AHIP Final Review Module 2 2027 Actual Exam Questions and Correct Answers

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1. Mr. Romero is 64, retiring soon, and considering enrollment in his em-
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ployer-
sponsored retiree group health plan that includes drug coverage with nomin v x v x v x v x v x v x v x v x v x v x




al copays. He heard about a neighbor's MA-
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PD plan that you represent and because he takes numerous prescription drug
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s, he is considering signing up for it. What should you tell him?: He should compare the be
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nefits in his employer-sponsored retiree grouphealth plan with the benefitsin hisneighbor'sMA-
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PDplan to determine whichone willprovide suflcient coverage for his prescription needs.
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2. Mrs. Chou likes a Private Fee-for- vx vx vx vx vx




Service (PFFS) plan available in her area that does not include drug coverage. S
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he wants to enroll in the plan and enroll in a stand-
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alone prescription drug plan. What should you tell her?: She could enroll in a PFFS plan an
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d a stand-alone Medicare prescription drug plan.
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3. Mr. Kelly wants to know whether he is eligible to sign up for a private
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fee-for-
service (PFFS) plan. What questions would you need to ask to deter-
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mine his eligibility?: You would need to ask Mr. Kelly if he is entitled to Part A, enrolled in Part B, and if he lives i
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n the PFFS plan's service area.
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4. Mrs. Radford asks whether there are any special eligibility requirements fo
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r
Medicare Advantage. What should you tell her?: Mrs. Radford must be entitled to Part A and enroll
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ed in Part B to enroll in Medicare Advantage.
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5. Dr. Elizabeth Brennan does not contract with the ABC PFFS plan but accepts the
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plan's terms and conditions for payment. Mary Rodgers sees Dr. Brennan for
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treatment. How much may Dr. Brennan charge?: Dr. Brennan can charge Mary Rogers no more
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than the cost sharing specified in the PFFS plan's terms and condition of payment which may include balance billing up to
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15%of the Medicare rate. vx vx vx




6. Mr. Lopez has heard that he can sign up for a product called "Medicare
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Advantage" but is not sure about what type of plan designs are available t v x v x v x v x v x v x v x v x v x v x v x v x vx




hrough this program. What should you tell him about the types of health
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plans that are available through the Medicare Advantage program?: There are Me
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dicare health plans such as HMOs, PPOs, PFFS, and MSAs.
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, AHIP Final Review Module 2
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7. Mrs. Velasquez cares for her frail elderly mother, Maria, who lives in North Car
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olina. She is worried that without additional support, her mother will need to
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go into a nursing home. Mrs. Velasquez asks you if there is any Medicare plan t
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hat might allow her mother to remain in the community rather than
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2vx/vx7