AHIP Final Exam Practice Test (200 Questions and
ANSWER wers 100% Correct) Latest (2023 * 2024)
(Verified ANSWER wers)
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 plANSWER that are available through the Medicare Advantage program? * ANSWER They are
Medicare health plANSWER such as HMOs, PPOs, PFFS, SNPs, and MSAs
(W) Mr. Wells is trying to understand the difference between Original Medicare and Medicare Advantage.
What would be a correct description? * ANSWER Medicare Advantage is a way of covering all of the
Original Medicare benefits through private health insurance companies.
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*Service (PFFS). She wants to know if this would be
available to her. What should you tell her about PFFS plANSWER ? * ANSWER A PFFS plan is one of
various types ofMedicare Advantage plANSWER offered by private entities and she may enroll in one if it
is available in her area.
(W) Mrs. Radford asks whether there are any special eligibility requirements for Medicare Advantage.
What should you tell her? * ANSWER Mrs. Radford must be entitled to Part A and enrolled in Part B to
enrollin Medicare Advantage
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? * ANSWER He is not eligible to enroll in a Medicare Advantage plan until he
re*enrolls in Medicare Part B
(W) Mrs. Billings enrolled in the ABC Medicare Advantage (MA) plan several years ago. Her doctor
1
,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? * ANSWER She may remain in her ABC
MAplan or enroll in a Special Needs Plan (SNP) for individuals suffering from ESRD if one is available in
her area
Mr. Kumar is considering a Medicare Advantage HMO and has questions about his ability to access
providers. What should you tell him? * ANSWER In most Medicare Advantage HMOs, Mr. Kumar must
obtainhis services only from providers who have a contractual relationship with the plan (except in an
emergency).
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
2
,provider who participates in Original Medicare, but generally will be charged a lower co*payment if she
goes to one of the plan's preferred providers.
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 PlANSWER
(SNPs). What could you tell him? * 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
(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? * ANSWER 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.
(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? * ANSWER 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.
(W) Mr. Bauer is 49 years old, but eighteen months ago he was declared disabled by the Social Security
Administration and has been receiving disability payments. He is wondering whether he can obtain
coverage under Medicare. What should you tell him? * ANSWER After receiving such disability payments
for24 months, he will be automatically enrolled in Medicare, regardless of age.
(W) Mr. Davis is 49 years old and has been receiving disability benefits from the Social Security
Administration for 12 months. Can you sell him a Medicare Advantage or Part D Prescription Drug
policy? * ANSWER 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.
(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
3
, should you tell her? * ANSWER In order to obtain Part B coverage, she must pay a standard monthly
premium, though it is higher for individuals with higher incomes
(W) Mr. Diaz continued working with his company and was insured under his employer's group plan until
he reached age 68. He has heard that there is a premium penalty for those who did not sign up forPart B
when first eligible and wants to know how much he will have to pay. What should you tell him? *ANSWER
Mr. Diaz will not pay any penalty because he had continuous coverage under his employer's plan.
(W) Mrs. Peňa is 66 years old, has coverage under an employer plan and will retire next year. She heard
she must enroll in Part B at the beginning of the year to ensure no gap in coverage. What can you tell her?
* ANSWER She may enroll at any time while she is covered under her employer plan, but she will have a
4
ANSWER wers 100% Correct) Latest (2023 * 2024)
(Verified ANSWER wers)
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 plANSWER that are available through the Medicare Advantage program? * ANSWER They are
Medicare health plANSWER such as HMOs, PPOs, PFFS, SNPs, and MSAs
(W) Mr. Wells is trying to understand the difference between Original Medicare and Medicare Advantage.
What would be a correct description? * ANSWER Medicare Advantage is a way of covering all of the
Original Medicare benefits through private health insurance companies.
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*Service (PFFS). She wants to know if this would be
available to her. What should you tell her about PFFS plANSWER ? * ANSWER A PFFS plan is one of
various types ofMedicare Advantage plANSWER offered by private entities and she may enroll in one if it
is available in her area.
(W) Mrs. Radford asks whether there are any special eligibility requirements for Medicare Advantage.
What should you tell her? * ANSWER Mrs. Radford must be entitled to Part A and enrolled in Part B to
enrollin Medicare Advantage
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? * ANSWER He is not eligible to enroll in a Medicare Advantage plan until he
re*enrolls in Medicare Part B
(W) Mrs. Billings enrolled in the ABC Medicare Advantage (MA) plan several years ago. Her doctor
1
,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? * ANSWER She may remain in her ABC
MAplan or enroll in a Special Needs Plan (SNP) for individuals suffering from ESRD if one is available in
her area
Mr. Kumar is considering a Medicare Advantage HMO and has questions about his ability to access
providers. What should you tell him? * ANSWER In most Medicare Advantage HMOs, Mr. Kumar must
obtainhis services only from providers who have a contractual relationship with the plan (except in an
emergency).
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
2
,provider who participates in Original Medicare, but generally will be charged a lower co*payment if she
goes to one of the plan's preferred providers.
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 PlANSWER
(SNPs). What could you tell him? * 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
(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? * ANSWER 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.
(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? * ANSWER 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.
(W) Mr. Bauer is 49 years old, but eighteen months ago he was declared disabled by the Social Security
Administration and has been receiving disability payments. He is wondering whether he can obtain
coverage under Medicare. What should you tell him? * ANSWER After receiving such disability payments
for24 months, he will be automatically enrolled in Medicare, regardless of age.
(W) Mr. Davis is 49 years old and has been receiving disability benefits from the Social Security
Administration for 12 months. Can you sell him a Medicare Advantage or Part D Prescription Drug
policy? * ANSWER 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.
(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
3
, should you tell her? * ANSWER In order to obtain Part B coverage, she must pay a standard monthly
premium, though it is higher for individuals with higher incomes
(W) Mr. Diaz continued working with his company and was insured under his employer's group plan until
he reached age 68. He has heard that there is a premium penalty for those who did not sign up forPart B
when first eligible and wants to know how much he will have to pay. What should you tell him? *ANSWER
Mr. Diaz will not pay any penalty because he had continuous coverage under his employer's plan.
(W) Mrs. Peňa is 66 years old, has coverage under an employer plan and will retire next year. She heard
she must enroll in Part B at the beginning of the year to ensure no gap in coverage. What can you tell her?
* ANSWER She may enroll at any time while she is covered under her employer plan, but she will have a
4
