1|Page
AHIP FINAL EXAM NEWEST 2025 TEST BANK|
COMPLETE 450 REAL EXAM QUESTIONS AND
CORRECT DETAILED ANSWERS (VERIFIED
ANSWERS) ALREADY GRADED A+| AHIP FINAL
EXAM PREP 2025 (BRAND NEW!!)
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? -
ANSWER - She can enroll in the PPO, but she will not be able to
purchase a stand-alone Medicare Part D prescription drug plan.
Mrs. Burton is a retiree with substantial income. She is enrolled in an
MA-PD plan and was disappointed with the service she received from
her primary care physician because she was told she would have to wait
five weeks to get an appointment when she was feeling ill. She called
you to ask what she could do so she would not have to put up with such
poor access to care. What could you tell her? - ANSWER - She could
file a grievance with her plan to complain about the lack of timeliness in
getting an appointment.
Mr. Wells is trying to understand the difference between Original
Medicare and Medicare Advantage. What would be the correct
description? - ANSWER - Medicare Advantage is a way of covering all
the Original Medicare benefits through private health insurance
companies.
pg. 1
,2|Page
Mr. Castillo, a naturalized citizen, previously enrolled in Medicare Part
B but has recently stopped paying his Part B premium. Mr. Castillo is
still covered by Part A. 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.
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? - 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.
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? - ANSWER - She cannot enroll in an
MA Medical Savings Account (MSA) plan.
Mr. Barker enjoys a comfortable retirement income. He recently had
surgery and expected that he would have certain services and items
covered by the plan with minimal out-of-pocket costs because his MA-
PD coverage has been very good. However, when he received the bill,
he was surprised to see large charges in excess of his maximum out-of-
pocket limit that included a number of services and items he thought
would be fully covered. He called you to ask what he could do? What
could you tell him? - ANSWER - You can offer to review the plans
appeal process to help him ask the plan to review the coverage decision.
pg. 2
,3|Page
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 enroll in
Medicare Advantage.
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? -
ANSWER - 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.
Mrs. Davenport enrolled in the ABC Medicare Advantage (MA) plan
several years ago. In mid-February of 2021, her doctor confirms a
diagnosis of end-stage renal disease (ESRD). What options will Mrs.
Davenport have regarding her MA plan during the next open enrollment
season? - ANSWER - She may remain in her ABC MA plan, enroll in
another MA plan in her service area, 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 generally obtain his services only from providers who have a
contractual relationship with the plan (except in an emergency or where
care is unavailable within the network).
pg. 3
, 4|Page
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? - 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. 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
provider who participates in Original Medicare, but generally will have a
higher cost-sharing amount if she sees a provider who/that is not a part
of the PPO network.
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? - ANSWER - In order to join a Medicare
Advantage plan, she also must enroll in Part B.
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? - 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.
pg. 4
AHIP FINAL EXAM NEWEST 2025 TEST BANK|
COMPLETE 450 REAL EXAM QUESTIONS AND
CORRECT DETAILED ANSWERS (VERIFIED
ANSWERS) ALREADY GRADED A+| AHIP FINAL
EXAM PREP 2025 (BRAND NEW!!)
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? -
ANSWER - She can enroll in the PPO, but she will not be able to
purchase a stand-alone Medicare Part D prescription drug plan.
Mrs. Burton is a retiree with substantial income. She is enrolled in an
MA-PD plan and was disappointed with the service she received from
her primary care physician because she was told she would have to wait
five weeks to get an appointment when she was feeling ill. She called
you to ask what she could do so she would not have to put up with such
poor access to care. What could you tell her? - ANSWER - She could
file a grievance with her plan to complain about the lack of timeliness in
getting an appointment.
Mr. Wells is trying to understand the difference between Original
Medicare and Medicare Advantage. What would be the correct
description? - ANSWER - Medicare Advantage is a way of covering all
the Original Medicare benefits through private health insurance
companies.
pg. 1
,2|Page
Mr. Castillo, a naturalized citizen, previously enrolled in Medicare Part
B but has recently stopped paying his Part B premium. Mr. Castillo is
still covered by Part A. 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.
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? - 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.
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? - ANSWER - She cannot enroll in an
MA Medical Savings Account (MSA) plan.
Mr. Barker enjoys a comfortable retirement income. He recently had
surgery and expected that he would have certain services and items
covered by the plan with minimal out-of-pocket costs because his MA-
PD coverage has been very good. However, when he received the bill,
he was surprised to see large charges in excess of his maximum out-of-
pocket limit that included a number of services and items he thought
would be fully covered. He called you to ask what he could do? What
could you tell him? - ANSWER - You can offer to review the plans
appeal process to help him ask the plan to review the coverage decision.
pg. 2
,3|Page
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 enroll in
Medicare Advantage.
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? -
ANSWER - 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.
Mrs. Davenport enrolled in the ABC Medicare Advantage (MA) plan
several years ago. In mid-February of 2021, her doctor confirms a
diagnosis of end-stage renal disease (ESRD). What options will Mrs.
Davenport have regarding her MA plan during the next open enrollment
season? - ANSWER - She may remain in her ABC MA plan, enroll in
another MA plan in her service area, 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 generally obtain his services only from providers who have a
contractual relationship with the plan (except in an emergency or where
care is unavailable within the network).
pg. 3
, 4|Page
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? - 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. 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
provider who participates in Original Medicare, but generally will have a
higher cost-sharing amount if she sees a provider who/that is not a part
of the PPO network.
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? - ANSWER - In order to join a Medicare
Advantage plan, she also must enroll in Part B.
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? - 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.
pg. 4
