AHIP 2026-2027 | Final Exam Questions & Verified Answers | Medicare Advantage, Part D & Insurance
Mr. Chen is enrolled in his employer's group health plan Mr. Chen can disenroll from his employer-sponsored coverage to elect a
and will be retiring soon. He would like to know his Medicare Advantage or Part D plan within 2 months of his disenrollment.
options since he has decided to drop his retiree
coverage and is eligible for Medicare. What should you
tell him?
Mr. Kumar is considering a Medicare Advantage HMO In most Medicare Advantage HMOs, Mr. Kumar must generally obtain his
and has questions about his ability to access providers. services only from providers within the plan's network (except in an emergency
What should you tell him? or where care is unavailable within the network).
ABC is a Medicare Advantage (MA) plan sponsor. It XXXIt must obtain a HIPAA complaint authorization from an enrollee that
would like to use its enrollees' information to market non- indicates the plan or plan sponsor may use their information for marketing
health related products such as life insurance and purposes.
annuities. Which statement best describes ABC's
obligation to its enrollees regarding marketing such
products?
Mr. Yoo's employer has recently dropped comprehensive It means that he qualifies for a one-time opportunity to enroll in an MA-PD or Part
creditable prescription drug coverage that was offered to D prescription drug plan.
company retirees. The company told Mr. Yoo that,
because he was affected by this change, he would
qualify for a Special election period. Mr. Yoo contacted
you to find out more about what this means. What can
you tell him?
Dr. Elizabeth Brennan does not contract with the ABC Dr. Brennan can charge Mary Rogers no more than the cost sharing specified in
PFFS plan but accepts the plan's terms and conditions the PFFS plan's terms and condition of payment which may include balance
for payment. Mary Rodgers sees Dr. Brennan for billing up to 15% of the Medicare rate.
treatment. How much may Dr. Brennan charge?
Mr. Rainey is experiencing paranoid delusions and his Medicare will cover a total of 190 days of inpatient psychiatric care during Mr.
physician feels that he should be hospitalized. What Rainey's entire lifetime.
should you tell Mr. Rainey (or his representative) about
the length of an inpatient psychiatric hospital stay that
Medicare will cover?
Mr. Moreno invited his neighbor, Agent Tom Smith, to A meal cannot be provided, but light snacks would be permitted.
discuss Medicare Advantage (MA) and Part D plans that
Agent Smith sells at the regular Tuesday brunch the
neighbors have for senior citizens. What should Agent
Tom Smith tell Mr. Moreno about the kinds of food that
can be provided to potential enrollees who attend the
sales presentation?
You have approached a hospital administrator about Tell her that Medicare guidelines allow you to conduct marketing activities in
marketing in her facility. The administrator is common areas of a provider's facility.
uncomfortable with the suggestion. How could you
address her concerns?
Mr. and Mrs. Vaughn both take a specialized multivitamin Medicare prescription drug plans are not permitted to cover the prescription
prescription each day. Mr. Vaughn takes a prescription medications the Vaughns are interested in under Part D coverage, however,
for helping to regrow his hair. They are anxious to have plans may cover them as supplemental benefits and the Vaughn's could look into
their Medicare prescription drug plan cover these drug that possibility.
needs. What should you tell them?
Mrs. Berkowitz wants to enroll in a Medicare Advantage If the Medicare Advantage plan is a Private Fee-for-Service (PFFS) plan that
plan that does not include drug coverage and also enroll does not offer drug coverage or a Medical Savings Account plan, Mrs. Berkowitz
in a stand-alone Medicare prescription drug plan. Under can do this.
what circumstances can she do this?
Which of the following is/are most likely to be I, II, and III only
characterized as an involuntary disenrollment from a
Medicare Advantage (MA) plan?
I. The enrollee dies.
II. An SNP enrollee loses special needs status due to
substantially improved health.
III. It is determined that the member is not lawfully
present in the United States.
IV. The member enrolls in another plan during the Annual
Open Enrollment period.
, AHIP 2026-2027 | Final Exam Questions & Verified Answers | Medicare Advantage, Part D & Insurance
Ms. Brooks has an aggressive cancer and would like to k Medicare covers hospice services and they will be available for her.
You are working several plans and community You must ensure that the advertisements indicate it is an educational event,
organizations to sponsor an educational event. When otherwise it will be considered a marketing event.
putting together advertisements for this event, what
should you do?
Which of the following statement is/are correct about a I and II, only
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.
Mr. Sinclair has diabetes and heart trouble and is SNPs have special programs for enrollees with chronic conditions, like Mr.
generally satisfied with the care he has received under Sinclair, and they provide prescription drug coverage that could be very helpful
Original Medicare, but he would like to know more about as well.
Medicare Advantage Special Needs Plans (SNPs). What
could you tell him?
