2025/2026 AHIP Final Exam Questions and Verified
Answers, 100% Guaranteed Pass
1. 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?
...Ans>> 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.
2. 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?
...Ans>> 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.
,3. 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?
...Ans>> 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.
4. 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?
...Ans>> 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.
,5. Mrs. Radford asks whether there are any special eligibility requirements for
Medicare Advantage. What should you tell her?
...Ans>> Mrs. Radford must be entitled to Part A and enrolled in Part B to
enroll in Medicare Advantage.
6. 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
some services and items he thought would be fully covered. He called you
, to ask what he could do? What could you tell him?
...Ans>> You can offer to review the plans appeal process to help him ask the
plan to review the coverage decision.
7. Which of the following statement(s) is/are correct about a Medicare Sav-
ings Account (MSA) Plans?
I. MSAs may have either a partial network, full network, or no network
of providers.
II. MSA plans cover Part A and Part B benefits but not Part D prescription drug
benefits.
III. An individual who is enrolled in an MSA plan is responsible for a minimal
deductible of $500 indexed for inflation.
IV. Non-network providers must accept the same amount that Original
Medicare would pay them as payment in full.
...Ans>> I, II, and IV only
8. 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 Advan-
tage 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.
Answers, 100% Guaranteed Pass
1. 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?
...Ans>> 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.
2. 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?
...Ans>> 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.
,3. 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?
...Ans>> 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.
4. 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?
...Ans>> 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.
,5. Mrs. Radford asks whether there are any special eligibility requirements for
Medicare Advantage. What should you tell her?
...Ans>> Mrs. Radford must be entitled to Part A and enrolled in Part B to
enroll in Medicare Advantage.
6. 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
some services and items he thought would be fully covered. He called you
, to ask what he could do? What could you tell him?
...Ans>> You can offer to review the plans appeal process to help him ask the
plan to review the coverage decision.
7. Which of the following statement(s) is/are correct about a Medicare Sav-
ings Account (MSA) Plans?
I. MSAs may have either a partial network, full network, or no network
of providers.
II. MSA plans cover Part A and Part B benefits but not Part D prescription drug
benefits.
III. An individual who is enrolled in an MSA plan is responsible for a minimal
deductible of $500 indexed for inflation.
IV. Non-network providers must accept the same amount that Original
Medicare would pay them as payment in full.
...Ans>> I, II, and IV only
8. 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 Advan-
tage 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.
