AHIP - 2026 - Modules 1-5 Exam Questions
with 100% correct Answers
1. If Mrs. Sanchez's mother is considering a Medicare Advantage plan, what
factors should she evaluate to ensure it meets her needs for community
living?
Coverage of home health services and community support options
The availability of specialists in nursing homes
The plan's coverage for international travel
Only the monthly premium costs
2. If Mr. Singh decides not to enroll in a Medicare Advantage plan, what steps
should he take to ensure he has adequate drug coverage?
He should wait until he needs medication to enroll.
He should contact his doctor for drug recommendations.
He should enroll in a standalone Part D plan during the enrollment
period.
He should apply for a Medigap policy instead.
3. Describe the steps Mr. Bryant should take if he believes he has been
incorrectly charged for services under his MA-PD plan.
Mr. Bryant should ignore the charges since they exceed the out-of-
pocket limit.
Mr. Bryant should switch to a different Medicare plan immediately.
Mr. Bryant should file a complaint with the federal government.
Mr. Bryant should contact his plan provider to dispute the charges
and seek clarification on coverage.
,4. If Mildred Savage's Allcare Medicare Advantage plan does not cover hospice
care, what alternative options might she consider for her end-of-life care?
Seeking coverage through traditional Medicare or exploring private
hospice insurance.
Only relying on family support for care.
Switching to a different Medicare Advantage plan without checking
coverage details.
Choosing not to seek any care.
5. A 70-year-old patient tells the nurse, "I can't go to the hospital for treatment,
because I have no hospital insurance. My Social Security and my pension pay
my living expenses, but I don't have any savings." The nurse's response should
be focused on
exploring the patient's ability to purchase group health insurance.
explaining the provisions of Medicaid.
providing information about Medicare.
investigating which hospitals provide free care for indigent patients.
6. Mr. Rivera has Qualified Medicare Beneficiary (QMB) eligibility and is thus
covered by both Medicare and Medicaid. He decides to enroll in a Medicare
Advantage (MA) PPO plan. Later he sees an out-of-network doctor to
receive a Medicare covered service. How much may the doctor collect from
Mr. Rivera?
The doctor may only collect the amount allowable under Medicare
plus 15 percent balance billing.
The doctor may only collect from Mr. Rivera the cost sharing
allowable under the state's Medicaid program.
, The doctor may only collect the amount allowable under Medicare
plus 25 percent balance billing.
The doctor may only collect the amount allowable under Medicare
Advantage (MA) PPO plan cost sharing for non-QMB enrollees.
7. Describe how enrolling in Medicare can affect a beneficiary's existing
employer-sponsored health insurance.
Enrolling in Medicare guarantees full coverage without any costs.
Enrolling in Medicare can lead to changes in coverage and costs
associated with employer-sponsored health insurance.
Enrolling in Medicare eliminates the need for employer-sponsored
insurance.
Enrolling in Medicare has no effect on employer-sponsored health
insurance.
8. Describe the implications for Mr. Wu if he does not qualify for the Part D low-
income subsidy.
He will automatically receive coverage under Medicare Advantage.
He may need to seek alternative assistance programs for his
prescription drug costs.
He will be eligible for additional benefits under Medigap.
He will have to pay all his medical expenses out of pocket.
9. If Mr. Smith is entitled to Part A but has not enrolled in Part B, what steps
should he take to ensure he can enroll in a Medicare Advantage plan during
the next enrollment period?
Enroll in Part A only.
Enroll in Part B before the enrollment period.
, Contact his healthcare provider for advice.
Wait until the enrollment period to decide.
10. If Mr. Moy has significant out-of-pocket medical expenses, which type of
Medicare coverage would you recommend he consider and why?
Medicare Part D, because it focuses on prescription drug coverage.
Original Medicare, because it has no additional costs.
Medicare Advantage, because it offers lower premiums.
Medicare Supplemental Insurance, because it helps cover out-of-
pocket costs not paid by Original Medicare.
11. Describe the criteria that must be met for Medicare to cover hospice
services.
The patient must have a primary care physician's referral.
The patient must have previously received inpatient care.
The patient must be enrolled in a Medicare Advantage plan.
The patient must be diagnosed with a terminal illness and have a
life expectancy of six months or less.
12. Mrs. Ramos is considering a Medicare Advantage PPO and has questions
about which providers she can go to for her health care. What should you
tell her?
In general, Mrs. Ramos can obtain care from any provider who
participates in Original Medicare but will have to pay the difference
between the plan's allowed amount and the provider's usual and
customary charge.
