AHIP PRACTICE EXAM QUESTIONS WITH COMPLETE
SOLUTIONS GUARANTEED PASS BRAND NEW 2025
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 - >They are Medicare health plans 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? - CORRECT 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
plans? - CORRECT ANSWER - >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.
(W) Mrs. Radford asks whether there are any special eligibility
requirements for Medicare Advantage. What should you tell
,her? - CORRECT ANSWER - >Mrs. Radford must be entitled to
Part A and enrolled in Part B to enroll in 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? -
CORRECT 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 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? - CORRECT ANSWER - >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
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 obtain his 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? - CORRECT ANSWER - >Mrs.
,Ramos can obtain care from any 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 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
(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? - CORRECT 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? - CORRECT 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? - CORRECT ANSWER - >After receiving such disability
payments for 24 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? - CORRECT 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 should you tell her? - CORRECT 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
SOLUTIONS GUARANTEED PASS BRAND NEW 2025
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 - >They are Medicare health plans 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? - CORRECT 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
plans? - CORRECT ANSWER - >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.
(W) Mrs. Radford asks whether there are any special eligibility
requirements for Medicare Advantage. What should you tell
,her? - CORRECT ANSWER - >Mrs. Radford must be entitled to
Part A and enrolled in Part B to enroll in 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? -
CORRECT 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 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? - CORRECT ANSWER - >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
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 obtain his 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? - CORRECT ANSWER - >Mrs.
,Ramos can obtain care from any 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 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
(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? - CORRECT 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? - CORRECT 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? - CORRECT ANSWER - >After receiving such disability
payments for 24 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? - CORRECT 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 should you tell her? - CORRECT 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
