MY AHIP EXAM QUESTIONS VERIFIED AND PROVIDED WITH
A+ GRADED ANSWERS LATEST UPDATED 2026
Mr.Gomez notes that a Private Fee for Service He may receive health care services from any doctor allowed to
(PFFS) plan avaliable in his area has an attractive bill Medicare as long as he shows the doctor the plan's identification
preminum. He wants to know if he must use card and the doctor agrees to accept the PFFS plan's payment
doctors in a network as his current HMO plan terms and conditions, which could include balance billing.
requires him to do. What should you tell him?
Mrs. Lee is discussing with you the possibility of PFFS plans may choose to offer Part D benefits but are not required to
enrolling in a Private Fee- for Service (PFFS) plan. do so.
As part of that discussion, what should you be
sure to tell her?
Mrs. Ramos is considering a Medicare Mrs. Ramos can obtain care from any provider who participates in
Advantage PPO and has questions about which Original Medicare but generally will have a higher cost-sharing amount
providers she can go to for her health care. What if she sees a provider who/that is not apart of the PPO network.
should you tell her?
Mr. McTaggert notes that a Private Fee for-Service Enrollees in a PFFS plan can obtain care from any provider in the US
(PFFS) plan avaliable in his area has an attractive who accepts Original Medicare, as long as the provider has a
premium. He wants to know what makes them reasonable opportunity to access the plan's terms and conditions and
different from an HMO or a PPO. What should you agrees to accept them.
tell him?
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
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?
Mr. Sinclar has diabetes and heart trouble and is SNPs have special programs from enrollees with chronic conditions, like
generally satisified with the care he has just Mr. Sinclair and they provide prescription drug coverage that could
received under Original Medicare, but he would be very helpful as well.
like to know more about Medicare Advantage
Special Needs Plans (SNPs). What could you tell
him?
Mrs.Davenport enrolled in the ABC She may remain in her ABC MA plan or enroll in a Special Needs Plan
Medicare Advantage (MA) plan several (SNP) for individuals sufferinf from ESRD if one is available in her area.
years ago. Her doctor recently confirmed a
diagnosis of end-
stage renal disease (ESRD). What options does
Mrs.Davenport have regarding her MA plan during
the next open enrollment season?
Daniel is a middle-income Medicare beneficiary. C-SNP
He has chronic bronchitis putting him at severe risk
for pneumonia. Otherwise, he has no problems
functioning. Which type of SNP is likely to be most
appropriate for him?
Mr. Gomez notes that a Private Fee-for Service He may receive health care services from any doctor allowed to
(PFFS) plan available in his area has an attractive bill Medicare as long as he shows the doctor the plan's identification
premium. He wants to know if he must use card and the doctor agrees to accept the PFFS plan's payment
doctors in a network as his curreny HMO plan terms and conditions, which could include balance billing.
requires him to do. What should you tell him?
, Mrs. Ramos is considering a Medicare Mrs. Ramos can obtain care from any provider who participates in
Advantage PPO and has questions about which Original Medicare but generally will have a higher cost-sharing amount
providers she can go to for her health care. What if she sees a provider who/that is not a part of the PPO network.
should you tell her?
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 emergency or where care is unavailable within
the network)
Mr.Greco is in excellent health, lives in his own SNPs limit enrollment to certain subpopulations of beneficiaries. Given
home, and has aa sizeable income from his his current situation, he is unlikelt 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).
His friend has mentioned that the SNP charges
very low costs sharing amounts and Mr. Greco
would like to join that plan. What should you tell
him?
Dr. Elizabeth Brennan does not contract with the Dr. Brennan can charge Mary Rodgers no more than the cost sharing
PFFS plan but she accepts the plan's terms and specified in the PFFS plan's terms and condition of payment which may
conditions for payment. Mary Rodgers sees Dr. include balance billing up to 15 percent of the Medicare rate.
Brennan for treatment. How much may Dr. Brennan
charge?
Mrs.Lyons is in good health, uses a single All MSAs cover Part A and Part B benefits, but not Part D
prescription, and lives independently in her own prescription drug benefits, which could be obtained by also enrolling
home. She is attracted by the idea of in a separate prescription drug plan.
maintaining
control over a Medical Savings Account (MSA) but
is not sure if the plan associated with the account
will fit her needs. What specific piece of
information about a Medicare MSA plan would it
be important for her to know, prior to enrolling in
such a plan?
Mrs.Lee is discussing with you the possibility of PFFS plans may choose to offer Part D benefits but are not required to
enrolling in a Private Fee-for-Service (PFFS) do so.
plan. As part of that discussion, what should you
be sure to tell her?
Which of the following statements is correct about I, II. and IV 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. Davies is turning 65 next month. He would like Cost plan enrollees can choose to receive Medicare covered
to enroll in a Medicare health plan but does services under the plan's benefits by going to plan network
not want to be limited in terms of where he providers and
obtains his care. What should you tell him paying plan cost-sharing or may receive services from non-network
about how a providers and pay cost-sharing due under Original Medicare.
