AHIP FINAL EXAM
AHIP FINAL EXAM NEWEST 2025/2026
COMPLETE ALL 250 QUESTIONS AND
CORRECT DETAILED ANSWERS
|ALREADY GRADED A+||ALREADY
GRADED A+
Mr. Romero is 64, retiring soon, and considering enrollment in his employer-sponsored
retiree group health plan that includes drug coverage with nominal copays. He heard about
a neighbor's MA-PD plan that you represent and because he takes numerous prescription
drugs, he is considering signing up for it. What should you tell him?
a.When possible, it is always the best option to have both the employer's plan and the MA-
PD, so he would have no out-of-pocket expenses.
b.Generally, employers prefer retirees to enroll in a stand-alone PDP, so he should consider
that instead of the MA-PD.
c.Generally, employers prefer retirees to have both the retiree group plan and the MA-PD
plan to fill in the gaps, but he would be better off with just the MA-PD plan.
d.He should compare the benefits in his employer-sponsored retiree group health plan with
the benefits in his neighbor's MA-PD plan to determine which one will provide sufficient
coverage for his prescription needs.
d.
He should compare the benefits in his employer-sponsored retiree group health plan with
the benefits in his neighbor's MA-PD plan to determine which one will provide sufficient
coverage for his prescription needs.
Mrs. Chi is age 75 and enjoys a comfortable but not extremely high-income 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.
A+ TEST BANK 1
, AHIP FINAL EXAM
How would you advise Mrs. Chi?
a.Mrs. Chi may enroll in a MA MSA plan but if she wishes prescription drug coverage it must
be a MSA-PD plan that includes drug coverage.
b.Mrs. Chi may enroll in a MA MSA plan and remain in her current standalone Part D
prescription drug plan.
c.Mrs. Chi is ineligible for a MA MSA plan because she is ineligible for Medicaid due to her
income level.
d.Mrs. Chi may enroll in a MA MSA plan but if she wishes prescription drug coverage she
must also enroll in a Medicare Supplement Plan (Medigap) F that covers the Medicare Part B
deductible and includes both drug coverage.
b. Mrs. Chi may enroll in a MA MSA plan and remain in her current standalone Part D
prescription drug plan.
Mr. Kumar is considering a Medicare Advantage HMO and has questions about his ability to
access providers. What should you tell him?
a.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).
b.With any Medicare Advantage HMO, Mr. Kumar will be able to see any provider he likes, so
long as that provider participates in Original Medicare.
c.Mr. Kumar will be able to obtain routine care outside of the plan's service area but will pay
a higher co-payment (except in an emergency).
d.In Medicare Advantage HMO plans, services provided by primary care physicians are
covered at 100%, but those of specialists are covered at 80%.
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).
Mr. Lopez has heard that he can sign up for a product called "Medicare Advantage" but is
not sure about what type of plan designs are available through this program. What should
you tell him about the types of health plans that are available through the Medicare
Advantage program?
a.They are Medigap Supplemental plans that fill in the gaps not covered by Medicare.
b.They are major medical policies but are only for low-income beneficiaries with Medicare.
A+ TEST BANK 2
, AHIP FINAL EXAM
c.They are Medicare health plans such as HMOs, PPOs, PFFS, and MSAs.
d.They are custodial long-term care plans for people with Medicare.
They are Medicare health plans such as HMOs, PPOs, PFFS, and MSAs.
Mr. Sanchez has just turned 65 and is entitled to Part A but has not enrolled in Part B
because he has coverage through an employer plan. If he wants to enroll in a Medicare
Advantage plan, what will he have to do?
a.He will not need to do anything. His entitlement to Part A makes him eligible to enroll in
any Medicare Advantage plan.
b.As long as his employer offers coverage that is equivalent to Medicare's, he cannot enroll
in Part B.
c.He must wait until the next Annual Election Period, at which time he can enroll in a
Medicare Advantage plan.
d.He will have to enroll in Part B.
d. He will have to enroll in Part B.
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?
a.In general, Mrs. Ramos can obtain care from any provider who participates in Original
Medicare but will have to pay the difference between the plan's allowed amount and the
provider's usual and customary charge.
b.In general, Mrs. Ramos will need a referral to see specialists.
c.Mrs. Ramos should be aware that generally plan providers can decide, on a case-by-case
basis, whether they will treat her.
d.Mrs. Ramos can obtain care from any provider who participates in Original Medicare, but
A+ TEST BANK 3
, AHIP FINAL EXAM
generally will have a higher cost-sharing amount if she sees a provider who/that is not a part
of the PPO network.
d. 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.
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?
a.She must write to the plan and wait for a response and then, if she is still dissatisfied, she
could file an appeal with her state Medicaid office requesting transfer to one of its managed
care plans.
b.She should not expect to get in to see her doctor any more quickly since she is a Medicare
patient.
c.She should call the doctor's office to complain since the plan cannot do anything about the
doctor's schedule.
d.She could file a grievance with her plan to complain about the lack of timeliness in getting
an appointment.
d. She could file a grievance with her plan to complain about the lack of timeliness in getting
an appointment.
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?
