AHIP 2026 Final Exam Prep | Complete Q&A Practice Test
1. Mrs. Radford asks whether there are any special eligibility requirements for
Medicare Advantage. What should you tell her?
Mrs. Radford must be entitled to Part A and enrolled in Part B to
enroll in Medicare Advantage.
Mrs. Radford can enroll in any Medicare Advantage plan that operates
within the United States
Mrs. Radford must be enrolled in both Medigap and Part A to enroll in
a Medicare Advantage plan.
Mrs. Radford must apply to the Medicare Advantage plan, which will
include a medical review, prior to being accepted and enrolled.
2. Mr. Robinson was quite ill recently and forgot to pay his monthly premium for
his MA-PD plan. He is worried that he will lose his coverage now when he
needs it the most. He is certain his plan will disenroll him because that is what
happened to a friend of his in a similar type of plan. What can you tell Mr.
Robinson about his situation?
Plan sponsors have the option to do nothing when a plan member
does not pay their premiums or disenroll the member after a grace
period and notice.
Plan sponsors have the option to disenroll members, but if they
choose to do so, they must act immediately and cannot permit a grace
period.
Plan sponsors must disenroll members who do not pay their
premiums, but he will have a special election period to sign up for a
different MA-PD plan.
, Plan sponsors must disenroll members who do not pay their
premiums, but they have the discretion to make exceptions for certain
members, so he should ask for an exception for this special
circumstance.
3. If Mr. Solomon missed the enrollment period for Medicare Part B, what might
be a potential consequence he could face?
Higher premiums for late enrollment.
Immediate loss of all health coverage.
Ineligibility for Medicare Advantage plans.
Automatic enrollment in a private insurance plan.
4. If a Medicare beneficiary fails to enroll in Medicare Part B during their initial
enrollment period, what could be a potential consequence when they later
seek to enroll in a Medicare Advantage plan?
They may face a late enrollment penalty and delayed coverage.
They will be automatically enrolled in a plan.
They will not be able to enroll in any Medicare plan.
They will receive a refund for any missed premiums.
5. Discuss the implications of not enrolling in Medicare Part B on access to
Medicare Advantage plans.
Part B enrollment is optional for Medicare Advantage plans.
Not enrolling in Medicare Part B can limit access to Medicare
Advantage plans, as enrollment in Part B is a prerequisite.
Not enrolling in Medicare Part B has no effect on Medicare
Advantage plans.
, Individuals can still enroll in Medicare Advantage without Part B but
face higher costs.
6. If Mr. Johannsen gains the Part D low-income subsidy, how does that affect
his ability to enroll or disenroll in a Part D plan? Choose one answer.
He can enroll in or disenroll from a Part D plan at any time and the
subsidy will apply to the plan he chooses.
He can only enroll into or disenroll from an MA-PD plan.
The subsidy will become effective next year when he can enroll in a
different plan or disenroll from his current plan during the next Annual
Election Period.
He can apply the subsidy amount to his existing plan immediately, but
he cannot enroll in a different plan.
7. If Mr. Smith is prescribed a high-cost medication but his Medicare plan
requires 'step therapy', what steps should he take to comply with his plan's
requirements?
He should insist on receiving the high-cost medication immediately.
He should first try the lower-cost alternatives prescribed by his
doctor.
He should stop taking any medication until he can get the high-cost
one.
He should switch to a different Medicare plan without consulting his
doctor.
, 8. Mrs. Shields is covered by Original Medicare. She sustained a hip fracture and
is being successfully treated for that condition. However, she and her
physicians feel that after her lengthy hospital stay she will need a month or
two of nursing and rehabilitative care. What should you tell them about
Original Medicare's coverage of care in a skilled nursing facility?
Medicare will cover Mrs. Shield's skilled nursing services provided
during the first 20 days of her stay, after which she would have a
copay until she has been in the facility for 100 days.
Mrs. Shields will have to apply for Medicaid to have her skilled nursing
services covered because Medicare does not provide such a benefit.
Once she has expended her liquid assets, Medicare will cover 80% of
Mrs. Shields long-term care costs.
Medicare will cover an unlimited number of days in a skilled-nursing
facility, as long as a physician certifies that such care is needed.
9. What is the annual election period for Medicare Advantage plans?
A deadline for submitting claims for Medicare services.
A designated time when individuals can enroll in or change their
Medicare Advantage plans.
A period when Medicare beneficiaries can apply for Social Security
benefits.
The time frame for enrolling in Medicare Part A only.
10. If Agent James Chan enrolls 10 clients in the FeelBetter Medicare Advantage
plan, how might his compensation be calculated according to CMS
guidelines?