Mr. Xi will soon turn age 65 and has come to you for .
advice as to what services are provided under Original Beneficiaries under Original Medicare have no cost-sharing for most preventive
Medicare. What should you tell Mr. Xi that best describes services which include immunizations such as annual flu shots.
the health coverage provided to Medicare beneficiaries?
During a sales presentation in Ms. Sullivan's home, she A PFFS plan is one of the various types of Medicare Advantage plans offered by
tells you that she has heard about a type of Medicare private entities and she may enroll in one if it is available in her area.
health plan known as Private Fee-for-Service (PFFS).
She wants to know if this would be available to her. What
should you tell her about PFFS plans?
You have come to Mrs. Midler's home for a sales You can only ask Mrs. Midler questions about conditions that affect eligibility,
presentation. At the beginning of the presentation, Mrs. specifically, whether she has one of the conditions that would qualify her for a
Midler tells you that she has a copy of her medical special needs plan.
records available because she thinks this will help you
understand her needs. She suggests that you will know
which questions to ask her about her health status in
order to best assist her in selecting a plan. What should
you do?
Ms. Edwards is enrolled in a Medicare Advantage plan She may fill prescriptions for covered drugs at non-network pharmacies, but
that includes prescription drug plan (PDP) coverage. She likely at a higher cost than paid at an in-network pharmacy.
is traveling and wishes to fill two of the prescriptions that
she has lost. How would you advise her?
Mr. Johannsen is entitled to Medicare Part A and Part B. He qualifies for a special election period and can enroll in or disenroll from a Part
He gains the Part D low-income subsidy. How does that D plan once during that period.
affect his ability to enroll or disenroll in a Part D plan?
Mr. Hutchinson has drug coverage through his former If the drug coverage he has is not expected to pay, on average, at least as much
employer's retiree plan. He is concerned about the Part as Medicare's standard Part D coverage expects to pay, then he will need to
D premium penalty if he does not enroll in a Medicare enroll in Medicare Part D during his initial eligibility period to avoid the late
prescription drug plan, but does not want to purchase enrollment penalty.
extra coverage that he will not need. What should you
tell him?
Mr. Moy's wife has a Medicare Advantage plan, but he Medicare Supplemental Insurance would help cover his Part A and Part B
wants to understand what coverage Medicare deductibles or coinsurance in Original Fee-for-Service (FFS) Medicare as well as
Supplemental Insurance provides since his health care possibly some services that Medicare does not cover.
needs are different from his wife's needs. What could
you tell Mr. Moy?
Mr. Chen is enrolled in his employer's group health plan Mr. Chen can disenroll from his employer-sponsored coverage to elect a
and will be retiring soon. He would like to know his Medicare Advantage or Part D plan within 2 months of his disenrollment.
options since he has decided to drop his retiree
coverage and is eligible for Medicare. What should you
tell him?
Mr. Kumar is considering a Medicare Advantage HMO In most Medicare Advantage HMOs, Mr. Kumar must generally obtain his
and has questions about his ability to access providers. services only from providers within the plan's network (except in an emergency
What should you tell him? or where care is unavailable within the network).
ABC is a Medicare Advantage (MA) plan sponsor. It XXXIt must obtain a HIPAA complaint authorization from an enrollee that
would like to use its enrollees' information to market non- indicates the plan or plan sponsor may use their information for marketing
health related products such as life insurance and purposes.
annuities. Which statement best describes ABC's
obligation to its enrollees regarding marketing such
products?
Mr. Yoo's employer has recently dropped comprehensive It means that he qualifies for a one-time opportunity to enroll in an MA-PD or Part
creditable prescription drug coverage that was offered to D prescription drug plan.
company retirees. The company told Mr. Yoo that,
because he was affected by this change, he would
qualify for a Special election period. Mr. Yoo contacted
you to find out more about what this means. What can
you tell him?
Dr. Elizabeth Brennan does not contract with the ABC Dr. Brennan can charge Mary Rogers no more than the cost sharing specified in
PFFS plan but accepts the plan's terms and conditions the PFFS plan's terms and condition of payment which may include balance
for payment. Mary Rodgers sees Dr. Brennan for billing up to 15% of the Medicare rate.
treatment. How much may Dr. Brennan charge?
Mr. Rainey is experiencing paranoid delusions and his Medicare will cover a total of 190 days of inpatient psychiatric care during Mr.
physician feels that he should be hospitalized. What Rainey's entire lifetime.
should you tell Mr. Rainey (or his representative) about
the length of an inpatient psychiatric hospital stay that
Medicare will cover?
Mr. Moreno invited his neighbor, Agent Tom Smith, to A meal cannot be provided, but light snacks would be permitted.
discuss Medicare Advantage (MA) and Part D plans that
Agent Smith sells at the regular Tuesday brunch the
neighbors have for senior citizens. What should Agent
Tom Smith tell Mr. Moreno about the kinds of food that
can be provided to potential enrollees who attend the
sales presentation?
