AHIP 2026 Final Exam — Medicare Certification Prep (Verified Solutions, A+ Grade 2026/2027 Edition)

AHIP 2026 Final Exam verified questions and answers A+
Grade 2026\2027

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?
- correct answer He is not eligible to enroll in a Medicare Advantage plan until he re-enrolls in Medicare
Part B.



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?
- correct answer To join a Medicare Advantage plan, she also must enroll in Part B.



Mr. Kumar is considering a Medicare Advantage HMO and has questions about his ability to access
providers. What should you tell him?
- correct answer 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).



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?
- correct answer 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.



Mrs. Lester is age 75 and enjoys a comfortable but not extremely high-income 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?
- correct answer Mrs. Lester may enroll in an MA MSA plan and remain in her current standalone Part D
prescription drug plan.



Mr. Dalton is in excellent health, lives in his own home, and has a sizeable income 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?
- correct answer 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.



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 determine his eligibility?
- correct answer 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.



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?
- correct answer 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.



Which of the following individuals is most likely to be eligible to enroll in a Part D Plan?
- correct answer Jose, a grandfather who was granted asylum and has worked in the United States for
many years.



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?
- correct answer 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.



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?
- correct answer 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.