AHIP 2026 Final Exam 200 most tested questions with
Accurate Answers
1. Describe how Original Medicare differs from Medicare Advantage in terms of
coverage.
Original Medicare covers only hospital services, while Medicare
Advantage covers outpatient services.
Original Medicare requires prior authorization for all services, while
Medicare Advantage does not.
Original Medicare is a fee-for-service plan, while Medicare
Advantage is a managed care plan that often includes additional
benefits.
Original Medicare is available to everyone, while Medicare Advantage
is only for low-income individuals.
2. Plans that may be offered under a Medicare Advantage Plan include:
HMO
POS
PPO
all of the above
3. Mrs. Gonzalez is enrolled in Original Medicare and has a Medigap policy as
well, but it provides no drug coverage. She would like to keep the coverage
she has but replace her existing Medigap plan with one that provides drug
coverage. What should you tell her?
Mrs. Gonzalez should purchase a K or L Medigap plan.
Mrs. Gonzalez cannot purchase a Medigap plan that covers drugs,
but she could keep her Medigap policy and enroll in a Part D
, prescription drug plan.
Mrs. Gonzalez can purchase a Medigap plan that covers drugs, but it
likely won’t offer coverage that is equivalent to that provided under
Part D.
Medigap is a replacement for Original Medicare and she has been
paying for double coverage. She should simply drop her Medigap
policy.
4. If Mrs. Geisler is currently taking multiple medications and finds that her
current Medicare Part D plan does not cover one of her essential drugs, what
steps should she take during the enrollment period?
She should continue with her current plan and hope the coverage
changes next year.
She should consult her doctor for advice on alternative medications.
She should compare other Medicare Part D plans to find one that
includes her essential drug and enroll in that plan.
She should switch to Medicare Advantage instead.
5. What is the primary purpose of Medicare Part D?
To cover outpatient services
To provide prescription drug coverage
To offer hospital insurance
To provide long-term care insurance
6. Describe the role of Medicare Part D in providing prescription drug
coverage for beneficiaries who choose not to enroll in Medicare Advantage
plans.
, Medicare Part D offers standalone prescription drug coverage for
beneficiaries who opt out of Medicare Advantage plans.
Medicare Part D is only available to those under 65 years old.
Medicare Part D requires beneficiaries to enroll in both Part A and Part
B.
Medicare Part D is a supplemental insurance that covers all medical
expenses.
7. Describe the implications of enrolling in a stand-alone Medicare prescription
drug plan for someone who is already covered by a Medicare Advantage
plan that includes drug coverage.
Mr. Block will need to reapply for Medicare Advantage coverage.
It results in a penalty for Mr. Block but does not affect his Medicare
Advantage plan.
Enrolling in a stand-alone Medicare prescription drug plan will lead
to automatic disenrollment from the Medicare Advantage plan.
It allows Mr. Block to have enhanced drug coverage without losing his
Medicare Advantage plan.
8. Mr. Chen is enrolled in his employer's group health plan and will be retiring
soon. He would like to know his options since he has decided to drop his
retiree coverage and is eligible for Medicare. What should you tell him?
Mr. Chen can disenroll from his employer-sponsored coverage to
elect a Medicare Advantage or Part D plan within 2 months of his
disenrollment.
Mr. Chen can disenroll from the employer-sponsored plan and his
only option is to choose a Medigap plan.
Mr. Chen can disenroll from his employer-sponsored coverage to
elect a Medicare Advantage or Part D plan, but he must wait until the
, next Annual Election Period.
Mr. Chen must convert his current coverage to employer-sponsored
retiree coverage and wait one year before enrolling in a MA or Part D
plan.
9. Describe the steps Mrs. Duarte should take if she disagrees with a claim
determination based on her Medicare Summary Notice.
Mrs. Duarte should file an appeal to contest the determination
made on her claim.
Mrs. Duarte should contact her healthcare provider for clarification.
Mrs. Duarte should switch to a different Medicare plan immediately.
Mrs. Duarte should accept the decision and not take any action.
10. Mr. Rodriguez is currently enrolled in a MA plan, but his plan doesn't
sufficiently cover his prescription drug needs. He is interested in changing
plans during the upcoming MA Open Enrollment Period. What are his
options during the MA OEP?
He can only switch to Original Medicare with a PDP.
He can change to Original Medicare with a PDP. But if he later finds a
MA-PD plan he likes better, he can switch to that as long as the
change is before the end of the MA OEP.
He can switch to a MA-PD plan.
He can only switch to another MA plan.
11. If Mr. and Mrs. Vaughn find that their Medicare prescription drug plan does
not cover their specialized multivitamin and hair regrowth prescriptions, what
steps can they take to address this issue?
