Ahip final exam 2025/2026 | complete test questions with verified correct
answers | fully graded a+ success guide
Mr. Arias, a naturalized citizen, previously enrolled in Medicare Part B but has recently
stopped paying his Part B premium. Mr. Arias 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? - -He is not eligible to enroll in a Medicare Advantage plan until he re-enrolls in
Medicare Part B.
--Mrs. Joy, age 65, is entitled to Part A but has not yet enrolled in Part B. She is considering
enrolling in a Medicare Advantage plan (Part C). What should you advise her to do before
she can enroll in a Medicare Advantage plan? - -To join a Medicare Advantage plan, she also
must enroll in Part B.
--Mr. Kumar is considering a Medicare Advantage HMO and has questions about his ability
to access providers. What should you tell him? - -In most Medicare Advantage HMOs, Mr.
Kumar must generally obtain his services only from providers within the plan's network
(except in an emergency or where care is unavailable within the network).
--Mrs. Robles 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? - -Mrs. Robles 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. Lester is age 75 and enjoys a comfortable but not extremely high-income level. She
wishes to enroll in an 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. Lester? - -Mrs. Lester may enroll in an MA MSA plan and remain
in her current standalone Part D prescription drug plan.
--Mr. Dalton 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. Dalton
would like to join that plan. What should you tell him? - -SNPs limit enrollment to certain
subpopulations of beneficiaries. Given his current situation, he is unlikely to qualify and
would not be able to enroll in the SNP.
--Mr. Anderson 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? - -You would
need to ask Mr. Anderson if he is entitled to Part A, enrolled in Part B, and if he lives in the
PFFS plan's service area.
--Herber Noble is turning 65 next month, Herber legally entered the United States over
twenty years ago but is not a citizen. Since his entry into the country, Herber has worked at
Smallcap Incorporated and contributed to the Medicare system. Herber 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? - -Herber is eligible to enroll in Medicare
Advantage as long as he is entitled to Part A and enrolled in Part B. Herber 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.
--Which of the following individuals is most likely to be eligible to enroll in a Part D Plan? - -
Jose, a grandfather who was granted asylum and has worked in the United States for many
years.
--Mrs. Castro has just turned 65, is in excellent health and has a relatively high income. She
uses no medications and sees no reason to spend money on a Medicare prescription drug
plan if she does not need the coverage. She currently does not have creditable coverage.
What could you tell her about the implications of such a decision? - -If she does not sign up
for a Medicare prescription drug plan as soon as she is eligible to do so, and if she does sign
up at a later date, her premium will be permanently increased by 1% of the national average
premium for every month that she was not covered.
--Mr. Chen was still working when he first qualified for Medicare. At that time, he had
employer group coverage that was creditable. During his initial Part D eligibility period, he
decided not to enroll because he was satisfied with his drug coverage. It is now a year later
and Mr. Chen has lost his employer group coverage within the last two weeks. How would
you advise him? - -Mr. Chen should enroll in a Part D plan before he has a 63-day break in
coverage in order to avoid a premium penalty.
--Ms. Ramos is enrolled in a Medicare Advantage plan that includes prescription drug plan
(PDP) coverage. She is traveling and wishes to fill two of the prescriptions that she has lost.
How would you advise her? - -She may fill prescriptions for covered drugs at non-network
pharmacies, but likely at a higher cost than paid at an in-network pharmacy.
--What types of tools can Medicare Part D prescription drug plans use that affect the way
their enrollees can access medications? - -Part D plans do not have to cover all medications.
As a result, their formularies, or lists of covered drugs, will vary from plan to plan. In
addition, they can use cost containment techniques such as tiered co-payments and step
therapy.
--Mrs. Esmeralda Avila is a Medicare beneficiary enrolled in a MA-PD plan you represent.
Her neighbor recently suffered from a painful case of shingles. Mrs. Avila hopes to avoid
such an illness through vaccination. She asks you whether the cost of the shingles
vaccination will be covered under the plan you represent. What should you say? - -Yes,
there is no cost sharing for the shingles vaccine even in the deductible phase of her
prescription drug plan because it is an adult vaccine recommended by the Advisory
Committee on Immunization Practices (AICP).
