AHIP 2027 Final Exam latest
updates!!! 2026-2027 | CORRECT
SOLUTIONS WITH QUIZ & ANSWERS |
HIGHLY GRADED A+
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? - CORRECT ANSWERS-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. Kumar is considering a Medicare Advantage HMO and has questions about his
ability to access providers. What should you tell him? - CORRECT ANSWERS-In most
Medicare Advantage HMOs, Mr. Kumar must generally obtain his services only from
providers within the plan's network (except in an emergency or where care is
unavailable within the network).
ABC is a Medicare Advantage (MA) plan sponsor. It would like to use its enrollees'
information to market non-health related products such as life insurance and annuities.
Which statement best describes ABC's obligation to its enrollees regarding marketing
such products? - CORRECT ANSWERS-XXXIt must obtain a HIPAA complaint
authorization from an enrollee that indicates the plan or plan sponsor may use their
information for marketing purposes.
Mr. Yoo's employer has recently dropped comprehensive creditable prescription drug
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? -
CORRECT ANSWERS-It means that he qualifies for a one-time opportunity to enroll in
an MA-PD or Part D prescription drug plan.
Dr. Elizabeth Brennan does not contract with the ABC PFFS plan but accepts the plan's
terms and conditions for payment. Mary Rodgers sees Dr. Brennan for treatment. How
much may Dr. Brennan charge? - CORRECT ANSWERS-Dr. Brennan can charge Mary
Rogers no more than the cost sharing specified in the PFFS plan's terms and condition
of payment which may include balance billing up to 15% of the Medicare rate.
Mr. Rainey is experiencing paranoid delusions and his physician feels that he should be
hospitalized. What should you tell Mr. Rainey (or his representative) about the length of
,an inpatient psychiatric hospital stay that Medicare will cover? - CORRECT ANSWERS-
Medicare will cover a total of 190 days of inpatient psychiatric care during Mr. Rainey's
entire lifetime.
Mr. Moreno invited his neighbor, Agent Tom Smith, 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? - CORRECT ANSWERS-A meal cannot be provided, but light snacks
would be permitted.
You have approached a hospital administrator about marketing in her facility. The
administrator is uncomfortable with the suggestion. How could you address her
concerns? - CORRECT ANSWERS-Tell her that Medicare guidelines allow you to
conduct marketing activities in common areas of a provider's facility.
Mr. and Mrs. Vaughn both take a specialized multivitamin prescription each day. Mr.
Vaughn takes a prescription for helping to regrow his hair. They are anxious to have
their Medicare prescription drug plan cover these drug needs. What should you tell
them? - CORRECT ANSWERS-Medicare prescription drug plans are not permitted to
cover the prescription medications the Vaughns are interested in under Part D
coverage, however, plans may cover them as supplemental benefits and the Vaughn's
could look into that possibility.
Mrs. Berkowitz wants to enroll in a Medicare Advantage plan that does not include drug
coverage and also enroll in a stand-alone Medicare prescription drug plan. Under what
circumstances can she do this? - CORRECT ANSWERS-If the Medicare Advantage
plan is a Private Fee-for-Service (PFFS) plan that does not offer drug coverage or a
Medical Savings Account plan, Mrs. Berkowitz can do this.
Which of the following is/are most likely to be 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. -
CORRECT ANSWERS-I, II, and III only
Ms. Brooks has an aggressive cancer and would like to k - CORRECT ANSWERS-
Medicare covers hospice services and they will be available for her.
You are working several plans and community organizations to sponsor an educational
event. When putting together advertisements for this event, what should you do? -
CORRECT ANSWERS-You must ensure that the advertisements indicate it is an
educational event, otherwise it will be considered a marketing event.
, Which of the following statement is/are correct 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. - CORRECT ANSWERS-I and II, only
Mr. Sinclair has diabetes and heart trouble and is generally satisfied with the care he
has received under Original Medicare, but he would like to know more about Medicare
Advantage Special Needs Plans (SNPs). What could you tell him? - CORRECT
ANSWERS-SNPs have special programs for enrollees with chronic conditions, like Mr.