Medicare Cost Plan might fit his needs?
A+ GRADED ANSWERS LATEST UPDATED 2026
Mr.Gomez notes that a Private Fee for Service He may receive health care services from any doctor allowed to
(PFFS) plan avaliable in his area has an attractive bill Medicare as long as he shows the doctor the plan's identification
preminum. He wants to know if he must use card and the doctor agrees to accept the PFFS plan's payment
doctors in a network as his current HMO plan terms and conditions, which could include balance billing.
requires him to do. What should you tell him?
Mrs. Lee is discussing with you the possibility of PFFS plans may choose to offer Part D benefits but are not required to
enrolling in a Private Fee- for Service (PFFS) plan. do so.
As part of that discussion, what should you be
sure to tell her?
Mrs. Ramos is considering a Medicare Mrs. Ramos can obtain care from any provider who participates in
Advantage PPO and has questions about which Original Medicare but generally will have a higher cost-sharing amount
providers she can go to for her health care. What if she sees a provider who/that is not apart of the PPO network.
should you tell her?
Mr. McTaggert notes that a Private Fee for-Service Enrollees in a PFFS plan can obtain care from any provider in the US
(PFFS) plan avaliable in his area has an attractive who accepts Original Medicare, as long as the provider has a
premium. He wants to know what makes them reasonable opportunity to access the plan's terms and conditions and
different from an HMO or a PPO. What should you agrees to accept them.
tell him?
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
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?
Mr. Sinclar has diabetes and heart trouble and is SNPs have special programs from enrollees with chronic conditions, like
generally satisified with the care he has just Mr. Sinclair and they provide prescription drug coverage that could
received under Original Medicare, but he would be very helpful as well.
like to know more about Medicare Advantage
Special Needs Plans (SNPs). What could you tell
him?
Mrs.Davenport enrolled in the ABC She may remain in her ABC MA plan or enroll in a Special Needs Plan
Medicare Advantage (MA) plan several (SNP) for individuals sufferinf from ESRD if one is available in her area.
years ago. Her doctor recently confirmed a
diagnosis of end-
stage renal disease (ESRD). What options does
Mrs.Davenport have regarding her MA plan during
the next open enrollment season?
Daniel is a middle-income Medicare beneficiary. C-SNP
He has chronic bronchitis putting him at severe risk
for pneumonia. Otherwise, he has no problems
functioning. Which type of SNP is likely to be most
appropriate for him?
Mr. Gomez notes that a Private Fee-for Service He may receive health care services from any doctor allowed to
(PFFS) plan available in his area has an attractive bill Medicare as long as he shows the doctor the plan's identification
premium. He wants to know if he must use card and the doctor agrees to accept the PFFS plan's payment
doctors in a network as his curreny HMO plan terms and conditions, which could include balance billing.
requires him to do. What should you tell him?
, Mrs. Ramos is considering a Medicare Mrs. Ramos can obtain care from any provider who participates in
Advantage PPO and has questions about which Original Medicare but generally will have a higher cost-sharing amount
providers she can go to for her health care. What if she sees a provider who/that is not a part of the PPO network.
should you tell her?
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 emergency or where care is unavailable within
the network)
Mr.Greco is in excellent health, lives in his own SNPs limit enrollment to certain subpopulations of beneficiaries. Given
home, and has aa sizeable income from his his current situation, he is unlikelt 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).
His friend has mentioned that the SNP charges
very low costs sharing amounts and Mr. Greco
would like to join that plan. What should you tell
him?
Dr. Elizabeth Brennan does not contract with the Dr. Brennan can charge Mary Rodgers no more than the cost sharing
PFFS plan but she accepts the plan's terms and specified in the PFFS plan's terms and condition of payment which may
conditions for payment. Mary Rodgers sees Dr. include balance billing up to 15 percent of the Medicare rate.
Brennan for treatment. How much may Dr. Brennan
charge?
Mrs.Lyons is in good health, uses a single All MSAs cover Part A and Part B benefits, but not Part D
prescription, and lives independently in her own prescription drug benefits, which could be obtained by also enrolling
home. She is attracted by the idea of in a separate prescription drug plan.
maintaining
control over a Medical Savings Account (MSA) but
is not sure if the plan associated with the account
will fit her needs. What specific piece of
information about a Medicare MSA plan would it
be important for her to know, prior to enrolling in
such a plan?
Mrs.Lee is discussing with you the possibility of PFFS plans may choose to offer Part D benefits but are not required to
enrolling in a Private Fee-for-Service (PFFS) do so.
plan. As part of that discussion, what should you
be sure to tell her?
Which of the following statements is correct about I, II. and IV 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. Davies is turning 65 next month. He would like Cost plan enrollees can choose to receive Medicare covered
to enroll in a Medicare health plan but does services under the plan's benefits by going to plan network
not want to be limited in terms of where he providers and
obtains his care. What should you tell him paying plan cost-sharing or may receive services from non-network
about how a providers and pay cost-sharing due under Original Medicare.
Medicare Cost Plan might fit his needs?
