AHIP Certification Exam 2027 | Actual Q&A (AHIP
Certification Exam 2027 (50 Questions)
Medicare Advantage, Part D, Enrollment Rules
Instructions: Select the best answer for each scenario-based question.
Answer Key
| # | Answer | # | Answer | # | Answer | # | Answer | # | Answer |
|---|--------|---|--------|---|--------|---|--------|---|--------|
| 1 | B | 11 | B | 21 | A | 31 | A | 41 | B |
| 2 | A | 12 | A | 22 | A | 32 | D | 42 | A |
| 3 | B | 13 | B | 23 | A | 33 | C | 43 | D |
| 4 | A | 14 | B | 24 | B | 34 | A | 44 | A |
| 5 | B | 15 | A | 25 | B | 35 | A | 45 | A |
| 6 | D | 16 | A | 26 | C | 36 | A | 46 | A |
| 7 | A | 17 | A | 27 | A | 37 | A | 47 | B |
| 8 | B | 18 | A | 28 | A | 38 | A | 48 | D |
| 9 | B | 19 | A | 29 | D | 39 | A | 49 | A |
| 10 | B | 20 | D | 30 | A | 40 | C | 50 | A |
1. A Medicare Advantage HMO plan requires a beneficiary to:
A) Pay higher premiums for out-of-network care.
B) Use only network providers, except for emergencies or urgent care.
C) Obtain a referral for all specialist visits, including in-network.
D) Select a primary care physician, but no referral is needed for specialists.
2. A Medicare Advantage PPO plan allows a beneficiary to:
A) See any provider, but pay more for out-of-network care.
B) Only see network providers.
C) Never use out-of-network providers.
D) Have all services covered at the same cost-sharing regardless of network.
3. A beneficiary enrolls in a Medicare Advantage plan with a $0 monthly premium. The
plan has a $3,500 out-of-pocket maximum. After reaching that amount, the plan:
, A) Stops covering all services.
B) Covers all Medicare-covered services at 100% for the rest of the year.
C) Covers only in-network services at 100%.
D) Requires the beneficiary to pay 20% coinsurance for all services.
4. A Medicare Advantage plan must cover:
A) At least the same benefits as Original Medicare (Parts A and B), except hospice.
B) Fewer benefits than Original Medicare to keep premiums low.
C) Only hospital and medical services, not prescription drugs.
D) All benefits at the same cost-sharing as Original Medicare.
5. A beneficiary is considering a Medicare Advantage SNP (Special Needs Plan) for dual
eligibles. Which is true?
A) The SNP is only available to beneficiaries under 65.
B) The SNP coordinates Medicare and Medicaid benefits.
C) The SNP does not have to cover Part D.
D) The SNP is available only in rural areas.
6. A Medicare Advantage plan can charge a Part B premium reduction if:
A) The plan reduces the Part B premium by up to 20%.
B) The plan pays a portion of the Part B premium as a benefit.
C) The plan reduces the Part B deductible.
D) The plan offers a rebate that can be used to reduce the Part B premium.
7. A beneficiary in a Medicare Advantage HMO wants to see a specialist. The plan
requires:
A) A referral from the primary care physician.
B) Prior authorization from the plan, but no referral.
C) No referral or prior authorization.
D) A referral only for out-of-network specialists.
8. Which Medicare Advantage plan type typically has the narrowest network?
Certification Exam 2027 (50 Questions)
Medicare Advantage, Part D, Enrollment Rules
Instructions: Select the best answer for each scenario-based question.
Answer Key
| # | Answer | # | Answer | # | Answer | # | Answer | # | Answer |
|---|--------|---|--------|---|--------|---|--------|---|--------|
| 1 | B | 11 | B | 21 | A | 31 | A | 41 | B |
| 2 | A | 12 | A | 22 | A | 32 | D | 42 | A |
| 3 | B | 13 | B | 23 | A | 33 | C | 43 | D |
| 4 | A | 14 | B | 24 | B | 34 | A | 44 | A |
| 5 | B | 15 | A | 25 | B | 35 | A | 45 | A |
| 6 | D | 16 | A | 26 | C | 36 | A | 46 | A |
| 7 | A | 17 | A | 27 | A | 37 | A | 47 | B |
| 8 | B | 18 | A | 28 | A | 38 | A | 48 | D |
| 9 | B | 19 | A | 29 | D | 39 | A | 49 | A |
| 10 | B | 20 | D | 30 | A | 40 | C | 50 | A |
1. A Medicare Advantage HMO plan requires a beneficiary to:
A) Pay higher premiums for out-of-network care.
B) Use only network providers, except for emergencies or urgent care.
C) Obtain a referral for all specialist visits, including in-network.
D) Select a primary care physician, but no referral is needed for specialists.
2. A Medicare Advantage PPO plan allows a beneficiary to:
A) See any provider, but pay more for out-of-network care.
B) Only see network providers.
C) Never use out-of-network providers.
D) Have all services covered at the same cost-sharing regardless of network.
3. A beneficiary enrolls in a Medicare Advantage plan with a $0 monthly premium. The
plan has a $3,500 out-of-pocket maximum. After reaching that amount, the plan:
, A) Stops covering all services.
B) Covers all Medicare-covered services at 100% for the rest of the year.
C) Covers only in-network services at 100%.
D) Requires the beneficiary to pay 20% coinsurance for all services.
4. A Medicare Advantage plan must cover:
A) At least the same benefits as Original Medicare (Parts A and B), except hospice.
B) Fewer benefits than Original Medicare to keep premiums low.
C) Only hospital and medical services, not prescription drugs.
D) All benefits at the same cost-sharing as Original Medicare.
5. A beneficiary is considering a Medicare Advantage SNP (Special Needs Plan) for dual
eligibles. Which is true?
A) The SNP is only available to beneficiaries under 65.
B) The SNP coordinates Medicare and Medicaid benefits.
C) The SNP does not have to cover Part D.
D) The SNP is available only in rural areas.
6. A Medicare Advantage plan can charge a Part B premium reduction if:
A) The plan reduces the Part B premium by up to 20%.
B) The plan pays a portion of the Part B premium as a benefit.
C) The plan reduces the Part B deductible.
D) The plan offers a rebate that can be used to reduce the Part B premium.
7. A beneficiary in a Medicare Advantage HMO wants to see a specialist. The plan
requires:
A) A referral from the primary care physician.
B) Prior authorization from the plan, but no referral.
C) No referral or prior authorization.
D) A referral only for out-of-network specialists.
8. Which Medicare Advantage plan type typically has the narrowest network?
