AHIP – 2 Questions Verified and Provided with A+ Graded Answers
Latest Updated 2026
Mr. Wells is trying to understand the difference Medicare Advantage is a way of covering all the Original Medicare
between Original Medicare and Medicare benefits through private health insurance companies.
Advantage. What would be the correct 3 multiple choice options
description?
Mr. Lopez has heard that he can sign up for a They are Medicare health plans such as HMOs, PPOs, PFFS, and MSAs.
product called "Medicare Advantage" but is not
3 multiple choice options
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?
Mr. Kumar is considering a Medicare Advantage In most Medicare Advantage HMOs, Mr. Kumar must generally obtain
HMO and has questions about his ability to access his services only from providers who have a contractual relationship
providers. What should you tell him? with the plan (except in an emergency or where care is unavailable
within the network).
3 multiple choice options
Mr. Castillo, a naturalized citizen, previously He is not eligible to enroll in a Medicare Advantage plan until he re-
enrolled in Medicare Part B but has recently enrolls in Medicare Part B.
stopped paying his Part B premium. Mr. Castillo is 3 multiple choice options
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?
Mrs. Walters is enrolled in her state's Medicaid She cannot enroll in an MA Medical Savings Account (MSA) plan.
program in addition to Medicare. What should she
3 multiple choice options
be aware of when considering enrollment in a
Medicare Advantage (MA) plan?
Daniel is a middle-income Medicare C-SNP
beneficiary. He has chronic bronchitis, putting
3 multiple choice options
him at severe risk for pneumonia. Otherwise, he
has no problems functioning. Which type of SNP is
likely to be most appropriate for him?
Mrs. Burton is a retiree with substantial income. She could file a grievance with her plan to complain about the lack of
She is enrolled in an MA-PD plan and was timeliness in getting an appointment.
disappointed with the service she received from 3 multiple choice options
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?
, Mr. Greco is in excellent health, lives in his own SNPs limit enrollment to certain subpopulations of beneficiaries. Given
home, and has a sizeable income from his his current situation, he is unlikely to qualify and would not be able to
investments. He has a friend enrolled in a enroll in the SNP.
Medicare Advantage Special Needs Plan (SNP). 3 multiple choice options
His friend has mentioned that the SNP charges
very low cost-sharing amounts and Mr. Greco
would like to join that plan. What should you tell
him?
Ms. Gibson recently lost her employer group She can enroll in the PPO, but she will not be able to purchase a stand-
health and drug coverage and now she wants to alone Medicare Part D prescription drug plan.
enroll in a PPO that does not include drug 3 multiple choice options
coverage. What should you tell her about
obtaining drug coverage?
Dr. Elizabeth Brennan does not contract with Dr. Brennan can charge Mary Rogers no more than the cost sharing
the ABC PFFS plan but accepts the plan's terms specified in the PFFS plan's terms and condition of payment which may
and conditions for payment. Mary Rodgers include balance billing up to 15%of the Medicare rate.
sees Dr.
3 multiple choice options
Brennan for treatment. How much may Dr. Brennan
charge?
Mrs. Chou likes a Private Fee-for-Service (PFFS) She could enroll in a PFFS plan and a stand-alone Medicare
plan available in her area that does not include prescription drug plan.
drug coverage. She wants to enroll in the plan and
3 multiple choice options
enroll in a stand-alone prescription drug plan.
What should you tell her?
Mrs. Davenport enrolled in the ABC Medicare She may remain in her ABC MA plan, enroll in another MA plan in her
Advantage (MA) plan several years ago. In mid- service area, or enroll in a Special Needs Plan (SNP) for individuals
February of 2021, her doctor confirms a suffering from ESRD if one is available in her area.
diagnosis of end-stage renal disease (ESRD). 3 multiple choice options
What options will Mrs. Davenport have
regarding her MA plan during the next open
enrollment season?
Mrs. Radford asks whether there are any Mrs. Radford must be entitled to Part A and enrolled in Part B to enroll
special eligibility requirements for Medicare in Medicare Advantage.
Advantage. What should you tell her? 3 multiple choice options
Mr. Barker enjoys a comfortable retirement You can offer to review the plans appeal process to help him ask the
income. He recently had surgery and expected plan to review the coverage decision.
that he would have certain services and
3 multiple choice options
items covered by the plan with minimal out-of-
pocket
costs because his MA-PD coverage has been very
good. However, when he received the bill, he was
surprised to see large charges in excess of his
maximum out-of-pocket limit that included a
number of services and items he thought would be
fully covered. He called you to ask what he could
do? What could you tell him?