They can only seek coverage through Medicare Part A.
Accurate Answers
1. Describe how Original Medicare differs from Medicare Advantage in terms of
coverage.
Original Medicare covers only hospital services, while Medicare
Advantage covers outpatient services.
Original Medicare requires prior authorization for all services, while
Medicare Advantage does not.
Original Medicare is a fee-for-service plan, while Medicare
Advantage is a managed care plan that often includes additional
benefits.
Original Medicare is available to everyone, while Medicare Advantage
is only for low-income individuals.
2. Plans that may be offered under a Medicare Advantage Plan include:
HMO
POS
PPO
all of the above
3. Mrs. Gonzalez is enrolled in Original Medicare and has a Medigap policy as
well, but it provides no drug coverage. She would like to keep the coverage
she has but replace her existing Medigap plan with one that provides drug
coverage. What should you tell her?
Mrs. Gonzalez should purchase a K or L Medigap plan.
Mrs. Gonzalez cannot purchase a Medigap plan that covers drugs,
but she could keep her Medigap policy and enroll in a Part D
, prescription drug plan.
Mrs. Gonzalez can purchase a Medigap plan that covers drugs, but it
likely won’t offer coverage that is equivalent to that provided under
Part D.
Medigap is a replacement for Original Medicare and she has been
paying for double coverage. She should simply drop her Medigap
policy.
4. If Mrs. Geisler is currently taking multiple medications and finds that her
current Medicare Part D plan does not cover one of her essential drugs, what
steps should she take during the enrollment period?
She should continue with her current plan and hope the coverage
changes next year.
She should consult her doctor for advice on alternative medications.
She should compare other Medicare Part D plans to find one that
includes her essential drug and enroll in that plan.
She should switch to Medicare Advantage instead.
5. What is the primary purpose of Medicare Part D?
To cover outpatient services
To provide prescription drug coverage
To offer hospital insurance
To provide long-term care insurance
6. Describe the role of Medicare Part D in providing prescription drug
coverage for beneficiaries who choose not to enroll in Medicare Advantage
plans.
, Medicare Part D offers standalone prescription drug coverage for
beneficiaries who opt out of Medicare Advantage plans.
Medicare Part D is only available to those under 65 years old.
Medicare Part D requires beneficiaries to enroll in both Part A and Part
B.
Medicare Part D is a supplemental insurance that covers all medical
expenses.
7. Describe the implications of enrolling in a stand-alone Medicare prescription
drug plan for someone who is already covered by a Medicare Advantage
plan that includes drug coverage.
Mr. Block will need to reapply for Medicare Advantage coverage.
It results in a penalty for Mr. Block but does not affect his Medicare
Advantage plan.
Enrolling in a stand-alone Medicare prescription drug plan will lead
to automatic disenrollment from the Medicare Advantage plan.
It allows Mr. Block to have enhanced drug coverage without losing his
Medicare Advantage plan.
8. Mr. Chen is enrolled in his employer's group health plan and will be retiring
soon. He would like to know his options since he has decided to drop his
retiree coverage and is eligible for Medicare. What should you tell him?
Mr. Chen can disenroll from his employer-sponsored coverage to
elect a Medicare Advantage or Part D plan within 2 months of his
disenrollment.
Mr. Chen can disenroll from the employer-sponsored plan and his
only option is to choose a Medigap plan.
Mr. Chen can disenroll from his employer-sponsored coverage to
elect a Medicare Advantage or Part D plan, but he must wait until the
, next Annual Election Period.
Mr. Chen must convert his current coverage to employer-sponsored
retiree coverage and wait one year before enrolling in a MA or Part D
plan.
9. Describe the steps Mrs. Duarte should take if she disagrees with a claim
determination based on her Medicare Summary Notice.
Mrs. Duarte should file an appeal to contest the determination
made on her claim.
Mrs. Duarte should contact her healthcare provider for clarification.
Mrs. Duarte should switch to a different Medicare plan immediately.
Mrs. Duarte should accept the decision and not take any action.
10. Mr. Rodriguez is currently enrolled in a MA plan, but his plan doesn't
sufficiently cover his prescription drug needs. He is interested in changing
plans during the upcoming MA Open Enrollment Period. What are his
options during the MA OEP?
He can only switch to Original Medicare with a PDP.
He can change to Original Medicare with a PDP. But if he later finds a
MA-PD plan he likes better, he can switch to that as long as the
change is before the end of the MA OEP.
He can switch to a MA-PD plan.
He can only switch to another MA plan.
11. If Mr. and Mrs. Vaughn find that their Medicare prescription drug plan does
not cover their specialized multivitamin and hair regrowth prescriptions, what
steps can they take to address this issue?
They can only seek coverage through Medicare Part A.
