AHIP - FINAL EXAMINATION
QUESTIONS WITH CORRECT
ANSWERS 2025/2026
Mr.AZachowAhasAaAconditionAforAwhichAthreeAdrugsAareAavailable.AHeAhasAtriedAtwoAbutAhadAan
AallergicAreactionAtoAthem.AOnlyAtheAthirdAdrugAworksAforAhimAandAitAisAnotAonAhisAPartADAplan's
Aformulary.AWhatAcouldAyouAtellAhimAtoAdo?A-
AcorrectAanswersMr.AZachowAhasAaArightAtoArequestAaAformularyAexceptionAtoAobtainAcoverageA
forAhisAPartADAdrug.AHeAorAhisAphysicianAcouldAobtainAtheAstandardizedArequestAformAonAtheApl
an'sAwebsite,AfillAitAout,AandAsubmitAitAtoAhisAplan.
Mr.APolanskiAlikesAtheAcostAofAanAHMOAplanAavailableAinAhisAarea,AbutAwouldAlikeAtoAbeAableAtoA
visitAoneAorAtwoAdoctorsAwhoAaren'tAparticipatingAproviders.AHeAwantsAtoAknowAifAtheAPointAofA
ServiceA(POS)AoptionAavailableAwithAsomeAHMOsAwillAbeAofAanyAhelpAinAthisAsituation.AWhatAsh
ouldAyouAtellAhim?A-
AcorrectAanswersTheAPOSAoptionAmightAbeAaAgoodAsolutionAforAhimAasAitAwillAallowAhimAtoAvisitA
out-of-
networkAproviders,AgenerallyAwithoutApriorAapproval.AHowever,AheAshouldAbeAawareAthatAitAisA
likelyAheAwillAhaveAtoApayAhigherAcost-sharingAforAservicesAfromAout-of-networkAproviders.
Mr.ABarkerAhadAsurgeryArecentlyAandAexpectedAthatAheAwouldAhaveAcertainAservicesAandAitems
AcoveredAbyAtheAplanAwithAminimalAout-of-pocketAcostsAbecauseAhisAMA-
PDAcoverageAhasAbeenAveryAgood.AHowever,AwhenAheAreceivedAtheAbill,AheAwasAsurprisedAtoAse
eAlargeAchargesAinAexcessAofAhisAmaximumAout-of-
pocketAlimitAthatAincludedAaAnumberAofAservicesAandAitemsAheAthoughtAwouldAbeAfullyAcovere
d.AHeAcalledAyouAtoAaskAwhatAheAcouldAdo?AWhatAcouldAyouAtellAhim?A-
AcorrectAanswersYouAcanAofferAtoAreviewAtheAplansAappealAprocessAtoAhelpAhimAaskAtheAplanAto
AreviewAtheAcoverageAdecision.
Ms.AStuartAhasAheardAaboutAaAspecialAneedsAplanA(SNP)AthatAoneAofAherAfriendsAisAenrolledAinA
andAisAinterestedAinAthatAproduct.ASheAwantsAtoAbeAsureAsheAalsoAhasAcoverageAforAprescriptio
nAdrugs.AWouldAsheAbeAableAtoAobtainAdrugAcoverageAifAsheAenrolledAinAtheASNP?A-
AcorrectAanswersa.AYes.AAllASNPsAareArequiredAtoAprovideAPartADAcoverageAforAprescriptionAdru
gs.
b.AYes,AbutAonlyAifAsheAqualifiesAforAPartADAprescriptionAdrugAcoverageAunderAherAstateAMedicai
dAprogram.
c.ANo.AMedicareAbeneficiariesAwhoAenrollAinAanASNPAmustAalwaysAobtainAtheirAdrugAcoverageAt
hroughAaAstand-
aloneAPartADAMedicareAprescriptionAdrugAplanAthatAtheyAsignAupAforAindependentAofAtheirAenr
ollmentAinAtheASNP.
, d.AMaybe.ASomeASNPsAofferAPartADAcoverageAforAprescriptionAdrugsAandAsomeAdoAnot.
