AHIP Final Exam Latest Update
2025/2026 Questions with Verified
Answers| Graded A+
- Correct Answers-a. A Cost Plan only if it does not offer drug coverage.
- Correct Answers-a. A PFFS plan is a type of Medicare Supplement plan and she may enroll
in one if it is available in her area.
- Correct Answers-a. A PFFS plan offering only medical benefits or a PFFS Medigap
Supplemental Insurance plan.
- Correct Answers-a. Alice because she will not have a break between her non-Medicare and
Medicare coverage through Spartan Health Plan.
- Correct Answers-a. All Medicare Health Plans offer cost-sharing that is lower than Original
Medicare for all Part A and Part B covered services, but the maximum out-of-pocket limit is
higher than in Original Medicare.
- Correct Answers-a. All that she needs to do is avoid being terminated for cause.
- Correct Answers-a. Because he is moving outside of the service area, the plan must
automatically disenroll him. He will have a special election period to select a new plan.
- Correct Answers-a. He can call them to let them know that if they do not like their new
plans, they can change back during the MA-OEP.
- Correct Answers-a. He is eligible for the Part D prescription drug benefit because he is
entitled to Part A and he does not have to be enrolled in Part B.
- Correct Answers-a. He must apply for the extra help at the same time he applies for
enrollment in a Part D plan. If he missed this opportunity, he will not be able to apply for the
extra help again until the next annual enrollment period.
- Correct Answers-a. If offered, beneficiaries can select a stand-alone Part D prescription
drug plan (PDP) with an HMO or a PPO, but not with a PFFS plan.
- Correct Answers-a. II and IV only
,- Correct Answers-a. In general, he must select a single Part D premium payment
mechanism that will be used throughout the year.
- Correct Answers-a. Inpatient psychiatric services are not covered under Original Medicare.
- Correct Answers-a. Medicaid beneficiaries are not eligible for enrollment into a PFFS plan.
They must obtain their care through their state's Medicaid program.
- Correct Answers-a. Medicare Advantage (MA) HMO-POS plan that does not include drug
coverage.
- Correct Answers-a. Medicare Advantage plans are required to create a benefits package
that results in roughly equivalent costs and may exclude coverage for some items and services
that are covered under Part A and/or Part B of Original Medicare.
- Correct Answers-a. Medicare permits plans that have the highest quality services to reduce
their premiums below the standard amount in order to increase their market share. This
accounts for the variation in premium amounts.
- Correct Answers-a. Mr. Wu has no alternative but to liquidate his remaining assets and
apply for coverage through his state's Medicaid program.
- Correct Answers-a. Mrs. Duarte should file an appeal of this initial determination within
120 days of the date she received the MSN in the mail.
- Correct Answers-a. Mrs. Tanner can go to non-plan doctors without receiving prior
approval for all services.
- Correct Answers-a. No, he cannot execute the enrollment for her. He must have a legal
authorization, under state law that explicitly allows him to make health care decisions for his
mother.
- Correct Answers-a. Obtaining approval of her materials from the State Department of
Insurance is a good practice and she should continue it with materials for the Medicare health
plans she represents.
- Correct Answers-a. Part D prescription drug coverage can only be obtained by enrollment
into a Medicare Advantage plan that also covers Part A and Part B services.
- Correct Answers-a. Sell personal information obtained as part of a raffle to a third-party
marketeer.
, - Correct Answers-a. She can enroll in the PPO, but she will not be able to purchase a stand-
alone Medicare Part D prescription drug plan.
- Correct Answers-a. She is unlikely to qualify for a SEP but will be automatically covered by
Original Medicare and a standalone Part D prescription drug plan.
- Correct Answers-a. She may fill one prescription out-of-network per year and it will be fully
covered. Her second prescription will require her to pay the full cost out-of-pocket.
- Correct Answers-a. She must first enroll in a Medicare Part D plan, before enrolling in a
Medicare Advantage plan.
- Correct Answers-a. She will have to obtain a job and work enough years to qualify for
Medicare Part A.
- Correct Answers-a. Since Mr. Peters requested a description of the Part D plan, his agent
must leave the Part D plan brochure, but not an enrollment form, and would have to schedule
another appointment after at least 48 hours have passed to discuss the Part D plan with Mr.
Peters.
- Correct Answers-a. So long as the hospital or its physician staff don't object, marketing
anywhere in the hospital is an acceptable practice.
- Correct Answers-a. Tell the client that she cannot speak to her until after open enrollment
begins on January 1st of the following year.
- Correct Answers-a. The beneficiary could only choose a Medicare Medical Savings Account
(MSA) plan.
- Correct Answers-a. The Federal government facilitates competition between hospice
programs to lower the price of their services for Medicare beneficiaries, but does not offer
coverage for hospice services through the Medicare program.
- Correct Answers-a. The letter is to inform her that her Medigap drug coverage must be
supplemented by purchasing coverage under a Part D plan. If she does not do so within 63 days,
she will not be able to obtain Part D coverage at a later date.
- Correct Answers-a. The neighbors may not provide a meal, but light snacks would be
permitted.
- Correct Answers-a. The SNP would select her primary care provider (PCP) but she could file
a grievance within 90 days if the PCP proved incapable.
