AHIP 2025 FINAL EXAM.WITH 100% VERIFIED
QUESTIONS AND ANSWERS.A+ GRADED.2025-
2026.
Mrs. Ramos - ANSWER>>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.
MSA Savings Account - ANSWER>>Which of the following statement(s) is/are
correct about a Medicare Savings Account (MSA) Plans?
ANSWER: I, II, and IV only
Mr. Sinclair - ANSWER>>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.
Mrs. Chi - ANSWER>>Mrs. Chi is age 75 and enjoys a comfortable but not
extremely highincome level. She wishes to enroll in a MA MSA plan that she heard
about from her neighbor. She also wants to have prescription drug coverage since
her doctor recently prescribed several expensive medications. Currently, she is
enrolled in Original Medicare and a standalone Part D plan. How would you advise
Mrs. Chi?
ANSWER: Mrs. Chi may enroll in a MA MSA plan and remain in her current
standalone Part D
prescription drug plan.
Mrs. Lyons - ANSWER>>Mrs. Lyons is in good health, uses a single prescription,
and lives independently in her own home. She is attracted by the idea of
,maintaining control over a Medical Savings Account (MSA) but is not sure if the
plan associated with the account will fit her needs. What specific piece of
information about a Medicare MSA plan would it be important for her to know,
prior to enrolling in such a plan?
ANSWER: All MSAs cover Part A and Part B benefits, but not Part D prescription
drug benefits, which could be obtained by also enrolling in a separate prescription
drug plan.
Daniel - ANSWER>>Daniel is a middle-income Medicare beneficiary. He has
chronic bronchitis, putting him at severe risk for pneumonia. Otherwise, he has no
problems functioning. Which type of SNP is likely to be most appropriate for him?
ANSWER: C-SNP
Mr. Gomez - ANSWER>>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.
Juan Hernandez - ANSWER>>Juan Hernandez is turning 65 next month, Juan
legally entered the United States over twenty years ago but is not a citizen. Since
his entry into the country, Juan has worked at Smallcap Incorporated and
contributed to the Medicare system. Juan suffers from diabetes. He will soon
retire and asks you if he can enroll in a Medicare Advantage plan that you
represent. How would you respond?
ANSWER: Juan is eligible to enroll in a Medicare Advantage as long as he is
entitled to Part A and enrolled in Part B. Juan should go to the Social Security
website to enroll in Medicare Part A
and B if he has not done so already. Once he is enrolled, he can choose a
Medicare Advantage plan.
, Ms. Gibson - ANSWER>>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.
Mr. Castillo - ANSWER>>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.
Mrs. Burton - ANSWER>>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. Kelly - ANSWER>>Mr. Kelly wants to know whether he is eligible to sign up for
a Private feefor-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.
Mrs. Radford - ANSWER>>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. Wells - ANSWER>>Mr. Wells is trying to understand the difference between
Original Medicare and Medicare Advantage. What would be the correct
description?
QUESTIONS AND ANSWERS.A+ GRADED.2025-
2026.
Mrs. Ramos - ANSWER>>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.
MSA Savings Account - ANSWER>>Which of the following statement(s) is/are
correct about a Medicare Savings Account (MSA) Plans?
ANSWER: I, II, and IV only
Mr. Sinclair - ANSWER>>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.
Mrs. Chi - ANSWER>>Mrs. Chi is age 75 and enjoys a comfortable but not
extremely highincome level. She wishes to enroll in a MA MSA plan that she heard
about from her neighbor. She also wants to have prescription drug coverage since
her doctor recently prescribed several expensive medications. Currently, she is
enrolled in Original Medicare and a standalone Part D plan. How would you advise
Mrs. Chi?
ANSWER: Mrs. Chi may enroll in a MA MSA plan and remain in her current
standalone Part D
prescription drug plan.
Mrs. Lyons - ANSWER>>Mrs. Lyons is in good health, uses a single prescription,
and lives independently in her own home. She is attracted by the idea of
,maintaining control over a Medical Savings Account (MSA) but is not sure if the
plan associated with the account will fit her needs. What specific piece of
information about a Medicare MSA plan would it be important for her to know,
prior to enrolling in such a plan?
ANSWER: All MSAs cover Part A and Part B benefits, but not Part D prescription
drug benefits, which could be obtained by also enrolling in a separate prescription
drug plan.
Daniel - ANSWER>>Daniel is a middle-income Medicare beneficiary. He has
chronic bronchitis, putting him at severe risk for pneumonia. Otherwise, he has no
problems functioning. Which type of SNP is likely to be most appropriate for him?
ANSWER: C-SNP
Mr. Gomez - ANSWER>>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.
Juan Hernandez - ANSWER>>Juan Hernandez is turning 65 next month, Juan
legally entered the United States over twenty years ago but is not a citizen. Since
his entry into the country, Juan has worked at Smallcap Incorporated and
contributed to the Medicare system. Juan suffers from diabetes. He will soon
retire and asks you if he can enroll in a Medicare Advantage plan that you
represent. How would you respond?
ANSWER: Juan is eligible to enroll in a Medicare Advantage as long as he is
entitled to Part A and enrolled in Part B. Juan should go to the Social Security
website to enroll in Medicare Part A
and B if he has not done so already. Once he is enrolled, he can choose a
Medicare Advantage plan.
, Ms. Gibson - ANSWER>>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.
Mr. Castillo - ANSWER>>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.
Mrs. Burton - ANSWER>>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. Kelly - ANSWER>>Mr. Kelly wants to know whether he is eligible to sign up for
a Private feefor-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.
Mrs. Radford - ANSWER>>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. Wells - ANSWER>>Mr. Wells is trying to understand the difference between
Original Medicare and Medicare Advantage. What would be the correct
description?