=A?????
PhionaAworksAinAtheAITADepartmentAofABestCareAHealthAPlan.APhionaAisAplacedAinAchargeAofABe
stCare'sAeffortsAtoAfacilitateAelectronicAenrollmentAinAitsAMedicareAAdvantageAplans.AInAsettingA
upAtheAenrollmentAsite,AwhichAofAtheAfollowingAmustAPhionaAconsider?A-
AcorrectAanswersII.AAllAdataAelementsArequiredAtoAcompleteAanAenrollmentArequestAmustAbeAca
ptured.
III.ATheAprocessAmustAincludeAaAclearAandAdistinctAstepAthatArequiresAtheAapplicantAtoAactivateA
anA"EnrollANow"AorA"IAAgree"AtypeAofAbuttonAorAtool.
Ms.ALewisAunderstandsAthatAMedicareAprescriptionAdrugAplansAmayAuseAvariousAmethodsAtoAc
ontrolAtheAuseAofAspecificAdrugs.ASheAhasAheardAaboutAaAtechniqueAcalledA"stepAtherapy"AandAi
sAwonderingAifAyouAcanAexplainAwhatAthatAis.AWhatAshouldAyouAtellAher?A-
AcorrectAanswersStepAtherapyAinvolvesAusingAoneAorAmoreAlowerApricedAdrugsAbeforeAtryingAaA
moreAexpensiveAdrugAwhenAallAareAusedAtoAtreatAtheAsameAcondition.
Mr.AGomezAnotesAthatAaAPrivateAFee-for-
ServiceA(PFFS)AplanAavailableAinAhisAareaAhasAanAattractiveApremium.AHeAwantsAtoAknowAifAheA
mustAuseAdoctorsAinAaAnetworkAasAhisAcurrentAHMOAplanArequiresAhimAtoAdo.AWhatAshouldAyou
AtellAhim?A-
AcorrectAanswersHeAmayAreceiveAhealthAcareAservicesAfromAANYAdoctorAallowedAtoAbillAMedica
re,AasAlongAasAheAshowsAtheAdoctorAtheAplan'sAidentificationAcardAandAtheAdoctorAagreesAtoAacc
eptAtheAPFFSAplan'sApaymentAtermsAandAconditions,AwhichAcouldAincludeAbalanceAbilling.
Mr.AWuAisAeligibleAforAMedicare.AHeAhasAlimitedAfinancialAresourcesAbutAfailedAtoAqualifyAforAth
eAPartADAlow-
incomeAsubsidy.AWhereAmightAheAturnAforAhelpAwithAhisAprescriptionAdrugAcosts?A-
AcorrectAanswersMr.AWuAmayAstillAqualifyAforAhelpAinApayingAPartADAcostsAthroughAhisAStateAPha
rmaceuticalAAssistanceAProgram.
YouAhaveAdecidedAtoAfocusAonAdoingAin-
homeApresentationsAtoAmarketAtheAMedicareAAdvantageA(MA)AplansAyouArepresent.ABeforeAyo
uAconductAsuchAsalesApresentations,AwhatAmustAyouAdo?A-AcorrectAanswers
Mr.AWongAisAaAsingleAindividual.AHeAhasAhadAaAsuccessfulAbusinessAcareerAandAisAnowAableAtoAr
etireAwithAaAcomfortableAincome.AMr.AWong'sAtaxableAincomeAisAinAexcessAofA$100,000.AMr.AW
ongAhasAhealthAcoverageAthroughAhisAemployerAbutAwillAsign-
upAMedicareAPartAA,APartABAandAPartADAwhenAheAleavesAtheAworkforce.AHowAwouldAyouAadvise
AhimAasAheAbudgetsAforAMedicareApremiums?A-
AcorrectAanswersa.ADueAtoAtheAprovisionsAofAMACRA,AhisAPartABAandADAcoverageAwillAbeAcombi
nedAandAcoveredAthroughAaAlow-costAMedigapApolicyAtoAsupplementAhisAPartAAAcoverage.