Sinclair, and they provide prescription drug coverage that could be very helpful as well.
Mr. Xi will soon turn age 65 and has come to you for advice as to what services are
provided under Original Medicare. What should you tell Mr. Xi that best describes the
health coverage provided to Medicare beneficiaries? - CORRECT ANSWERS-.
Beneficiaries under Original Medicare have no cost-sharing for most preventive services
which include immunizations such as annual flu shots.
During a sales presentation in Ms. Sullivan's home, she tells you that she has heard
about a type of Medicare health plan known as Private Fee-for-Service (PFFS). She
wants to know if this would be available to her. What should you tell her about PFFS
plans? - CORRECT ANSWERS-A PFFS plan is one of the various types of Medicare
Advantage plans offered by private entities and she may enroll in one if it is available in
her area.
You have come to Mrs. Midler's home for a sales presentation. At the beginning of the
presentation, Mrs. Midler tells you that she has a copy of her medical records available
because she thinks this will help you understand her needs. She suggests that you will
know which questions to ask her about her health status in order to best assist her in
selecting a plan. What should you do? - CORRECT ANSWERS-You can only ask Mrs.
Midler questions about conditions that affect eligibility, specifically, whether she has one
of the conditions that would qualify her for a special needs plan.
Ms. Edwards is enrolled in a Medicare Advantage plan that includes prescription drug
plan (PDP) coverage. She is traveling and wishes to fill two of the prescriptions that she
has lost. How would you advise her? - CORRECT ANSWERS-She may fill prescriptions
for covered drugs at non-network pharmacies, but likely at a higher cost than paid at an
in-network pharmacy.
Mr. Johannsen is entitled to Medicare Part A and Part B. He gains the Part D low-
income subsidy. How does that affect his ability to enroll or disenroll in a Part D plan? -
updates!!! 2026-2027 | CORRECT
SOLUTIONS WITH QUIZ & ANSWERS |
HIGHLY GRADED A+
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? - CORRECT ANSWERS-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. Kumar is considering a Medicare Advantage HMO and has questions about his
ability to access providers. What should you tell him? - CORRECT ANSWERS-In most
Medicare Advantage HMOs, Mr. Kumar must generally obtain his services only from
providers within the plan's network (except in an emergency or where care is
unavailable within the network).
ABC is a Medicare Advantage (MA) plan sponsor. It would like to use its enrollees'
information to market non-health related products such as life insurance and annuities.
Which statement best describes ABC's obligation to its enrollees regarding marketing
such products? - CORRECT ANSWERS-XXXIt must obtain a HIPAA complaint
authorization from an enrollee that indicates the plan or plan sponsor may use their
information for marketing purposes.
Mr. Yoo's employer has recently dropped comprehensive creditable prescription drug
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? -
CORRECT ANSWERS-It means that he qualifies for a one-time opportunity to enroll in
an MA-PD or Part D prescription drug plan.
Dr. Elizabeth Brennan does not contract with the ABC PFFS plan but accepts the plan's
terms and conditions for payment. Mary Rodgers sees Dr. Brennan for treatment. How
much may Dr. Brennan charge? - CORRECT ANSWERS-Dr. Brennan can charge Mary
Rogers no more than the cost sharing specified in the PFFS plan's terms and condition
of payment which may include balance billing up to 15% of the Medicare rate.
Mr. Rainey is experiencing paranoid delusions and his physician feels that he should be
hospitalized. What should you tell Mr. Rainey (or his representative) about the length of
,an inpatient psychiatric hospital stay that Medicare will cover? - CORRECT ANSWERS-
Medicare will cover a total of 190 days of inpatient psychiatric care during Mr. Rainey's
entire lifetime.
