AHIP 2025 FINAL EXAM PRACTICE 2025
2026 MEDICARE CERTIFICATION STUDY
GUIDE PRACTICE QUESTIONS DETAILED
RATIONALES and EXAM PREP
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? -
CORRECT ANSWER-There are Medicare health plans such as
HMOs, PPOs, PFFS, and MSAs.
Mr. Kelly 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
determine his eligibility? - CORRECT ANSWER-You would need to
ask Mr. Kelly if he is entitled to Part A, enrolled in Part B, and if he lives in
the PFFS plan's service area.
Mr. Wells is trying to understand the difference between Original Medicare
and Medicare Advantage. What would be the correct description? -
CORRECT ANSWER-Medicare Advantage is a way of covering all the
Original Medicare benefits through private health insurance companies.
Mrs. Lyons is in good health, uses a single prescription, and lives
independently in her own home. She is attracted by the idea of maintaining
control over a Medical Savings Account (MSA) but is not sure if the plan
associated with the account will fit her needs. What specific piece of
, information about a Medicare MSA plan would it be important for her to
know, prior to enrolling in such a plan? - CORRECT ANSWER-All
MSAs cover Part A and Part B benefits, but not Part D prescription drug
benefits, which could be obtained by also enrolling in a separate
prescription drug plan.
Mrs. Chou likes a Private Fee-for-Service (PFFS) plan available in her area
that does not include drug coverage. She wants to enroll in the plan and
enroll in a stand-alone prescription drug plan. What should you tell her? -
CORRECT ANSWER-She could enroll in a PFFS plan and a stand-
alone Medicare prescription drug plan.
Mrs. Radford asks whether there are any special eligibility requirements for
Medicare Advantage. What should you tell her? - CORRECT
ANSWER-Mrs. Radford must be entitled to Part A and enrolled in Part B
to enroll in Medicare Advantage.
Dr. Elizabeth Brennan does not contract with the ABC PFFS plan but
accepts the plan's terms and conditions for payment. Mary Rodgers sees
Dr. Brennan for treatment. How much may Dr. Brennan charge? -
CORRECT ANSWER-Dr. Brennan can charge Mary Rogers no more
than the cost sharing specified in the PFFS plan's terms and condition of
payment which may include balance billing up to 15%of the Medicare rate.
Mrs. Lopez is enrolled in a cost plan for her Medicare benefits. She has
recently lost creditable coverage previously available through her husband's
employer. She is interested in enrolling in a Medicare Part D prescription
drug plan (PDP). What should you tell her? - CORRECT ANSWER-If
a Part D benefit is offered through her plan she may choose to enroll in that
plan or a standalone PDP.
2026 MEDICARE CERTIFICATION STUDY
GUIDE PRACTICE QUESTIONS DETAILED
RATIONALES and EXAM PREP
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? -
CORRECT ANSWER-There are Medicare health plans such as
HMOs, PPOs, PFFS, and MSAs.
Mr. Kelly 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
determine his eligibility? - CORRECT ANSWER-You would need to
ask Mr. Kelly if he is entitled to Part A, enrolled in Part B, and if he lives in
the PFFS plan's service area.
Mr. Wells is trying to understand the difference between Original Medicare
and Medicare Advantage. What would be the correct description? -
CORRECT ANSWER-Medicare Advantage is a way of covering all the
Original Medicare benefits through private health insurance companies.
Mrs. Lyons is in good health, uses a single prescription, and lives
independently in her own home. She is attracted by the idea of maintaining
control over a Medical Savings Account (MSA) but is not sure if the plan
associated with the account will fit her needs. What specific piece of
, information about a Medicare MSA plan would it be important for her to
know, prior to enrolling in such a plan? - CORRECT ANSWER-All
MSAs cover Part A and Part B benefits, but not Part D prescription drug
benefits, which could be obtained by also enrolling in a separate
prescription drug plan.
Mrs. Chou likes a Private Fee-for-Service (PFFS) plan available in her area
that does not include drug coverage. She wants to enroll in the plan and
enroll in a stand-alone prescription drug plan. What should you tell her? -
CORRECT ANSWER-She could enroll in a PFFS plan and a stand-
alone Medicare prescription drug plan.
Mrs. Radford asks whether there are any special eligibility requirements for
Medicare Advantage. What should you tell her? - CORRECT
ANSWER-Mrs. Radford must be entitled to Part A and enrolled in Part B
to enroll in Medicare Advantage.
Dr. Elizabeth Brennan does not contract with the ABC PFFS plan but
accepts the plan's terms and conditions for payment. Mary Rodgers sees
Dr. Brennan for treatment. How much may Dr. Brennan charge? -
CORRECT ANSWER-Dr. Brennan can charge Mary Rogers no more
than the cost sharing specified in the PFFS plan's terms and condition of
payment which may include balance billing up to 15%of the Medicare rate.
Mrs. Lopez is enrolled in a cost plan for her Medicare benefits. She has
recently lost creditable coverage previously available through her husband's
employer. She is interested in enrolling in a Medicare Part D prescription
drug plan (PDP). What should you tell her? - CORRECT ANSWER-If
a Part D benefit is offered through her plan she may choose to enroll in that
plan or a standalone PDP.