A+ TEST BANK 4
AHIP FINAL EXAM NEWEST 2025/2026
COMPLETE ALL 250 QUESTIONS AND
CORRECT DETAILED ANSWERS
|ALREADY GRADED A+||ALREADY
GRADED A+
Mr. Romero is 64, retiring soon, and considering enrollment in his employer-sponsored
retiree group health plan that includes drug coverage with nominal copays. He heard about
a neighbor's MA-PD plan that you represent and because he takes numerous prescription
drugs, he is considering signing up for it. What should you tell him?
a.When possible, it is always the best option to have both the employer's plan and the MA-
PD, so he would have no out-of-pocket expenses.
b.Generally, employers prefer retirees to enroll in a stand-alone PDP, so he should consider
that instead of the MA-PD.
c.Generally, employers prefer retirees to have both the retiree group plan and the MA-PD
plan to fill in the gaps, but he would be better off with just the MA-PD plan.
d.He should compare the benefits in his employer-sponsored retiree group health plan with
the benefits in his neighbor's MA-PD plan to determine which one will provide sufficient
coverage for his prescription needs.
d.
He should compare the benefits in his employer-sponsored retiree group health plan with
the benefits in his neighbor's MA-PD plan to determine which one will provide sufficient
coverage for his prescription needs.
Mrs. Chi is age 75 and enjoys a comfortable but not extremely high-income 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.
A+ TEST BANK 1
, AHIP FINAL EXAM
How would you advise Mrs. Chi?
a.Mrs. Chi may enroll in a MA MSA plan but if she wishes prescription drug coverage it must
be a MSA-PD plan that includes drug coverage.
b.Mrs. Chi may enroll in a MA MSA plan and remain in her current standalone Part D
prescription drug plan.
c.Mrs. Chi is ineligible for a MA MSA plan because she is ineligible for Medicaid due to her
income level.
d.Mrs. Chi may enroll in a MA MSA plan but if she wishes prescription drug coverage she
must also enroll in a Medicare Supplement Plan (Medigap) F that covers the Medicare Part B
deductible and includes both drug coverage.
b. Mrs. Chi may enroll in a MA MSA plan and remain in her current standalone Part D
prescription drug plan.
Mr. Kumar is considering a Medicare Advantage HMO and has questions about his ability to
access providers. What should you tell him?
a.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).
b.With any Medicare Advantage HMO, Mr. Kumar will be able to see any provider he likes, so
long as that provider participates in Original Medicare.
c.Mr. Kumar will be able to obtain routine care outside of the plan's service area but will pay
a higher co-payment (except in an emergency).
d.In Medicare Advantage HMO plans, services provided by primary care physicians are
covered at 100%, but those of specialists are covered at 80%.
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).
Mr. Lopez has heard that he can sign up for a product called "Medicare Advantage" but is
not sure about what type of plan designs are available through this program. What should
you tell him about the types of health plans that are available through the Medicare
Advantage program?
a.They are Medigap Supplemental plans that fill in the gaps not covered by Medicare.
b.They are major medical policies but are only for low-income beneficiaries with Medicare.
A+ TEST BANK 2
, AHIP FINAL EXAM
c.They are Medicare health plans such as HMOs, PPOs, PFFS, and MSAs.
d.They are custodial long-term care plans for people with Medicare.
They are Medicare health plans such as HMOs, PPOs, PFFS, and MSAs.
Mr. Sanchez has just turned 65 and is entitled to Part A but has not enrolled in Part B
because he has coverage through an employer plan. If he wants to enroll in a Medicare
Advantage plan, what will he have to do?
a.He will not need to do anything. His entitlement to Part A makes him eligible to enroll in
any Medicare Advantage plan.
b.As long as his employer offers coverage that is equivalent to Medicare's, he cannot enroll
in Part B.
c.He must wait until the next Annual Election Period, at which time he can enroll in a
Medicare Advantage plan.
d.He will have to enroll in Part B.
d. He will have to enroll in Part B.
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?
a.In general, Mrs. Ramos can obtain care from any provider who participates in Original
Medicare but will have to pay the difference between the plan's allowed amount and the
provider's usual and customary charge.
b.In general, Mrs. Ramos will need a referral to see specialists.
c.Mrs. Ramos should be aware that generally plan providers can decide, on a case-by-case
basis, whether they will treat her.
d.Mrs. Ramos can obtain care from any provider who participates in Original Medicare, but
A+ TEST BANK 3
, AHIP FINAL EXAM
generally will have a higher cost-sharing amount if she sees a provider who/that is not a part
of the PPO network.
d. 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.
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?
a.She must write to the plan and wait for a response and then, if she is still dissatisfied, she
could file an appeal with her state Medicaid office requesting transfer to one of its managed
care plans.
b.She should not expect to get in to see her doctor any more quickly since she is a Medicare
patient.
c.She should call the doctor's office to complain since the plan cannot do anything about the
doctor's schedule.
d.She could file a grievance with her plan to complain about the lack of timeliness in getting
an appointment.
d. She could file a grievance with her plan to complain about the lack of timeliness in getting
an appointment.
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?
A+ TEST BANK 4
