AHIP 2026 Final Exam questions and answers
with complete solutions verified latest update
2026/2027
Terms in this set (50)
Mr. Arias, a naturalized citizen, He is not eligible to enroll in a Medicare
previously enrolled in Advantage plan until he re-enrolls in Medicare
Medicare Part B but has recently Part B.
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?
Mrs. Joy, age 65, is entitled to To join a Medicare Advantage plan, she also
Part A but has not yet must enroll in Part B.
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?
Mr. Kumar is considering a In most Medicare Advantage HMOs, Mr. Kumar
Medicare Advantage HMO and must generally obtain his services only from
has questions about his ability providers within the plan's network (except in
to access providers. What an emergency or where care is unavailable
should you tell him? within the network).
, Mrs. Robles is considering a Medicare Advantage Mrs. Robles can obtain care from any provider who participates in Original
PPO and has questions about which providers she can Medicare, but generally will have a higher cost-sharing amount if she sees a
go to for her health care. What should you tell her? provider who/that is not a part of the PPO network.
Mrs. Lester is age 75 and enjoys a comfortable but Mrs. Lester may enroll in an MA MSA plan and remain in her current standalone
not extremely high-income level. She wishes to enroll Part D prescription drug plan.
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?
Mr. Dalton is in excellent health, lives in his own home, SNPs limit enrollment to certain subpopulations of beneficiaries. Given his current
and has a sizeable income from his investments. He has a situation, he is unlikely to qualify and would not be able to enroll in the SNP.
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?
Mr. Anderson wants to know whether he is eligible to sign You would need to ask Mr. Anderson if he is entitled to Part A, enrolled in Part B,
up for a Private fee-for-service (PFFS) plan. What and if he lives in the PFFS plan's service area.
questions would you need to ask to determine his
eligibility?
Herber Noble is turning 65 next month, Herber legally Herber is eligible to enroll in Medicare Advantage as long as he is entitled to Part
entered the United States over twenty years ago but is A and enrolled in Part B. Herber should go to the Social Security website to enroll
not a citizen. Since his entry into the country, Herber has in Medicare Part A and B if he has not done so already. Once he is enrolled,
worked at Smallcap Incorporated and contributed to the he can choose a Medicare Advantage plan.
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?
Which of the following individuals is most likely to be Jose, a grandfather who was granted asylum and has worked in the United
eligible to enroll in a Part D Plan? States for many years.
Mrs. Castro has just turned 65, is in excellent health and If she does not sign up for a Medicare prescription drug plan as soon as she is
has a relatively high income. She uses no medications and eligible to do so, and if she does sign up at a later date, her premium will be
sees no reason to spend money on a Medicare permanently increased by 1% of the national average premium for every month
prescription drug plan if she does not need the that she was not covered.
coverage. She currently does not have creditable
coverage. What could you tell her about the implications
of such a decision?
with complete solutions verified latest update
2026/2027
Terms in this set (50)
Mr. Arias, a naturalized citizen, He is not eligible to enroll in a Medicare
previously enrolled in Advantage plan until he re-enrolls in Medicare
Medicare Part B but has recently Part B.
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?
Mrs. Joy, age 65, is entitled to To join a Medicare Advantage plan, she also
Part A but has not yet must enroll in Part B.
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?
Mr. Kumar is considering a In most Medicare Advantage HMOs, Mr. Kumar
Medicare Advantage HMO and must generally obtain his services only from
has questions about his ability providers within the plan's network (except in
to access providers. What an emergency or where care is unavailable
should you tell him? within the network).
, Mrs. Robles is considering a Medicare Advantage Mrs. Robles can obtain care from any provider who participates in Original
PPO and has questions about which providers she can Medicare, but generally will have a higher cost-sharing amount if she sees a
go to for her health care. What should you tell her? provider who/that is not a part of the PPO network.
Mrs. Lester is age 75 and enjoys a comfortable but Mrs. Lester may enroll in an MA MSA plan and remain in her current standalone
not extremely high-income level. She wishes to enroll Part D prescription drug plan.
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?
Mr. Dalton is in excellent health, lives in his own home, SNPs limit enrollment to certain subpopulations of beneficiaries. Given his current
and has a sizeable income from his investments. He has a situation, he is unlikely to qualify and would not be able to enroll in the SNP.
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?
Mr. Anderson wants to know whether he is eligible to sign You would need to ask Mr. Anderson if he is entitled to Part A, enrolled in Part B,
up for a Private fee-for-service (PFFS) plan. What and if he lives in the PFFS plan's service area.
questions would you need to ask to determine his
eligibility?
Herber Noble is turning 65 next month, Herber legally Herber is eligible to enroll in Medicare Advantage as long as he is entitled to Part
entered the United States over twenty years ago but is A and enrolled in Part B. Herber should go to the Social Security website to enroll
not a citizen. Since his entry into the country, Herber has in Medicare Part A and B if he has not done so already. Once he is enrolled,
worked at Smallcap Incorporated and contributed to the he can choose a Medicare Advantage plan.
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?
Which of the following individuals is most likely to be Jose, a grandfather who was granted asylum and has worked in the United
eligible to enroll in a Part D Plan? States for many years.
Mrs. Castro has just turned 65, is in excellent health and If she does not sign up for a Medicare prescription drug plan as soon as she is
has a relatively high income. She uses no medications and eligible to do so, and if she does sign up at a later date, her premium will be
sees no reason to spend money on a Medicare permanently increased by 1% of the national average premium for every month
prescription drug plan if she does not need the that she was not covered.
coverage. She currently does not have creditable
coverage. What could you tell her about the implications
of such a decision?
