AHIP Final & Module 1–5 Test 2027 Bank | Verified Questions
and Answers Study Pack Graded A+ Success
Question 1.
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.
Question 2.
Mr. Gomez notes that a Private Fee-for-Service (PFFS) plan available in his area has an
attractive premium. He wants to know if he must use doctors in a network as his current
HMO plan requires him to do. What should you tell him?
Correct Answer: He may receive health care services from any doctor allowed
to bill Medicare, as long as he shows the doctor the plan's identification card
and the doctor agrees to accept the PFFS plan's payment terms and
conditions, which could include balance billing.
Question 3.
Ms. Gibson recently lost her employer group health and drug coverage and now she
wants to enroll in a PPO that does not include drug coverage. What should you tell her
about obtaining drug coverage?
Correct Answer: She can enroll in the PPO, but she will not be able to purchase
a stand-alone Medicare Part D prescription drug plan.
Question 4.
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 will be able to enroll in a Medicare Advantage plan?
Correct Answer: To join a Medicare Advantage plan, she also must enroll in
Part B.
Question 5.
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?
Correct Answer: Medicaid may provide additional benefits, but Medicaid will
only pay for these services if they are furnished by Medicaid participating
providers.
,Question 6.
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).
Question 7.
Juan Perez, who is turning age 65 next month, intends to work for several more years at
Smallcap, Incorporated. Smallcap has a workforce of 15 employees and offers
employer-sponsored healthcare coverage. Juan is a naturalized citizen and has
contributed to the Medicare system for over 20 years. Juan asks you if he will be entitled
to Medicare and if he enrolls how that will impact his employer-sponsored healthcare
coverage. How would you respond?
Correct Answer: Juan is likely to be eligible for Medicare once he turns age 65
and if he enrolls Medicare would become the primary payor of his healthcare
claims and Smallcap does not have to continue to offer him coverage
comparable to those under age 65 under its employer-sponsored group health
plan.
• 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? -✓✓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.
Question 8.
Daniel is a middle-income Medicare beneficiary. He has chronic bronchitis, putting him
at severe risk for pneumonia. Otherwise, he has no problems functioning. Which type of
SNP is likely to be most appropriate for him?
Correct Answer: C-SNP
Question 9.
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.
Question 10.
Mr. Romero is 64, retiring soon, and considering enrollment in his employer-sponsored
retiree group health plan that includes drug coverage with nominal copays. He heard
about a neighbor's MA-PD plan that you represent and because he takes numerous
prescription drugs, he is considering signing up for it. What should you tell him?
Correct Answer: He should compare the benefits in his employer-sponsored
retiree group health plan with the benefits in his neighbor's MA-PD plan to
determine which one will provide sufficient coverage for his prescription
needs.
Question 11.
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.
Question 12.
Mr. Sinclair has diabetes and heart trouble and is generally satisfied with the care he has
received under Original Medicare, but he would like to know more about Medicare
Advantage Special Needs Plans (SNPs). What could you tell him?
Correct Answer: SNPs have special programs for enrollees with chronic
conditions, like Mr. Sinclair, and they provide prescription drug coverage that
could be very helpful as well.
Question 13.
Mrs. Willard 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
and must include a maximum out-of-pocket limit on Part A and Part B services.
• Mrs. Chi is age 75 and enjoys a comfortable but not extremely high- income
level. She wishes to enroll in a 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.
and Answers Study Pack Graded A+ Success
Question 1.
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.
Question 2.
Mr. Gomez notes that a Private Fee-for-Service (PFFS) plan available in his area has an
attractive premium. He wants to know if he must use doctors in a network as his current
HMO plan requires him to do. What should you tell him?
Correct Answer: He may receive health care services from any doctor allowed
to bill Medicare, as long as he shows the doctor the plan's identification card
and the doctor agrees to accept the PFFS plan's payment terms and
conditions, which could include balance billing.
Question 3.
Ms. Gibson recently lost her employer group health and drug coverage and now she
wants to enroll in a PPO that does not include drug coverage. What should you tell her
about obtaining drug coverage?
Correct Answer: She can enroll in the PPO, but she will not be able to purchase
a stand-alone Medicare Part D prescription drug plan.
Question 4.
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 will be able to enroll in a Medicare Advantage plan?
Correct Answer: To join a Medicare Advantage plan, she also must enroll in
Part B.
Question 5.
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?
Correct Answer: Medicaid may provide additional benefits, but Medicaid will
only pay for these services if they are furnished by Medicaid participating
providers.
,Question 6.
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).
Question 7.
Juan Perez, who is turning age 65 next month, intends to work for several more years at
Smallcap, Incorporated. Smallcap has a workforce of 15 employees and offers
employer-sponsored healthcare coverage. Juan is a naturalized citizen and has
contributed to the Medicare system for over 20 years. Juan asks you if he will be entitled
to Medicare and if he enrolls how that will impact his employer-sponsored healthcare
coverage. How would you respond?
Correct Answer: Juan is likely to be eligible for Medicare once he turns age 65
and if he enrolls Medicare would become the primary payor of his healthcare
claims and Smallcap does not have to continue to offer him coverage
comparable to those under age 65 under its employer-sponsored group health
plan.
• 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? -✓✓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.
Question 8.
Daniel is a middle-income Medicare beneficiary. He has chronic bronchitis, putting him
at severe risk for pneumonia. Otherwise, he has no problems functioning. Which type of
SNP is likely to be most appropriate for him?
Correct Answer: C-SNP
Question 9.
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.
Question 10.
Mr. Romero is 64, retiring soon, and considering enrollment in his employer-sponsored
retiree group health plan that includes drug coverage with nominal copays. He heard
about a neighbor's MA-PD plan that you represent and because he takes numerous
prescription drugs, he is considering signing up for it. What should you tell him?
Correct Answer: He should compare the benefits in his employer-sponsored
retiree group health plan with the benefits in his neighbor's MA-PD plan to
determine which one will provide sufficient coverage for his prescription
needs.
Question 11.
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.
Question 12.
Mr. Sinclair has diabetes and heart trouble and is generally satisfied with the care he has
received under Original Medicare, but he would like to know more about Medicare
Advantage Special Needs Plans (SNPs). What could you tell him?
Correct Answer: SNPs have special programs for enrollees with chronic
conditions, like Mr. Sinclair, and they provide prescription drug coverage that
could be very helpful as well.
Question 13.
Mrs. Willard 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
and must include a maximum out-of-pocket limit on Part A and Part B services.
• Mrs. Chi is age 75 and enjoys a comfortable but not extremely high- income
level. She wishes to enroll in a 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.