--Mrs. Strickland is a new Medicare beneficiary who has just retired from retail work. She is
interested in selecting a Medicare Part D prescription drug plan. She takes several
medications and is concerned that she has not been able to identify a plan that covers all of
her medications. She does not want to make an abrupt change to new drugs that would be
answers | fully graded a+ success guide
Mr. Arias, a naturalized citizen, previously enrolled in Medicare Part B but has recently
stopped paying his Part B premium. Mr. Arias 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? - -He is not eligible to enroll in a Medicare Advantage plan until he re-enrolls in
Medicare Part B.
--Mrs. Joy, age 65, is entitled to Part A but has not yet enrolled in Part B. She is considering
enrolling in a Medicare Advantage plan (Part C). What should you advise her to do before
she can enroll in a Medicare Advantage plan? - -To join a Medicare Advantage plan, she also
must enroll in Part B.
--Mr. Kumar is considering a Medicare Advantage HMO and has questions about his ability
to access providers. What should you tell him? - -In most Medicare Advantage HMOs, Mr.
Kumar must generally obtain his services only from providers within the plan's network
(except in an emergency or where care is unavailable within the network).
--Mrs. Robles 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? - -Mrs. Robles 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. Lester is age 75 and enjoys a comfortable but not extremely high-income level. She
wishes to enroll in an 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. Lester? - -Mrs. Lester may enroll in an MA MSA plan and remain
in her current standalone Part D prescription drug plan.
--Mr. Dalton 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. Dalton
would like to join that plan. What should you tell him? - -SNPs limit enrollment to certain
subpopulations of beneficiaries. Given his current situation, he is unlikely to qualify and
would not be able to enroll in the SNP.
--Mr. Anderson 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? - -You would
need to ask Mr. Anderson if he is entitled to Part A, enrolled in Part B, and if he lives in the
PFFS plan's service area.
--Herber Noble is turning 65 next month, Herber legally entered the United States over
twenty years ago but is not a citizen. Since his entry into the country, Herber has worked at
Smallcap Incorporated and contributed to the Medicare system. Herber 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? - -Herber is eligible to enroll in Medicare
Advantage as long as he is entitled to Part A and enrolled in Part B. Herber 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.
--Which of the following individuals is most likely to be eligible to enroll in a Part D Plan? - -
Jose, a grandfather who was granted asylum and has worked in the United States for many
years.
--Mrs. Castro has just turned 65, is in excellent health and has a relatively high income. She
uses no medications and sees no reason to spend money on a Medicare prescription drug
plan if she does not need the coverage. She currently does not have creditable coverage.
What could you tell her about the implications of such a decision? - -If she does not sign up
for a Medicare prescription drug plan as soon as she is eligible to do so, and if she does sign
up at a later date, her premium will be permanently increased by 1% of the national average
premium for every month that she was not covered.
--Mr. Chen was still working when he first qualified for Medicare. At that time, he had
employer group coverage that was creditable. During his initial Part D eligibility period, he
decided not to enroll because he was satisfied with his drug coverage. It is now a year later
and Mr. Chen has lost his employer group coverage within the last two weeks. How would
you advise him? - -Mr. Chen should enroll in a Part D plan before he has a 63-day break in
coverage in order to avoid a premium penalty.
--Ms. Ramos is enrolled in a Medicare Advantage plan that includes prescription drug plan
(PDP) coverage. She is traveling and wishes to fill two of the prescriptions that she has lost.
How would you advise her? - -She may fill prescriptions for covered drugs at non-network
pharmacies, but likely at a higher cost than paid at an in-network pharmacy.
--What types of tools can Medicare Part D prescription drug plans use that affect the way
their enrollees can access medications? - -Part D plans do not have to cover all medications.
As a result, their formularies, or lists of covered drugs, will vary from plan to plan. In
addition, they can use cost containment techniques such as tiered co-payments and step
therapy.
--Mrs. Esmeralda Avila is a Medicare beneficiary enrolled in a MA-PD plan you represent.
Her neighbor recently suffered from a painful case of shingles. Mrs. Avila hopes to avoid
such an illness through vaccination. She asks you whether the cost of the shingles
vaccination will be covered under the plan you represent. What should you say? - -Yes,
there is no cost sharing for the shingles vaccine even in the deductible phase of her
prescription drug plan because it is an adult vaccine recommended by the Advisory
Committee on Immunization Practices (AICP).
--Mrs. Strickland is a new Medicare beneficiary who has just retired from retail work. She is
interested in selecting a Medicare Part D prescription drug plan. She takes several
medications and is concerned that she has not been able to identify a plan that covers all of
her medications. She does not want to make an abrupt change to new drugs that would be