Mrs. Ramos should be aware that generally plan providers can
decide, on a case-by-case basis, whether they will treat her.
with 100% correct Answers
1. If Mrs. Sanchez's mother is considering a Medicare Advantage plan, what
factors should she evaluate to ensure it meets her needs for community
living?
Coverage of home health services and community support options
The availability of specialists in nursing homes
The plan's coverage for international travel
Only the monthly premium costs
2. If Mr. Singh decides not to enroll in a Medicare Advantage plan, what steps
should he take to ensure he has adequate drug coverage?
He should wait until he needs medication to enroll.
He should contact his doctor for drug recommendations.
He should enroll in a standalone Part D plan during the enrollment
period.
He should apply for a Medigap policy instead.
3. Describe the steps Mr. Bryant should take if he believes he has been
incorrectly charged for services under his MA-PD plan.
Mr. Bryant should ignore the charges since they exceed the out-of-
pocket limit.
Mr. Bryant should switch to a different Medicare plan immediately.
Mr. Bryant should file a complaint with the federal government.
Mr. Bryant should contact his plan provider to dispute the charges
and seek clarification on coverage.
,4. If Mildred Savage's Allcare Medicare Advantage plan does not cover hospice
care, what alternative options might she consider for her end-of-life care?
Seeking coverage through traditional Medicare or exploring private
hospice insurance.
Only relying on family support for care.
Switching to a different Medicare Advantage plan without checking
coverage details.
Choosing not to seek any care.
5. A 70-year-old patient tells the nurse, "I can't go to the hospital for treatment,
because I have no hospital insurance. My Social Security and my pension pay
my living expenses, but I don't have any savings." The nurse's response should
be focused on
exploring the patient's ability to purchase group health insurance.
explaining the provisions of Medicaid.
providing information about Medicare.
investigating which hospitals provide free care for indigent patients.
6. Mr. Rivera has Qualified Medicare Beneficiary (QMB) eligibility and is thus
covered by both Medicare and Medicaid. He decides to enroll in a Medicare
Advantage (MA) PPO plan. Later he sees an out-of-network doctor to
receive a Medicare covered service. How much may the doctor collect from
Mr. Rivera?
The doctor may only collect the amount allowable under Medicare
plus 15 percent balance billing.
The doctor may only collect from Mr. Rivera the cost sharing
allowable under the state's Medicaid program.
, The doctor may only collect the amount allowable under Medicare
plus 25 percent balance billing.
The doctor may only collect the amount allowable under Medicare
Advantage (MA) PPO plan cost sharing for non-QMB enrollees.
7. Describe how enrolling in Medicare can affect a beneficiary's existing
employer-sponsored health insurance.
Enrolling in Medicare guarantees full coverage without any costs.
Enrolling in Medicare can lead to changes in coverage and costs
associated with employer-sponsored health insurance.
Enrolling in Medicare eliminates the need for employer-sponsored
insurance.
Enrolling in Medicare has no effect on employer-sponsored health
insurance.
8. Describe the implications for Mr. Wu if he does not qualify for the Part D low-
income subsidy.
He will automatically receive coverage under Medicare Advantage.
He may need to seek alternative assistance programs for his
prescription drug costs.
He will be eligible for additional benefits under Medigap.
He will have to pay all his medical expenses out of pocket.
9. If Mr. Smith is entitled to Part A but has not enrolled in Part B, what steps
should he take to ensure he can enroll in a Medicare Advantage plan during
the next enrollment period?
Enroll in Part A only.
Enroll in Part B before the enrollment period.
, Contact his healthcare provider for advice.
Wait until the enrollment period to decide.
10. If Mr. Moy has significant out-of-pocket medical expenses, which type of
Medicare coverage would you recommend he consider and why?
Medicare Part D, because it focuses on prescription drug coverage.
Original Medicare, because it has no additional costs.
Medicare Advantage, because it offers lower premiums.
Medicare Supplemental Insurance, because it helps cover out-of-
pocket costs not paid by Original Medicare.
11. Describe the criteria that must be met for Medicare to cover hospice
services.
The patient must have a primary care physician's referral.
The patient must have previously received inpatient care.
The patient must be enrolled in a Medicare Advantage plan.
The patient must be diagnosed with a terminal illness and have a
life expectancy of six months or less.
12. Mrs. Ramos is considering a Medicare Advantage PPO and has questions
about which providers she can go to for her health care. What should you
tell her?
In general, Mrs. Ramos can obtain care from any provider who
participates in Original Medicare but will have to pay the difference
between the plan's allowed amount and the provider's usual and
customary charge.
Mrs. Ramos should be aware that generally plan providers can
decide, on a case-by-case basis, whether they will treat her.