QUESTIONS WITH CORRECT
ANSWERS 2025/2026
Mr.AZachowAhasAaAconditionAforAwhichAthreeAdrugsAareAavailable.AHeAhasAtriedAtwoAbutAhadAan
AallergicAreactionAtoAthem.AOnlyAtheAthirdAdrugAworksAforAhimAandAitAisAnotAonAhisAPartADAplan's
Aformulary.AWhatAcouldAyouAtellAhimAtoAdo?A-
AcorrectAanswersMr.AZachowAhasAaArightAtoArequestAaAformularyAexceptionAtoAobtainAcoverageA
forAhisAPartADAdrug.AHeAorAhisAphysicianAcouldAobtainAtheAstandardizedArequestAformAonAtheApl
an'sAwebsite,AfillAitAout,AandAsubmitAitAtoAhisAplan.
Mr.APolanskiAlikesAtheAcostAofAanAHMOAplanAavailableAinAhisAarea,AbutAwouldAlikeAtoAbeAableAtoA
visitAoneAorAtwoAdoctorsAwhoAaren'tAparticipatingAproviders.AHeAwantsAtoAknowAifAtheAPointAofA
ServiceA(POS)AoptionAavailableAwithAsomeAHMOsAwillAbeAofAanyAhelpAinAthisAsituation.AWhatAsh
ouldAyouAtellAhim?A-
AcorrectAanswersTheAPOSAoptionAmightAbeAaAgoodAsolutionAforAhimAasAitAwillAallowAhimAtoAvisitA
out-of-
networkAproviders,AgenerallyAwithoutApriorAapproval.AHowever,AheAshouldAbeAawareAthatAitAisA
likelyAheAwillAhaveAtoApayAhigherAcost-sharingAforAservicesAfromAout-of-networkAproviders.
Mr.ABarkerAhadAsurgeryArecentlyAandAexpectedAthatAheAwouldAhaveAcertainAservicesAandAitems
AcoveredAbyAtheAplanAwithAminimalAout-of-pocketAcostsAbecauseAhisAMA-
PDAcoverageAhasAbeenAveryAgood.AHowever,AwhenAheAreceivedAtheAbill,AheAwasAsurprisedAtoAse
eAlargeAchargesAinAexcessAofAhisAmaximumAout-of-
pocketAlimitAthatAincludedAaAnumberAofAservicesAandAitemsAheAthoughtAwouldAbeAfullyAcovere
d.AHeAcalledAyouAtoAaskAwhatAheAcouldAdo?AWhatAcouldAyouAtellAhim?A-
AcorrectAanswersYouAcanAofferAtoAreviewAtheAplansAappealAprocessAtoAhelpAhimAaskAtheAplanAto
AreviewAtheAcoverageAdecision.
Ms.AStuartAhasAheardAaboutAaAspecialAneedsAplanA(SNP)AthatAoneAofAherAfriendsAisAenrolledAinA
andAisAinterestedAinAthatAproduct.ASheAwantsAtoAbeAsureAsheAalsoAhasAcoverageAforAprescriptio
nAdrugs.AWouldAsheAbeAableAtoAobtainAdrugAcoverageAifAsheAenrolledAinAtheASNP?A-
AcorrectAanswersa.AYes.AAllASNPsAareArequiredAtoAprovideAPartADAcoverageAforAprescriptionAdru
gs.
b.AYes,AbutAonlyAifAsheAqualifiesAforAPartADAprescriptionAdrugAcoverageAunderAherAstateAMedicai
dAprogram.
c.ANo.AMedicareAbeneficiariesAwhoAenrollAinAanASNPAmustAalwaysAobtainAtheirAdrugAcoverageAt
hroughAaAstand-
aloneAPartADAMedicareAprescriptionAdrugAplanAthatAtheyAsignAupAforAindependentAofAtheirAenr
ollmentAinAtheASNP.
, d.AMaybe.ASomeASNPsAofferAPartADAcoverageAforAprescriptionAdrugsAandAsomeAdoAnot.
