AHIP Exam Questions Verified and Provided with A+ Graded
Answers Latest Updated 2026
Mr. Chen is enrolled in his employer's group health Mr. Chen can disenroll from his employer-sponsored coverage to elect
plan and will be retiring soon. He would like to a Medicare Advantage or Part D plan within 2 months of his
know his options since he has decided to drop his disenrollment.
retiree coverage and is eligible for Medicare. What
should you tell him?
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 within the plan's network (except in an
providers. What should you tell him? emergency or where care is unavailable within the network).
ABC is a Medicare Advantage (MA) plan sponsor. XXXIt must obtain a HIPAA complaint authorization from an enrollee
It would like to use its enrollees' information that indicates the plan or plan sponsor may use their information
to market non-health related products such as for marketing purposes.
life
insurance and annuities. Which statement best
describes ABC's obligation to its enrollees
regarding marketing such products?
Mr. Yoo's employer has recently dropped It means that he qualifies for a one-time opportunity to enroll in an MA-
comprehensive creditable prescription drug PD or Part D prescription drug plan.
coverage that was offered to 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 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.
Brennan for treatment. How much may Dr. Brennan
charge?
Mr. Rainey is experiencing paranoid delusions and Medicare will cover a total of 190 days of inpatient psychiatric care
his physician feels that he should be hospitalized. during Mr. Rainey's entire lifetime.
What 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, A meal cannot be provided, but light snacks would be permitted.
to 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 Tell her that Medicare guidelines allow you to conduct marketing
about marketing in her facility. The administrator is activities in 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 Medicare prescription drug plans are not permitted to cover the
multivitamin prescription each day. Mr. Vaughn prescription medications the Vaughns are interested in under Part D
takes a prescription for helping to regrow his hair. coverage, however, plans may cover them as supplemental benefits and
They are anxious to have their Medicare the Vaughn's could look into that possibility.
prescription drug plan cover these drug needs.
What should you tell them?
Mrs. Berkowitz wants to enroll in a Medicare If the Medicare Advantage plan is a Private Fee-for-Service (PFFS) plan
Advantage plan that does not include drug that does not offer drug coverage or a Medical Savings Account
coverage and also enroll in a stand-alone plan, Mrs. Berkowitz can do this.
Medicare prescription drug plan. Under 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.
Ms. Brooks has an aggressive cancer and would Medicare covers hospice services and they will be available for her.
like to k
You are working several plans and community You must ensure that the advertisements indicate it is an educational
organizations to sponsor an educational event. event, otherwise it will be considered a marketing event.
When putting together advertisements for this
event, what should you do?
Which of the following statement is/are correct I and II, only
about a 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 SNPs have special programs for enrollees with chronic conditions, like
is generally satisfied with the care he has Mr. Sinclair, and they provide prescription drug coverage that could be
received under Original Medicare, but he very helpful as well.
would like to know more about 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 Beneficiaries under Original Medicare have no cost-sharing for most
under Original Medicare. What should you tell Mr. preventive services which include immunizations such as annual flu
Xi that best describes the health coverage shots.
provided to Medicare beneficiaries?
Answers Latest Updated 2026
Mr. Chen is enrolled in his employer's group health Mr. Chen can disenroll from his employer-sponsored coverage to elect
plan and will be retiring soon. He would like to a Medicare Advantage or Part D plan within 2 months of his
know his options since he has decided to drop his disenrollment.
retiree coverage and is eligible for Medicare. What
should you tell him?
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 within the plan's network (except in an
providers. What should you tell him? emergency or where care is unavailable within the network).
ABC is a Medicare Advantage (MA) plan sponsor. XXXIt must obtain a HIPAA complaint authorization from an enrollee
It would like to use its enrollees' information that indicates the plan or plan sponsor may use their information
to market non-health related products such as for marketing purposes.
life
insurance and annuities. Which statement best
describes ABC's obligation to its enrollees
regarding marketing such products?
Mr. Yoo's employer has recently dropped It means that he qualifies for a one-time opportunity to enroll in an MA-
comprehensive creditable prescription drug PD or Part D prescription drug plan.
coverage that was offered to 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 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.
Brennan for treatment. How much may Dr. Brennan
charge?
Mr. Rainey is experiencing paranoid delusions and Medicare will cover a total of 190 days of inpatient psychiatric care
his physician feels that he should be hospitalized. during Mr. Rainey's entire lifetime.
What 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, A meal cannot be provided, but light snacks would be permitted.
to 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 Tell her that Medicare guidelines allow you to conduct marketing
about marketing in her facility. The administrator is activities in 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 Medicare prescription drug plans are not permitted to cover the
multivitamin prescription each day. Mr. Vaughn prescription medications the Vaughns are interested in under Part D
takes a prescription for helping to regrow his hair. coverage, however, plans may cover them as supplemental benefits and
They are anxious to have their Medicare the Vaughn's could look into that possibility.
prescription drug plan cover these drug needs.
What should you tell them?
Mrs. Berkowitz wants to enroll in a Medicare If the Medicare Advantage plan is a Private Fee-for-Service (PFFS) plan
Advantage plan that does not include drug that does not offer drug coverage or a Medical Savings Account
coverage and also enroll in a stand-alone plan, Mrs. Berkowitz can do this.
Medicare prescription drug plan. Under 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.
Ms. Brooks has an aggressive cancer and would Medicare covers hospice services and they will be available for her.
like to k
You are working several plans and community You must ensure that the advertisements indicate it is an educational
organizations to sponsor an educational event. event, otherwise it will be considered a marketing event.
When putting together advertisements for this
event, what should you do?
Which of the following statement is/are correct I and II, only
about a 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 SNPs have special programs for enrollees with chronic conditions, like
is generally satisfied with the care he has Mr. Sinclair, and they provide prescription drug coverage that could be
received under Original Medicare, but he very helpful as well.
would like to know more about 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 Beneficiaries under Original Medicare have no cost-sharing for most
under Original Medicare. What should you tell Mr. preventive services which include immunizations such as annual flu
Xi that best describes the health coverage shots.
provided to Medicare beneficiaries?
