying for Part D costs
through the Federal Pharmaceutical Assistance Program.
7. Describe the significance of the 190-day limit on inpatient psychiatric
hospital stays under Medicare.
The 190-day limit indicates that Medicare covers a maximum of
190 days of inpatient psychiatric care during a beneficiary's
lifetime, emphasizing the need for careful management of
mental health services.
The 190-day limit applies only to beneficiaries over the age of 65.
The 190-day limit means that beneficiaries can receive unlimited
outpatient psychiatric care.
The 190-day limit is a recommendation and not a requirement for
coverage.
8. Describe the role of prior authorization in Medicare Advantage plans
and provide an example of when it might be necessary.
Prior authorization in Medicare Advantage plans is required for
certain out-of-network services to ensure coverage; for
example, a specialist visit may require approval.
Prior authorization is not applicable to any Medicare plans.
Prior authorization is used to expedite claims processing in
Medigap plans.
Prior authorization is only needed for emergency services in
|Questions & Verified Answers | Medicare Certification
Exam Prep
1. If a beneficiary enrolled in a Medicare Advantage plan wants to
continue treatment with a non-network provider, what steps should they
consider?
They should switch back to Original Medicare to avoid network
restrictions.
They must immediately stop treatment with the non-network
provider.
They can continue treatment without any changes to their
coverage.
They should check if their plan covers out-of-network services
and understand any additional costs involved.
2. What is a key consideration for Avery regarding drug coverage after
losing her employer's health plan?
She needs to enroll in a separate Part D plan for drug
coverage.
She must wait until the next open enrollment period.
She is automatically enrolled in drug coverage.
She can rely on her PPO for drug coverage.
3. 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?
All individuals who are citizens and age 65 or over will be
covered under Part A.
,Most individuals who are citizens and age 65 or over and are
, covered under Part A must pay a monthly premium for that
coverage.
Most individuals who are citizens and age 65 or over and wish to
be covered under Part A must enroll in a Medicare Advantage
Plan.
Most individuals who are citizens and age 65 or over 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.
4. Dakota is 67 and recently retired. Upon retirement, they lost their group
health insurance. Dakota is now eligible for ____, which will provide health
care due to their age.
Medicaid
Social Security
Medicare
COBRA
5. If Mr. Church is considering switching from his HMO plan to a PFFS plan,
what should he evaluate regarding his current healthcare providers?
He should check if his current doctors accept the payment
terms of the PFFS plan.
He should ensure that all his doctors are in the PFFS network.
He should find out if he needs referrals to see specialists.
He should confirm that his current plan has lower premiums.
6. Mr. Wu is eligible for Medicare. He has limited financial resources but
failed to qualify for the Part D low-income subsidy. Where might he turn
for help with his prescription drug costs?
, Mr. Wu may still qualify for help in paying for Part D costs
through the local Office of the Aging.
Mr. Wu may still qualify for help in paying Part D costs through
his State Pharmaceutical Assistance Program.
Mr. Wu has no alternative but to liquidate his remaining assets
and apply for coverage through his state's Medicaid program.
Mr. Wu may still qualify for help in paying for Part D costs
through the Federal Pharmaceutical Assistance Program.
7. Describe the significance of the 190-day limit on inpatient psychiatric
hospital stays under Medicare.
The 190-day limit indicates that Medicare covers a maximum of
190 days of inpatient psychiatric care during a beneficiary's
lifetime, emphasizing the need for careful management of
mental health services.
The 190-day limit applies only to beneficiaries over the age of 65.
The 190-day limit means that beneficiaries can receive unlimited
outpatient psychiatric care.
The 190-day limit is a recommendation and not a requirement for
coverage.
8. Describe the role of prior authorization in Medicare Advantage plans
and provide an example of when it might be necessary.
Prior authorization in Medicare Advantage plans is required for
certain out-of-network services to ensure coverage; for
example, a specialist visit may require approval.
Prior authorization is not applicable to any Medicare plans.
Prior authorization is used to expedite claims processing in
Medigap plans.
Prior authorization is only needed for emergency services in
