AHIP FINAL EXAM
2026-2027 Update Exam
Actual Questions and Answers
100% Guarantee Pass
This Exam contains:
➤ 105 Questions and Answers
➤ 100% Guarantee Pass
➤ Multiple-Choice & Direct Q&A
➤ Each Question Includes The Correct Answer
➤ Expert-Verified explanation
,AHIP FINAL EXAM — 2026-2027 UPDATE EXAM
1. 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.
2. Mrs. Kelly, age 65, is entitled to Part A but has not yet enrolled in Part B. She is considering enrollment 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.
3. 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.
4. Mr. Lombardi is interested in a Medicare Advantage (MA) PPO plan that you represent. It is one of three
plans operated by the same organization in Mr. Lombardi's area. The MA PPO plan does not include drug
coverage, but the other two plans do. Mr. Lombardi likes the PPO plan that does not include drug coverage and
intends to obtain his drug coverage through a stand-alone Medicare prescription drug plan. What should you tell
him about this situation?
Correct answer ✔✔ He could enroll either in one of the MA plans that include prescription drug
coverage or Original Medicare with a Medigap plan and standalone Part D prescription drug coverage,
but he cannot enroll in the MA-only PPO plan and a stand-alone prescription drug plan.
5. Mrs. Wang wants to know generally how the benefits under Original Medicare might compare to the benefits
package of a Medicare Advantage Plan before she starts looking at specific plans. What could you tell her?
Correct answer ✔✔ Medicare Advantage Plans may offer extra benefits that Original Medicare does not
offer such as vision, hearing, and dental services. It must include a maximum out-of-pocket limit on Part
A and Part B services.
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, AHIP FINAL EXAM — 2026-2027 UPDATE EXAM
6. 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.
7. 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.
8. Mr. Barker enjoys a comfortable retirement income. He recently had surgery and expected that he would
have certain services and items covered by the plan with minimal out-of-pocket costs because his MA-PD
coverage has been very good. However, when he received the bill, he was surprised to see large charges in
excess of his maximum out-of-pocket limit that included some services and items he thought would be fully
covered. He called you to ask what he could do? What could you tell him?
Correct answer ✔✔ You can offer to review the plans appeal process to help him ask the plan to review
the coverage decision.
9. Mrs. Walters is enrolled in her state's Medicaid program in addition to Medicare. What should she be aware
of when considering enrollment in a Medicare Advantage (MA) plan?
Correct answer ✔✔ She cannot enroll in an MA Medical Savings Account (MSA) plan.
10. Mr. Shapiro gets by on a very small amount of fixed income. He has heard there may be extra help paying
for Part D prescription drugs for Medicare beneficiaries with limited income. He wants to know whether he
might qualify. What should you tell him?
Correct answer ✔✔ The extra help is available to beneficiaries whose income and assets do not exceed
annual limits specified by the government.
Page 3
2026-2027 Update Exam
Actual Questions and Answers
100% Guarantee Pass
This Exam contains:
➤ 105 Questions and Answers
➤ 100% Guarantee Pass
➤ Multiple-Choice & Direct Q&A
➤ Each Question Includes The Correct Answer
➤ Expert-Verified explanation
,AHIP FINAL EXAM — 2026-2027 UPDATE EXAM
1. 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.
2. Mrs. Kelly, age 65, is entitled to Part A but has not yet enrolled in Part B. She is considering enrollment 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.
3. 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.
4. Mr. Lombardi is interested in a Medicare Advantage (MA) PPO plan that you represent. It is one of three
plans operated by the same organization in Mr. Lombardi's area. The MA PPO plan does not include drug
coverage, but the other two plans do. Mr. Lombardi likes the PPO plan that does not include drug coverage and
intends to obtain his drug coverage through a stand-alone Medicare prescription drug plan. What should you tell
him about this situation?
Correct answer ✔✔ He could enroll either in one of the MA plans that include prescription drug
coverage or Original Medicare with a Medigap plan and standalone Part D prescription drug coverage,
but he cannot enroll in the MA-only PPO plan and a stand-alone prescription drug plan.
5. Mrs. Wang wants to know generally how the benefits under Original Medicare might compare to the benefits
package of a Medicare Advantage Plan before she starts looking at specific plans. What could you tell her?
Correct answer ✔✔ Medicare Advantage Plans may offer extra benefits that Original Medicare does not
offer such as vision, hearing, and dental services. It must include a maximum out-of-pocket limit on Part
A and Part B services.
Page 2
, AHIP FINAL EXAM — 2026-2027 UPDATE EXAM
6. 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.
7. 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.
8. Mr. Barker enjoys a comfortable retirement income. He recently had surgery and expected that he would
have certain services and items covered by the plan with minimal out-of-pocket costs because his MA-PD
coverage has been very good. However, when he received the bill, he was surprised to see large charges in
excess of his maximum out-of-pocket limit that included some services and items he thought would be fully
covered. He called you to ask what he could do? What could you tell him?
Correct answer ✔✔ You can offer to review the plans appeal process to help him ask the plan to review
the coverage decision.
9. Mrs. Walters is enrolled in her state's Medicaid program in addition to Medicare. What should she be aware
of when considering enrollment in a Medicare Advantage (MA) plan?
Correct answer ✔✔ She cannot enroll in an MA Medical Savings Account (MSA) plan.
10. Mr. Shapiro gets by on a very small amount of fixed income. He has heard there may be extra help paying
for Part D prescription drugs for Medicare beneficiaries with limited income. He wants to know whether he
might qualify. What should you tell him?
Correct answer ✔✔ The extra help is available to beneficiaries whose income and assets do not exceed
annual limits specified by the government.
Page 3
