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AHIP 2026 CERTIFICATION EXAM NEWEST 2026
ACTUAL EXAM QUESTIONS AND CORRECT
DETAILED ANSWERS (VERIFIED ANSWERS) ALL
ANSWERED {100 Q & A} ALREADY GRADED A+ |
BRAND NEW! | 100% GUARANTEED PASS
Ms. Moss decided to remain in Original Medicare (Parts A and B)
and Part D during the Annual Enrollment Period (AEP). At the
beginning of January, her neighbor told her about the Medicare
Advantage (MA) plan he selected. He also told her there was an
open enrollment period that she might be able to use to enroll in
an MA plan. Ms. Moss comes to you for advice shortly after
speaking to her neighbor. What should you tell her? - ✔✔✔ Correct
Answer > There is an MA Open Enrollment Period (OEP) that takes
place between January 1 and March 31, but Ms. Moss cannot use
it because eligibility to use the OEP is available only to MA
enrollees.
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? - ✔✔✔ Correct Answer > He is not eligible to
enroll in a Medicare Advantage plan until he re-enrolls in
Medicare Part B.
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Which of the following statement(s) is/are correct about a
Medicare Savings 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. - ✔✔✔ Correct
Answer > I, II, and IV only
Mrs. Duran is enrolled in a prescription drug plan. She has heard
about something called True-Out-Pocket costs or "TrOOP" and
asks you if any of the following count toward reaching the
catastrophic coverage phase. What do you say?
I. Her annual PDP deductible
II. Supplemental coverage provided by an employer group waiver
plan
III. The off formulary drug her doctor prescribed but she pays for
because the plan denied her exception request
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IV. Her over-the-counter (OTC) allergy medication. - ✔✔✔ Correct
Answer > I and II only
Mr. Pham is a Qualified Medicare Beneficiary (QMB). He enrolls in
a Medicare Advantage HMO. Shortly thereafter, Mr. Pham visits
his primary care provider (PCP), Dr. Maria Sanchez. Mr. Pham
complains of a bad cold and receives care - a Medicare-covered
service. The normal copayment is $40. How much may Dr.
Sanchez collects? - ✔✔✔ Correct Answer > The minimal copayment
that would apply under Medicaid, regardless of what the plan
requires of other enrollees.
Tariq is a Medicare beneficiary who is considering switching to a
Medicare Advantage plan during this year's open enrollment
season. He has read about prior authorization and the need for
referrals in the newspapers and asks you what type of plans can
require prior authorization. What do you say? - ✔✔✔ Correct Answer >
PPO plans cannot require prior authorization for either in-
network or out-of-network services, such as a visit to a
specialist. However, if a PPO requires authorization or a referral
for an in-network service and such authorization or referral is
not obtained, if the service is covered, the member may only be
charged the higher out-of-network cost-sharing.
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
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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? - ✔✔✔ Correct Answer > Mrs. Lester may enroll in
an MA MSA plan and remain in her current standalone Part D
prescription drug plan.
Mr. Abbott 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? - ✔✔✔ Correct Answer > There are
Medicare health plans such as HMOs, PPOs, PFFS, and MSAs.
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? - ✔✔✔ Correct Answer > 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.
Mrs. Sanchez cares for her frail elderly mother, Maria, who lives
in North Carolina. She is worried that without additional support,
her mother will need to go into a nursing home. Mrs. Sanchez
asks you if there is any Medicare plan that might allow her
mother to remain in the community rather than going into a
nursing home. How should you advise Mrs. Sanchez? - ✔✔✔ Correct
Answer > There are Programs of All-Inclusive Care for the Elderly
AHIP 2026 CERTIFICATION EXAM NEWEST 2026
ACTUAL EXAM QUESTIONS AND CORRECT
DETAILED ANSWERS (VERIFIED ANSWERS) ALL
ANSWERED {100 Q & A} ALREADY GRADED A+ |
BRAND NEW! | 100% GUARANTEED PASS
Ms. Moss decided to remain in Original Medicare (Parts A and B)
and Part D during the Annual Enrollment Period (AEP). At the
beginning of January, her neighbor told her about the Medicare
Advantage (MA) plan he selected. He also told her there was an
open enrollment period that she might be able to use to enroll in
an MA plan. Ms. Moss comes to you for advice shortly after
speaking to her neighbor. What should you tell her? - ✔✔✔ Correct
Answer > There is an MA Open Enrollment Period (OEP) that takes
place between January 1 and March 31, but Ms. Moss cannot use
it because eligibility to use the OEP is available only to MA
enrollees.
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? - ✔✔✔ Correct Answer > He is not eligible to
enroll in a Medicare Advantage plan until he re-enrolls in
Medicare Part B.
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Which of the following statement(s) is/are correct about a
Medicare Savings 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. - ✔✔✔ Correct
Answer > I, II, and IV only
Mrs. Duran is enrolled in a prescription drug plan. She has heard
about something called True-Out-Pocket costs or "TrOOP" and
asks you if any of the following count toward reaching the
catastrophic coverage phase. What do you say?
I. Her annual PDP deductible
II. Supplemental coverage provided by an employer group waiver
plan
III. The off formulary drug her doctor prescribed but she pays for
because the plan denied her exception request
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IV. Her over-the-counter (OTC) allergy medication. - ✔✔✔ Correct
Answer > I and II only
Mr. Pham is a Qualified Medicare Beneficiary (QMB). He enrolls in
a Medicare Advantage HMO. Shortly thereafter, Mr. Pham visits
his primary care provider (PCP), Dr. Maria Sanchez. Mr. Pham
complains of a bad cold and receives care - a Medicare-covered
service. The normal copayment is $40. How much may Dr.
Sanchez collects? - ✔✔✔ Correct Answer > The minimal copayment
that would apply under Medicaid, regardless of what the plan
requires of other enrollees.
Tariq is a Medicare beneficiary who is considering switching to a
Medicare Advantage plan during this year's open enrollment
season. He has read about prior authorization and the need for
referrals in the newspapers and asks you what type of plans can
require prior authorization. What do you say? - ✔✔✔ Correct Answer >
PPO plans cannot require prior authorization for either in-
network or out-of-network services, such as a visit to a
specialist. However, if a PPO requires authorization or a referral
for an in-network service and such authorization or referral is
not obtained, if the service is covered, the member may only be
charged the higher out-of-network cost-sharing.
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
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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? - ✔✔✔ Correct Answer > Mrs. Lester may enroll in
an MA MSA plan and remain in her current standalone Part D
prescription drug plan.
Mr. Abbott 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? - ✔✔✔ Correct Answer > There are
Medicare health plans such as HMOs, PPOs, PFFS, and MSAs.
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? - ✔✔✔ Correct Answer > 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.
Mrs. Sanchez cares for her frail elderly mother, Maria, who lives
in North Carolina. She is worried that without additional support,
her mother will need to go into a nursing home. Mrs. Sanchez
asks you if there is any Medicare plan that might allow her
mother to remain in the community rather than going into a
nursing home. How should you advise Mrs. Sanchez? - ✔✔✔ Correct
Answer > There are Programs of All-Inclusive Care for the Elderly
