AHIP FINAL TEST EXAM 2025/2026 NEWEST STUDY QUESTIONS
WITH CORRECT DETAILED ANSWERS GUARANTEED PASS | RATED
A+
Mrs. Chou likes a Private Fee-for-Service (PFFS) plan available in her area that does not include
drug coverage. She wants to enroll in the plan and enroll in a stand-alone prescription drug plan.
What should you tell her? - Answer>>> She could enroll in a PFFS plan and a stand-alone
Medicare prescription drug plan.
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.
Mr. Kelly wants to know whether he is eligible to sign up for a private fee-for-service (PFFS)
plan. What questions would you need to ask to determine his eligibility? - Answer>>> You
would need to ask Mr. Kelly if he is entitled to Part A, enrolled in Part B, and if he lives in the
PFFS plan's service area.
You have set up an appointment for an in-home sales presentation with Mrs. Fernandez, who
expressed interest in the Medicare plans you represent. In preparation for the sales presentation,
what must you do? - Answer>>> Before conducting the presentation, obtain and document
having obtained her permission to visit, along with her interest in the specific products you will
present.
Mr. Rodriguez is currently enrolled in a MA plan, but his plan doesn't sufficiently cover his
prescription drug needs. He is interested in changing plans during the upcoming MA Open
Enrollment Period. What are his options during the MA OEP? - Answer>>> He can switch to a
MA-PD plan.
Mr. Xi will soon turn age 65 and has come to you for advice as to what services are provided
under Original Medicare. What should you tell Mr. Xi that best describes the health coverage
provided to Medicare beneficiaries? - Answer>>> Beneficiaries under Original Medicare have
no cost-sharing for most preventive services.
,Mr. Garcia was told he qualifies for a special election period (SEP), but he lost the paper that
explains what he could do during the SEP. What can you tell him? - Answer>>> If the SEP is for
MA coverage, he will generally have one opportunity to change his MA coverage.
Mr. Jacob understands that there is a standard Medicare Part D prescription drug benefit, but
when he looks at information on various plans available in his area, he sees a wide range in what
they charge for deductibles, premiums, and cost sharing. How can you explain this to him? -
Answer>>> Medicare Part D drug plans may have different benefit structures, but on average,
they must all be at least as good as the standard model established by the government.
Mrs. Schmidt is moving and a friend told her she might qualify for a "special election period" to
enroll in a new Medicare Advantage plan. She contacted you to ask what a special election
period is. What could you tell her? - Answer>>> It is a period, outside of the Annual Election
Period, when a Medicare beneficiary can select a new or different Medicare Advantage and/or
Part D prescription drug plan. Typically, the special election period is beneficiary specific and
results from events, such as when the beneficiary moves outside of the service area.
Mrs. Kendrick is in good health, has worked for many years, and is six months away from
turning 65. She wants to know what she will have to do to enroll in a Medicare Advantage (MA)
plan as soon as possible. What could you tell her? - Answer>>> She may enroll in an MA plan
beginning three months immediately before her first entitlement to both Medicare Part A and
Part B.
Mr. Singh would like drug coverage but does not want to be enrolled in a Medicare Advantage
plan. What should you tell him? - Answer>>> Mr. Singh can enroll in a stand-alone prescription
drug plan and continue to be covered for Part A and Part B services through Original Fee-for-
Service Medicare.
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 age 65 or over 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.
, Mrs. Quinn recently turned 66 and decided after many years of work to retire and begin
receiving Social Security benefits. Shortly thereafter Mrs. Quinn received a letter informing her
that she had been automatically enrolled in Medicare Part B. She wants to understand what this
means. What should you tell Mrs. Quinn? - Answer>>> Part B primarily covers physician
services. She will be paying a monthly premium and, except for many preventive and screening
tests, generally will have 20% co-payments for these services, in addition to an annual
deductible.
Mr. Patel is in good health and is preparing a budget in anticipation of his retirement when he
turns 66. He wants to understand the health care costs he might be exposed to under Medicare if
he were to require hospitalization because of an illness. In general terms, what could you tell him
about his costs for inpatient hospital services under Original Medicare? - Answer>>> Under
Original Medicare, there is a single deductible amount due for the first 60 days of any inpatient
hospital stay, after which it converts into a per-day coinsurance amount through day 90. After
day 90, he would pay a daily amount up to 60 days over his lifetime, after which he would be
responsible for all costs.
What impact, if any, have recent regulatory changes had on Medigap plans? - Answer>>> The
Part B deductible is no longer covered for individuals newly eligible for Medicare starting
January 1, 2020.
Mrs. Paterson is concerned about the deductibles and co-payments associated with Original
Medicare. What can you tell her about Medigap as an option to address this concern? -
Answer>>> Medigap plans do not cover Original Medicare benefits, but they coordinate with
Original Medicare coverage.
Mrs. Turner is comparing her employer's retiree insurance to Original Medicare and would like
to know which of the following services Original Medicare will cover if the appropriate criteria
are met. What could you tell her? - Answer>>> Original Medicare covers ambulance services.
Ms. Brooks has aggressive cancer and would like to know if Medicare will cover hospice
services in case she needs them. What should you tell her? - Answer>>> Medicare covers
hospice services, and they will be available for her.