You have approached a hospital administrator about Tell her that Medicare guidelines allow you to conduct marketing activities in
marketing in her facility. The administrator is common areas of a provider's facility.
uncomfortable with the suggestion. How could you
address her concerns?
Mr. and Mrs. Vaughn both take a specialized multivitamin Medicare prescription drug plans are not permitted to cover the prescription
prescription each day. Mr. Vaughn takes a prescription medications the Vaughns are interested in under Part D coverage, however,
for helping to regrow his hair. They are anxious to have plans may cover them as supplemental benefits and the Vaughn's could look into
their Medicare prescription drug plan cover these drug that possibility.
needs. What should you tell them?
Mrs. Berkowitz wants to enroll in a Medicare Advantage If the Medicare Advantage plan is a Private Fee-for-Service (PFFS) plan that
plan that does not include drug coverage and also enroll does not offer drug coverage or a Medical Savings Account plan, Mrs. Berkowitz
in a stand-alone Medicare prescription drug plan. Under can do this.
what circumstances can she do this?
Which of the following is/are most likely to be I, II, and III only
characterized as an involuntary disenrollment from a
Medicare Advantage (MA) plan?
I. The enrollee dies.
II. An SNP enrollee loses special needs status due to
substantially improved health.
III. It is determined that the member is not lawfully
present in the United States.
IV. The member enrolls in another plan during the Annual
Open Enrollment period.
, AHIP 2026-2027 | Final Exam Questions & Verified Answers | Medicare Advantage, Part D & Insurance
Ms. Brooks has an aggressive cancer and would like to k Medicare covers hospice services and they will be available for her.
You are working several plans and community You must ensure that the advertisements indicate it is an educational event,
organizations to sponsor an educational event. When otherwise it will be considered a marketing event.
putting together advertisements for this event, what
should you do?
Which of the following statement is/are correct about a I and II, only
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.
Mr. Sinclair has diabetes and heart trouble and is SNPs have special programs for enrollees with chronic conditions, like Mr.
generally satisfied with the care he has received under Sinclair, and they provide prescription drug coverage that could be very helpful
Original Medicare, but he would like to know more about as well.
Medicare Advantage Special Needs Plans (SNPs). What
could you tell him?
Mr. Xi will soon turn age 65 and has come to you for .
advice as to what services are provided under Original Beneficiaries under Original Medicare have no cost-sharing for most preventive
Medicare. What should you tell Mr. Xi that best describes services which include immunizations such as annual flu shots.
the health coverage provided to Medicare beneficiaries?
During a sales presentation in Ms. Sullivan's home, she A PFFS plan is one of the various types of Medicare Advantage plans offered by
tells you that she has heard about a type of Medicare private entities and she may enroll in one if it is available in her area.
health plan known as Private Fee-for-Service (PFFS).
She wants to know if this would be available to her. What
should you tell her about PFFS plans?
You have come to Mrs. Midler's home for a sales You can only ask Mrs. Midler questions about conditions that affect eligibility,
presentation. At the beginning of the presentation, Mrs. specifically, whether she has one of the conditions that would qualify her for a
Midler tells you that she has a copy of her medical special needs plan.
records available because she thinks this will help you
understand her needs. She suggests that you will know
which questions to ask her about her health status in
order to best assist her in selecting a plan. What should
you do?
Ms. Edwards is enrolled in a Medicare Advantage plan She may fill prescriptions for covered drugs at non-network pharmacies, but
that includes prescription drug plan (PDP) coverage. She likely at a higher cost than paid at an in-network pharmacy.
is traveling and wishes to fill two of the prescriptions that
she has lost. How would you advise her?
Mr. Johannsen is entitled to Medicare Part A and Part B. He qualifies for a special election period and can enroll in or disenroll from a Part
He gains the Part D low-income subsidy. How does that D plan once during that period.
affect his ability to enroll or disenroll in a Part D plan?
Mr. Hutchinson has drug coverage through his former If the drug coverage he has is not expected to pay, on average, at least as much
employer's retiree plan. He is concerned about the Part as Medicare's standard Part D coverage expects to pay, then he will need to
D premium penalty if he does not enroll in a Medicare enroll in Medicare Part D during his initial eligibility period to avoid the late
prescription drug plan, but does not want to purchase enrollment penalty.
extra coverage that he will not need. What should you
tell him?
Mr. Moy's wife has a Medicare Advantage plan, but he Medicare Supplemental Insurance would help cover his Part A and Part B
wants to understand what coverage Medicare deductibles or coinsurance in Original Fee-for-Service (FFS) Medicare as well as
Supplemental Insurance provides since his health care possibly some services that Medicare does not cover.
needs are different from his wife's needs. What could
you tell Mr. Moy?
