1
AHIP FINAL EXAM ACTUAL 2026-27 STUDY GUIDE
TEST WITH QUESTIONS AND CORRECT SOLUTIONS
Mr. Zachow has a condition for which three drugs are available. He has
tried two, but had an allergic reaction to them. Only the third drug
works for him and it is not on his Part D plan's formulary. What could
you tell him to do? - ANSWER-Mr.
Zachow has a right to request a formulary exception to obtain coverage
for his Part D drug. He or his physician could obtain the standardized
request form on the plan's website, fill it out, and submit it to his plan.
Mr. Patel is in good health and is preparing a budget in anticipation of
his retirement when he turns 66. He wants to understand the health
care costs he might be exposed to under Medicare if he were to require
hospitalization as a result of an illness. In general terms, what could you
tell him about his costs for inpatient hospital services under Original
Medicare? - ANSWER-Under Original Medicare, there is a single
deductible amount due for the first 60 days of any inpatient
hospital stay, after which it converts into a per-day amount through day
90. After day 90, he would pay a daily
amount up to 60 days over his lifetime, after which he would be
responsible for all costs
Mrs. Duarte is enrolled in Original Medicare Parts A and B. She has
recently reviewed her Medicare Summary Notice (MSN) and disagrees
with a determination that partially denied one of her claims for
services. What advice would you give her? - ANSWER-Mrs. Duarte
should file and appeal of this initial determination within 120 days of
the date she received the MSN in the mail
,2
Your friend's mother just moved to an assisted living facility and he
asked if you could present a program for the residents about the MA-
PD plans you market.
What could you tell him? - ANSWER-You appreciate the opportunity
and would be happy to schedule an appointment with anyone at their
request.
Mrs. Andrews asked how a Private Fee-for-Service (PFFS) plan might
affect her access to services since she receives some assistance for her
health care costs from the State. What should you tell her? - ANSWER-
Medicaid may provide additional benefits, but Medicaid will coordinate
benefits only with Medicaid participating providers.
, 3
Mrs. Schmidt is moving and a friend told her she might qualify for a
"Special Election Period" to enroll in a new Medicare Advantage plan.
She contacted you to ask what a Special Election Period is. What could
you tell her? - ANSWER-It is a time period, outside of the Annual
Election Period, when a Medicare beneficiary can select a new or
different Medicare Advantage and/or Part D prescription drug plan.
Typically the Special Election Period is beneficiary specific and results
from events, such as when the beneficiary moves outside of the service
area.
Mrs. Quinn 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. What could you tell her about the implications of
such a decision? - ANSWER-If she does not sign up for a Medicare
prescription drug plan as soon as she is eligible to do so, 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.
Mrs. Ramos 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? - ANSWER-Mrs. Ramos 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 part of the PPO network.
Mr. Sanchez has just turned 65 and is entitled to Part A but has not
enrolled in Part B because he has coverage through an employer plan. If
he wants to enroll in a Medicare Advantage plan, what will he have to
do? - ANSWER-He will have to enroll in Part B.
Mr. Moy's wife has a Medicare Advantage plan, but he wants to
AHIP FINAL EXAM ACTUAL 2026-27 STUDY GUIDE
TEST WITH QUESTIONS AND CORRECT SOLUTIONS
Mr. Zachow has a condition for which three drugs are available. He has
tried two, but had an allergic reaction to them. Only the third drug
works for him and it is not on his Part D plan's formulary. What could
you tell him to do? - ANSWER-Mr.
Zachow has a right to request a formulary exception to obtain coverage
for his Part D drug. He or his physician could obtain the standardized
request form on the plan's website, fill it out, and submit it to his plan.
Mr. Patel is in good health and is preparing a budget in anticipation of
his retirement when he turns 66. He wants to understand the health
care costs he might be exposed to under Medicare if he were to require
hospitalization as a result of an illness. In general terms, what could you
tell him about his costs for inpatient hospital services under Original
Medicare? - ANSWER-Under Original Medicare, there is a single
deductible amount due for the first 60 days of any inpatient
hospital stay, after which it converts into a per-day amount through day
90. After day 90, he would pay a daily
amount up to 60 days over his lifetime, after which he would be
responsible for all costs
Mrs. Duarte is enrolled in Original Medicare Parts A and B. She has
recently reviewed her Medicare Summary Notice (MSN) and disagrees
with a determination that partially denied one of her claims for
services. What advice would you give her? - ANSWER-Mrs. Duarte
should file and appeal of this initial determination within 120 days of
the date she received the MSN in the mail
,2
Your friend's mother just moved to an assisted living facility and he
asked if you could present a program for the residents about the MA-
PD plans you market.
What could you tell him? - ANSWER-You appreciate the opportunity
and would be happy to schedule an appointment with anyone at their
request.
Mrs. Andrews asked how a Private Fee-for-Service (PFFS) plan might
affect her access to services since she receives some assistance for her
health care costs from the State. What should you tell her? - ANSWER-
Medicaid may provide additional benefits, but Medicaid will coordinate
benefits only with Medicaid participating providers.
, 3
Mrs. Schmidt is moving and a friend told her she might qualify for a
"Special Election Period" to enroll in a new Medicare Advantage plan.
She contacted you to ask what a Special Election Period is. What could
you tell her? - ANSWER-It is a time period, outside of the Annual
Election Period, when a Medicare beneficiary can select a new or
different Medicare Advantage and/or Part D prescription drug plan.
Typically the Special Election Period is beneficiary specific and results
from events, such as when the beneficiary moves outside of the service
area.
Mrs. Quinn 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. What could you tell her about the implications of
such a decision? - ANSWER-If she does not sign up for a Medicare
prescription drug plan as soon as she is eligible to do so, 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.
Mrs. Ramos 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? - ANSWER-Mrs. Ramos 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 part of the PPO network.
Mr. Sanchez has just turned 65 and is entitled to Part A but has not
enrolled in Part B because he has coverage through an employer plan. If
he wants to enroll in a Medicare Advantage plan, what will he have to
do? - ANSWER-He will have to enroll in Part B.
Mr. Moy's wife has a Medicare Advantage plan, but he wants to