=A?????
PhionaAworksAinAtheAITADepartmentAofABestCareAHealthAPlan.APhionaAisAplacedAinAchargeAofABe
stCare'sAeffortsAtoAfacilitateAelectronicAenrollmentAinAitsAMedicareAAdvantageAplans.AInAsettingA
upAtheAenrollmentAsite,AwhichAofAtheAfollowingAmustAPhionaAconsider?A-
AcorrectAanswersII.AAllAdataAelementsArequiredAtoAcompleteAanAenrollmentArequestAmustAbeAca
ptured.
III.ATheAprocessAmustAincludeAaAclearAandAdistinctAstepAthatArequiresAtheAapplicantAtoAactivateA
anA"EnrollANow"AorA"IAAgree"AtypeAofAbuttonAorAtool.
Ms.ALewisAunderstandsAthatAMedicareAprescriptionAdrugAplansAmayAuseAvariousAmethodsAtoAc
ontrolAtheAuseAofAspecificAdrugs.ASheAhasAheardAaboutAaAtechniqueAcalledA"stepAtherapy"AandAi
sAwonderingAifAyouAcanAexplainAwhatAthatAis.AWhatAshouldAyouAtellAher?A-
AcorrectAanswersStepAtherapyAinvolvesAusingAoneAorAmoreAlowerApricedAdrugsAbeforeAtryingAaA
moreAexpensiveAdrugAwhenAallAareAusedAtoAtreatAtheAsameAcondition.
Mr.AGomezAnotesAthatAaAPrivateAFee-for-
ServiceA(PFFS)AplanAavailableAinAhisAareaAhasAanAattractiveApremium.AHeAwantsAtoAknowAifAheA
mustAuseAdoctorsAinAaAnetworkAasAhisAcurrentAHMOAplanArequiresAhimAtoAdo.AWhatAshouldAyou
AtellAhim?A-
AcorrectAanswersHeAmayAreceiveAhealthAcareAservicesAfromAANYAdoctorAallowedAtoAbillAMedica
re,AasAlongAasAheAshowsAtheAdoctorAtheAplan'sAidentificationAcardAandAtheAdoctorAagreesAtoAacc
eptAtheAPFFSAplan'sApaymentAtermsAandAconditions,AwhichAcouldAincludeAbalanceAbilling.
Mr.AWuAisAeligibleAforAMedicare.AHeAhasAlimitedAfinancialAresourcesAbutAfailedAtoAqualifyAforAth
eAPartADAlow-
incomeAsubsidy.AWhereAmightAheAturnAforAhelpAwithAhisAprescriptionAdrugAcosts?A-
AcorrectAanswersMr.AWuAmayAstillAqualifyAforAhelpAinApayingAPartADAcostsAthroughAhisAStateAPha
rmaceuticalAAssistanceAProgram.
YouAhaveAdecidedAtoAfocusAonAdoingAin-
homeApresentationsAtoAmarketAtheAMedicareAAdvantageA(MA)AplansAyouArepresent.ABeforeAyo
uAconductAsuchAsalesApresentations,AwhatAmustAyouAdo?A-AcorrectAanswers
Mr.AWongAisAaAsingleAindividual.AHeAhasAhadAaAsuccessfulAbusinessAcareerAandAisAnowAableAtoAr
etireAwithAaAcomfortableAincome.AMr.AWong'sAtaxableAincomeAisAinAexcessAofA$100,000.AMr.AW
ongAhasAhealthAcoverageAthroughAhisAemployerAbutAwillAsign-
upAMedicareAPartAA,APartABAandAPartADAwhenAheAleavesAtheAworkforce.AHowAwouldAyouAadvise
AhimAasAheAbudgetsAforAMedicareApremiums?A-
AcorrectAanswersa.ADueAtoAtheAprovisionsAofAMACRA,AhisAPartABAandADAcoverageAwillAbeAcombi
nedAandAcoveredAthroughAaAlow-costAMedigapApolicyAtoAsupplementAhisAPartAAAcoverage.