WITH CORRECT DETAILED ANSWERS GUARANTEED PASS | RATED
A+
Mrs. Chou likes a Private Fee-for-Service (PFFS) plan available in her area that does not include
drug coverage. She wants to enroll in the plan and enroll in a stand-alone prescription drug plan.
What should you tell her? - Answer>>> She could enroll in a PFFS plan and a stand-alone
Medicare prescription drug plan.
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.
Mr. Kelly wants to know whether he is eligible to sign up for a private fee-for-service (PFFS)
plan. What questions would you need to ask to determine his eligibility? - Answer>>> You
would need to ask Mr. Kelly if he is entitled to Part A, enrolled in Part B, and if he lives in the
PFFS plan's service area.
You have set up an appointment for an in-home sales presentation with Mrs. Fernandez, who
expressed interest in the Medicare plans you represent. In preparation for the sales presentation,
what must you do? - Answer>>> Before conducting the presentation, obtain and document
having obtained her permission to visit, along with her interest in the specific products you will
present.
Mr. Rodriguez is currently enrolled in a MA plan, but his plan doesn't sufficiently cover his
prescription drug needs. He is interested in changing plans during the upcoming MA Open
Enrollment Period. What are his options during the MA OEP? - Answer>>> He can switch to a
MA-PD plan.
Mr. Xi will soon turn age 65 and has come to you for advice as to what services are provided
under Original Medicare. What should you tell Mr. Xi that best describes the health coverage
provided to Medicare beneficiaries? - Answer>>> Beneficiaries under Original Medicare have
no cost-sharing for most preventive services.
,Mr. Garcia was told he qualifies for a special election period (SEP), but he lost the paper that
explains what he could do during the SEP. What can you tell him? - Answer>>> If the SEP is for
MA coverage, he will generally have one opportunity to change his MA coverage.
Mr. Jacob understands that there is a standard Medicare Part D prescription drug benefit, but
when he looks at information on various plans available in his area, he sees a wide range in what
they charge for deductibles, premiums, and cost sharing. How can you explain this to him? -
Answer>>> Medicare Part D drug plans may have different benefit structures, but on average,
they must all be at least as good as the standard model established by the government.
Mrs. Schmidt is moving and a friend told her she might qualify for a "special election period" to
enroll in a new Medicare Advantage plan. She contacted you to ask what a special election
period is. What could you tell her? - Answer>>> It is a period, outside of the Annual Election
Period, when a Medicare beneficiary can select a new or different Medicare Advantage and/or
Part D prescription drug plan. Typically, the special election period is beneficiary specific and
results from events, such as when the beneficiary moves outside of the service area.
Mrs. Kendrick is in good health, has worked for many years, and is six months away from
turning 65. She wants to know what she will have to do to enroll in a Medicare Advantage (MA)
plan as soon as possible. What could you tell her? - Answer>>> She may enroll in an MA plan
beginning three months immediately before her first entitlement to both Medicare Part A and
Part B.
Mr. Singh would like drug coverage but does not want to be enrolled in a Medicare Advantage
plan. What should you tell him? - Answer>>> Mr. Singh can enroll in a stand-alone prescription
drug plan and continue to be covered for Part A and Part B services through Original Fee-for-
Service Medicare.
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 age 65 or over 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.
, Mrs. Quinn recently turned 66 and decided after many years of work to retire and begin
receiving Social Security benefits. Shortly thereafter Mrs. Quinn received a letter informing her
that she had been automatically enrolled in Medicare Part B. She wants to understand what this
means. What should you tell Mrs. Quinn? - Answer>>> Part B primarily covers physician
services. She will be paying a monthly premium and, except for many preventive and screening
tests, generally will have 20% co-payments for these services, in addition to an annual
deductible.
Mr. Patel is in good health and is preparing a budget in anticipation of his retirement when he
turns 66. He wants to understand the health care costs he might be exposed to under Medicare if
he were to require hospitalization because of an illness. In general terms, what could you tell him
about his costs for inpatient hospital services under Original Medicare? - Answer>>> Under
Original Medicare, there is a single deductible amount due for the first 60 days of any inpatient
hospital stay, after which it converts into a per-day coinsurance amount through day 90. After
day 90, he would pay a daily amount up to 60 days over his lifetime, after which he would be
responsible for all costs.
What impact, if any, have recent regulatory changes had on Medigap plans? - Answer>>> The
Part B deductible is no longer covered for individuals newly eligible for Medicare starting
January 1, 2020.
Mrs. Paterson is concerned about the deductibles and co-payments associated with Original
Medicare. What can you tell her about Medigap as an option to address this concern? -
Answer>>> Medigap plans do not cover Original Medicare benefits, but they coordinate with
Original Medicare coverage.
Mrs. Turner is comparing her employer's retiree insurance to Original Medicare and would like
to know which of the following services Original Medicare will cover if the appropriate criteria
are met. What could you tell her? - Answer>>> Original Medicare covers ambulance services.
Ms. Brooks has aggressive cancer and would like to know if Medicare will cover hospice
services in case she needs them. What should you tell her? - Answer>>> Medicare covers
hospice services, and they will be available for her.