He would not receive any compensation for multiple enrollments.
1. Mrs. Radford asks whether there are any special eligibility requirements for
Medicare Advantage. What should you tell her?
Mrs. Radford must be entitled to Part A and enrolled in Part B to
enroll in Medicare Advantage.
Mrs. Radford can enroll in any Medicare Advantage plan that operates
within the United States
Mrs. Radford must be enrolled in both Medigap and Part A to enroll in
a Medicare Advantage plan.
Mrs. Radford must apply to the Medicare Advantage plan, which will
include a medical review, prior to being accepted and enrolled.
2. Mr. Robinson was quite ill recently and forgot to pay his monthly premium for
his MA-PD plan. He is worried that he will lose his coverage now when he
needs it the most. He is certain his plan will disenroll him because that is what
happened to a friend of his in a similar type of plan. What can you tell Mr.
Robinson about his situation?
Plan sponsors have the option to do nothing when a plan member
does not pay their premiums or disenroll the member after a grace
period and notice.
Plan sponsors have the option to disenroll members, but if they
choose to do so, they must act immediately and cannot permit a grace
period.
Plan sponsors must disenroll members who do not pay their
premiums, but he will have a special election period to sign up for a
different MA-PD plan.
, Plan sponsors must disenroll members who do not pay their
premiums, but they have the discretion to make exceptions for certain
members, so he should ask for an exception for this special
circumstance.
3. If Mr. Solomon missed the enrollment period for Medicare Part B, what might
be a potential consequence he could face?
Higher premiums for late enrollment.
Immediate loss of all health coverage.
Ineligibility for Medicare Advantage plans.
Automatic enrollment in a private insurance plan.
4. If a Medicare beneficiary fails to enroll in Medicare Part B during their initial
enrollment period, what could be a potential consequence when they later
seek to enroll in a Medicare Advantage plan?
They may face a late enrollment penalty and delayed coverage.
They will be automatically enrolled in a plan.
They will not be able to enroll in any Medicare plan.
They will receive a refund for any missed premiums.
5. Discuss the implications of not enrolling in Medicare Part B on access to
Medicare Advantage plans.
Part B enrollment is optional for Medicare Advantage plans.
Not enrolling in Medicare Part B can limit access to Medicare
Advantage plans, as enrollment in Part B is a prerequisite.
Not enrolling in Medicare Part B has no effect on Medicare
Advantage plans.
, Individuals can still enroll in Medicare Advantage without Part B but
face higher costs.
6. If Mr. Johannsen gains the Part D low-income subsidy, how does that affect
his ability to enroll or disenroll in a Part D plan? Choose one answer.
He can enroll in or disenroll from a Part D plan at any time and the
subsidy will apply to the plan he chooses.
He can only enroll into or disenroll from an MA-PD plan.
The subsidy will become effective next year when he can enroll in a
different plan or disenroll from his current plan during the next Annual
Election Period.
He can apply the subsidy amount to his existing plan immediately, but
he cannot enroll in a different plan.
7. If Mr. Smith is prescribed a high-cost medication but his Medicare plan
requires 'step therapy', what steps should he take to comply with his plan's
requirements?
He should insist on receiving the high-cost medication immediately.
He should first try the lower-cost alternatives prescribed by his
doctor.
He should stop taking any medication until he can get the high-cost
one.
He should switch to a different Medicare plan without consulting his
doctor.
, 8. Mrs. Shields is covered by Original Medicare. She sustained a hip fracture and
is being successfully treated for that condition. However, she and her
physicians feel that after her lengthy hospital stay she will need a month or
two of nursing and rehabilitative care. What should you tell them about
Original Medicare's coverage of care in a skilled nursing facility?
Medicare will cover Mrs. Shield's skilled nursing services provided
during the first 20 days of her stay, after which she would have a
copay until she has been in the facility for 100 days.
Mrs. Shields will have to apply for Medicaid to have her skilled nursing
services covered because Medicare does not provide such a benefit.
Once she has expended her liquid assets, Medicare will cover 80% of
Mrs. Shields long-term care costs.
Medicare will cover an unlimited number of days in a skilled-nursing
facility, as long as a physician certifies that such care is needed.
9. What is the annual election period for Medicare Advantage plans?
A deadline for submitting claims for Medicare services.
A designated time when individuals can enroll in or change their
Medicare Advantage plans.
A period when Medicare beneficiaries can apply for Social Security
benefits.
The time frame for enrolling in Medicare Part A only.
10. If Agent James Chan enrolls 10 clients in the FeelBetter Medicare Advantage
plan, how might his compensation be calculated according to CMS
guidelines?
He would not receive any compensation for multiple enrollments.