2025/2026 Questions with Verified
Answers| Graded A+
- Correct Answers-a. A Cost Plan only if it does not offer drug coverage.
- Correct Answers-a. A PFFS plan is a type of Medicare Supplement plan and she may enroll
in one if it is available in her area.
- Correct Answers-a. A PFFS plan offering only medical benefits or a PFFS Medigap
Supplemental Insurance plan.
- Correct Answers-a. Alice because she will not have a break between her non-Medicare and
Medicare coverage through Spartan Health Plan.
- Correct Answers-a. All Medicare Health Plans offer cost-sharing that is lower than Original
Medicare for all Part A and Part B covered services, but the maximum out-of-pocket limit is
higher than in Original Medicare.
- Correct Answers-a. All that she needs to do is avoid being terminated for cause.
- Correct Answers-a. Because he is moving outside of the service area, the plan must
automatically disenroll him. He will have a special election period to select a new plan.
- Correct Answers-a. He can call them to let them know that if they do not like their new
plans, they can change back during the MA-OEP.
- Correct Answers-a. He is eligible for the Part D prescription drug benefit because he is
entitled to Part A and he does not have to be enrolled in Part B.
- Correct Answers-a. He must apply for the extra help at the same time he applies for
enrollment in a Part D plan. If he missed this opportunity, he will not be able to apply for the
extra help again until the next annual enrollment period.
- Correct Answers-a. If offered, beneficiaries can select a stand-alone Part D prescription
drug plan (PDP) with an HMO or a PPO, but not with a PFFS plan.
- Correct Answers-a. II and IV only
,- Correct Answers-a. In general, he must select a single Part D premium payment
mechanism that will be used throughout the year.
- Correct Answers-a. Inpatient psychiatric services are not covered under Original Medicare.
- Correct Answers-a. Medicaid beneficiaries are not eligible for enrollment into a PFFS plan.
They must obtain their care through their state's Medicaid program.
- Correct Answers-a. Medicare Advantage (MA) HMO-POS plan that does not include drug
coverage.
- Correct Answers-a. Medicare Advantage plans are required to create a benefits package
that results in roughly equivalent costs and may exclude coverage for some items and services
that are covered under Part A and/or Part B of Original Medicare.
- Correct Answers-a. Medicare permits plans that have the highest quality services to reduce
their premiums below the standard amount in order to increase their market share. This
accounts for the variation in premium amounts.
- Correct Answers-a. Mr. Wu has no alternative but to liquidate his remaining assets and
apply for coverage through his state's Medicaid program.
- Correct Answers-a. Mrs. Duarte should file an appeal of this initial determination within
120 days of the date she received the MSN in the mail.
- Correct Answers-a. Mrs. Tanner can go to non-plan doctors without receiving prior
approval for all services.
- Correct Answers-a. No, he cannot execute the enrollment for her. He must have a legal
authorization, under state law that explicitly allows him to make health care decisions for his
mother.
- Correct Answers-a. Obtaining approval of her materials from the State Department of
Insurance is a good practice and she should continue it with materials for the Medicare health
plans she represents.
- Correct Answers-a. Part D prescription drug coverage can only be obtained by enrollment
into a Medicare Advantage plan that also covers Part A and Part B services.
- Correct Answers-a. Sell personal information obtained as part of a raffle to a third-party
marketeer.
, - Correct Answers-a. She can enroll in the PPO, but she will not be able to purchase a stand-
alone Medicare Part D prescription drug plan.
- Correct Answers-a. She is unlikely to qualify for a SEP but will be automatically covered by
Original Medicare and a standalone Part D prescription drug plan.
- Correct Answers-a. She may fill one prescription out-of-network per year and it will be fully
covered. Her second prescription will require her to pay the full cost out-of-pocket.
- Correct Answers-a. She must first enroll in a Medicare Part D plan, before enrolling in a
Medicare Advantage plan.
- Correct Answers-a. She will have to obtain a job and work enough years to qualify for
Medicare Part A.
- Correct Answers-a. Since Mr. Peters requested a description of the Part D plan, his agent
must leave the Part D plan brochure, but not an enrollment form, and would have to schedule
another appointment after at least 48 hours have passed to discuss the Part D plan with Mr.
Peters.
- Correct Answers-a. So long as the hospital or its physician staff don't object, marketing
anywhere in the hospital is an acceptable practice.
- Correct Answers-a. Tell the client that she cannot speak to her until after open enrollment
begins on January 1st of the following year.
- Correct Answers-a. The beneficiary could only choose a Medicare Medical Savings Account
(MSA) plan.
- Correct Answers-a. The Federal government facilitates competition between hospice
programs to lower the price of their services for Medicare beneficiaries, but does not offer
coverage for hospice services through the Medicare program.
- Correct Answers-a. The letter is to inform her that her Medigap drug coverage must be
supplemented by purchasing coverage under a Part D plan. If she does not do so within 63 days,
she will not be able to obtain Part D coverage at a later date.
- Correct Answers-a. The neighbors may not provide a meal, but light snacks would be
permitted.
- Correct Answers-a. The SNP would select her primary care provider (PCP) but she could file
a grievance within 90 days if the PCP proved incapable.