Latest Updated 2026
Mr. Wells is trying to understand the difference Medicare Advantage is a way of covering all the Original Medicare
between Original Medicare and Medicare benefits through private health insurance companies.
Advantage. What would be the correct 3 multiple choice options
description?
Mr. Lopez has heard that he can sign up for a They are Medicare health plans such as HMOs, PPOs, PFFS, and MSAs.
product called "Medicare Advantage" but is not
3 multiple choice options
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?
Mr. Kumar is considering a Medicare Advantage In most Medicare Advantage HMOs, Mr. Kumar must generally obtain
HMO and has questions about his ability to access his services only from providers who have a contractual relationship
providers. What should you tell him? with the plan (except in an emergency or where care is unavailable
within the network).
3 multiple choice options
Mr. Castillo, a naturalized citizen, previously He is not eligible to enroll in a Medicare Advantage plan until he re-
enrolled in Medicare Part B but has recently enrolls in Medicare Part B.
stopped paying his Part B premium. Mr. Castillo is 3 multiple choice options
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?
Mrs. Walters is enrolled in her state's Medicaid She cannot enroll in an MA Medical Savings Account (MSA) plan.
program in addition to Medicare. What should she
3 multiple choice options
be aware of when considering enrollment in a
Medicare Advantage (MA) plan?
Daniel is a middle-income Medicare C-SNP
beneficiary. He has chronic bronchitis, putting
3 multiple choice options
him at severe risk for pneumonia. Otherwise, he
has no problems functioning. Which type of SNP is
likely to be most appropriate for him?
Mrs. Burton is a retiree with substantial income. She could file a grievance with her plan to complain about the lack of
She is enrolled in an MA-PD plan and was timeliness in getting an appointment.
disappointed with the service she received from 3 multiple choice options
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?
, Mr. Greco is in excellent health, lives in his own SNPs limit enrollment to certain subpopulations of beneficiaries. Given
home, and has a sizeable income from his his current situation, he is unlikely to qualify and would not be able to
investments. He has a friend enrolled in a enroll in the SNP.
Medicare Advantage Special Needs Plan (SNP). 3 multiple choice options
His friend has mentioned that the SNP charges
very low cost-sharing amounts and Mr. Greco
would like to join that plan. What should you tell
him?
Ms. Gibson recently lost her employer group She can enroll in the PPO, but she will not be able to purchase a stand-
health and drug coverage and now she wants to alone Medicare Part D prescription drug plan.
enroll in a PPO that does not include drug 3 multiple choice options
coverage. What should you tell her about
obtaining drug coverage?
Dr. Elizabeth Brennan does not contract with Dr. Brennan can charge Mary Rogers no more than the cost sharing
the ABC PFFS plan but accepts the plan's terms specified in the PFFS plan's terms and condition of payment which may
and conditions for payment. Mary Rodgers include balance billing up to 15%of the Medicare rate.
sees Dr.
3 multiple choice options
Brennan for treatment. How much may Dr. Brennan
charge?
Mrs. Chou likes a Private Fee-for-Service (PFFS) She could enroll in a PFFS plan and a stand-alone Medicare
plan available in her area that does not include prescription drug plan.
drug coverage. She wants to enroll in the plan and
3 multiple choice options
enroll in a stand-alone prescription drug plan.
What should you tell her?
Mrs. Davenport enrolled in the ABC Medicare She may remain in her ABC MA plan, enroll in another MA plan in her
Advantage (MA) plan several years ago. In mid- service area, or enroll in a Special Needs Plan (SNP) for individuals
February of 2021, her doctor confirms a suffering from ESRD if one is available in her area.
diagnosis of end-stage renal disease (ESRD). 3 multiple choice options
What options will Mrs. Davenport have
regarding her MA plan during the next open
enrollment season?
Mrs. Radford asks whether there are any Mrs. Radford must be entitled to Part A and enrolled in Part B to enroll
special eligibility requirements for Medicare in Medicare Advantage.
Advantage. What should you tell her? 3 multiple choice options
Mr. Barker enjoys a comfortable retirement You can offer to review the plans appeal process to help him ask the
income. He recently had surgery and expected plan to review the coverage decision.
that he would have certain services and
3 multiple choice options
items covered by the plan with minimal out-of-
costs because his MA-PD coverage has been very
good. However, when he received the bill, he was
surprised to see large charges in excess of his
maximum out-of-pocket limit that included a
number of services and items he thought would be
fully covered. He called you to ask what he could
do? What could you tell him?
