AHIP Practice Test Questions & Answers 2022/2023
1. 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?: They
are Medicare health plans such as HMOs, PPOs, PFFS, SNPs, and MSAs
2. (W) Mr. Wells is trying to understand the difference between
Original Medicare and Medicare Advantage. What would be a correct
description?-
: Medicare Advantage is a way of covering all of the Original
Medicare benefits through private health insurance companies.
3. During a sales presentation in Ms. Sullivan's home, she tells you that
she has heard about a type of Medicare health plan known as Private
Fee- for-Ser- vice (PFFS). She wants to know if this would be available to
her. What should you tell her about PFFS plans?: A PFFS plan is one of
various types of Medicare Advantage plans offered by private entities
and she may enroll in one if it is available in her area.
4. (W) Mrs. Radford asks whether there are any special eligibility require-
ments 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
5. Mr. Castillo, a naturalized citizen, previously enrolled in Medicare Part B
but has recently stopped paying his Part B premium. He would like to
enroll in a Medicare Advantage (MA) plan and is still covered by Part A.
What should you tell him?: He is not eligible to enroll in a Medicare
Advantage plan until he re-enrolls in Medicare Part B
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,6. (W) Mrs. Billings enrolled in the ABC Medicare Advantage (MA) plan
sev- eral years ago. Her doctor recently confirmed a diagnosis of end-
stage renal disease (ESRD). What options does Mrs. Billings have in
regard to her MA plan during the next open enrollment season?: She
may remain in her ABC MA plan or enroll in a Special Needs Plan (SNP)
for individuals suffering from ESRD if one is available in her area
7. Mr. Kumar is considering a Medicare Advantage HMO and has ques-
tions about his ability to access providers. What should you tell him?: In
most Medicare Advantage HMOs, Mr. Kumar must obtain his services
only from providers who have a contractual relationship with the plan
(except in an emer- gency).
8. 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?: Mrs. Ramos can obtain care from any provider
who participates in Original
2 / 30
,Medicare, but generally will be charged a lower co-payment if she
goes to one of the plan's preferred providers.
9. 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?: 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
10.(W) Mr. Greco 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. Greco would
like to join that plan. What should you tell him?: SNPs limit enrollment to
certain
sub-populations of beneficiaries. Given his current situation, he is
unlikely to qualify and would not be able to enroll in the SNP.
11.(W) Mrs. Chen will be 65 soon, has been a citizen for twelve years, has
been employed full time, and paid taxes during that entire period. She is
concerned that she will not qualify for coverage under part A because she
was not born in the United States. What should you tell her?: Most
individuals who are citizens and over age 65 are covered under Part A
by virtue of having paid Medicare taxes while working, though some
may be covered as a result of paying monthly premiums.
12.(W) Mr. Bauer is 49 years old, but eighteen months ago he was
declared disabled by the Social Security Administration and has been
receiving dis- ability payments. He is wondering whether he can obtain
coverage under Medicare. What should you tell him?: After receiving
such disability payments for 24 months, he will be automatically
enrolled in Medicare, regardless of age.
13. (W) Mr. Davis is 49 years old and has been receiving disability
benefits from the Social Security Administration for 12 months. Can you
3 / 30
, sell him
a Medicare Advantage or Part D Prescription Drug policy?: No, he
cannot purchase a Medicare Advantage or Part D policy because he
has not received Social Security or Railroad Retirement disability
benefits for 24 months.
14.(W) Ms. Henderson believes that she will qualify for Medicare coverage
when she turns 65, without paying any premiums, because she has been
working for 40 years and paying Medicare taxes. What should you tell her?:
In order to obtain Part B coverage, she must pay a standard monthly
premium, though it is higher for individuals with higher incomes
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1. 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?: They
are Medicare health plans such as HMOs, PPOs, PFFS, SNPs, and MSAs
2. (W) Mr. Wells is trying to understand the difference between
Original Medicare and Medicare Advantage. What would be a correct
description?-
: Medicare Advantage is a way of covering all of the Original
Medicare benefits through private health insurance companies.
3. During a sales presentation in Ms. Sullivan's home, she tells you that
she has heard about a type of Medicare health plan known as Private
Fee- for-Ser- vice (PFFS). She wants to know if this would be available to
her. What should you tell her about PFFS plans?: A PFFS plan is one of
various types of Medicare Advantage plans offered by private entities
and she may enroll in one if it is available in her area.
4. (W) Mrs. Radford asks whether there are any special eligibility require-
ments 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
5. Mr. Castillo, a naturalized citizen, previously enrolled in Medicare Part B
but has recently stopped paying his Part B premium. He would like to
enroll in a Medicare Advantage (MA) plan and is still covered by Part A.
What should you tell him?: He is not eligible to enroll in a Medicare
Advantage plan until he re-enrolls in Medicare Part B
1 / 30
,6. (W) Mrs. Billings enrolled in the ABC Medicare Advantage (MA) plan
sev- eral years ago. Her doctor recently confirmed a diagnosis of end-
stage renal disease (ESRD). What options does Mrs. Billings have in
regard to her MA plan during the next open enrollment season?: She
may remain in her ABC MA plan or enroll in a Special Needs Plan (SNP)
for individuals suffering from ESRD if one is available in her area
7. Mr. Kumar is considering a Medicare Advantage HMO and has ques-
tions about his ability to access providers. What should you tell him?: In
most Medicare Advantage HMOs, Mr. Kumar must obtain his services
only from providers who have a contractual relationship with the plan
(except in an emer- gency).
8. 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?: Mrs. Ramos can obtain care from any provider
who participates in Original
2 / 30
,Medicare, but generally will be charged a lower co-payment if she
goes to one of the plan's preferred providers.
9. 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?: 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
10.(W) Mr. Greco 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. Greco would
like to join that plan. What should you tell him?: SNPs limit enrollment to
certain
sub-populations of beneficiaries. Given his current situation, he is
unlikely to qualify and would not be able to enroll in the SNP.
11.(W) Mrs. Chen will be 65 soon, has been a citizen for twelve years, has
been employed full time, and paid taxes during that entire period. She is
concerned that she will not qualify for coverage under part A because she
was not born in the United States. What should you tell her?: Most
individuals who are citizens and over age 65 are covered under Part A
by virtue of having paid Medicare taxes while working, though some
may be covered as a result of paying monthly premiums.
12.(W) Mr. Bauer is 49 years old, but eighteen months ago he was
declared disabled by the Social Security Administration and has been
receiving dis- ability payments. He is wondering whether he can obtain
coverage under Medicare. What should you tell him?: After receiving
such disability payments for 24 months, he will be automatically
enrolled in Medicare, regardless of age.
13. (W) Mr. Davis is 49 years old and has been receiving disability
benefits from the Social Security Administration for 12 months. Can you
3 / 30
, sell him
a Medicare Advantage or Part D Prescription Drug policy?: No, he
cannot purchase a Medicare Advantage or Part D policy because he
has not received Social Security or Railroad Retirement disability
benefits for 24 months.
14.(W) Ms. Henderson believes that she will qualify for Medicare coverage
when she turns 65, without paying any premiums, because she has been
working for 40 years and paying Medicare taxes. What should you tell her?:
In order to obtain Part B coverage, she must pay a standard monthly
premium, though it is higher for individuals with higher incomes
4 / 30