Mr. Moreno invited his neighbor, Agent Tom Smith, 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? - CORRECT ANSWERS-A meal cannot be provided, but light snacks
would be permitted.
You have approached a hospital administrator about marketing in her facility. The
administrator is uncomfortable with the suggestion. How could you address her
concerns? - CORRECT ANSWERS-Tell her that Medicare guidelines allow you to
conduct marketing activities in common areas of a provider's facility.
Mr. and Mrs. Vaughn both take a specialized multivitamin prescription each day. Mr.
Vaughn takes a prescription for helping to regrow his hair. They are anxious to have
their Medicare prescription drug plan cover these drug needs. What should you tell
them? - CORRECT ANSWERS-Medicare prescription drug plans are not permitted to
cover the prescription medications the Vaughns are interested in under Part D
coverage, however, plans may cover them as supplemental benefits and the Vaughn's
could look into that possibility.
Mrs. Berkowitz wants to enroll in a Medicare Advantage plan that does not include drug
coverage and also enroll in a stand-alone Medicare prescription drug plan. Under what
circumstances can she do this? - CORRECT ANSWERS-If the Medicare Advantage
plan is a Private Fee-for-Service (PFFS) plan that does not offer drug coverage or a
Medical Savings Account plan, Mrs. Berkowitz can do this.
Which of the following is/are most likely to be 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. -
CORRECT ANSWERS-I, II, and III only
Ms. Brooks has an aggressive cancer and would like to k - CORRECT ANSWERS-
Medicare covers hospice services and they will be available for her.
You are working several plans and community organizations to sponsor an educational
event. When putting together advertisements for this event, what should you do? -
CORRECT ANSWERS-You must ensure that the advertisements indicate it is an
educational event, otherwise it will be considered a marketing event.
, Which of the following statement is/are correct 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. - CORRECT ANSWERS-I and II, only
Mr. Sinclair has diabetes and heart trouble and is generally satisfied with the care he
has received under Original Medicare, but he would like to know more about Medicare
Advantage Special Needs Plans (SNPs). What could you tell him? - CORRECT
ANSWERS-SNPs have special programs for enrollees with chronic conditions, like Mr.
Sinclair, and they provide prescription drug coverage that could be very helpful as well.
Mr. Xi will soon turn age 65 and has come to you for advice as to what services are
provided under Original Medicare. What should you tell Mr. Xi that best describes the
health coverage provided to Medicare beneficiaries? - CORRECT ANSWERS-.
Beneficiaries under Original Medicare have no cost-sharing for most preventive services
which include immunizations such as annual flu shots.
During a sales presentation in Ms. Sullivan's home, she tells you that she has heard
about a type of Medicare health plan known as Private Fee-for-Service (PFFS). She
wants to know if this would be available to her. What should you tell her about PFFS
plans? - CORRECT ANSWERS-A PFFS plan is one of the various types of Medicare
Advantage plans offered by private entities and she may enroll in one if it is available in
her area.
You have come to Mrs. Midler's home for a sales presentation. At the beginning of the
presentation, Mrs. Midler tells you that she has a copy of her medical records available
because she thinks this will help you understand her needs. She suggests that you will
know which questions to ask her about her health status in order to best assist her in
selecting a plan. What should you do? - CORRECT ANSWERS-You can only ask Mrs.
Midler questions about conditions that affect eligibility, specifically, whether she has one
of the conditions that would qualify her for a special needs plan.
Ms. Edwards is enrolled in a Medicare Advantage plan that includes prescription drug
plan (PDP) coverage. She is traveling and wishes to fill two of the prescriptions that she
has lost. How would you advise her? - CORRECT ANSWERS-She may fill prescriptions
for covered drugs at non-network pharmacies, but likely at a higher cost than paid at an
in-network pharmacy.
Mr. Johannsen is entitled to Medicare Part A and Part B. He gains the Part D low-
income subsidy. How does that affect his ability to enroll or disenroll in a Part D plan? -
