AHIP 2025 (CORRECTED) ALL
POSSIBLE QUESTIONS & VERIFIED
CORRECT ANSWERS
Mrs. Radford asks whether there are any special eligibility requirements for Medicare
Advantage. What should you tell her? - correct answer ✔✔Mrs. Radford must be entitled to
Part A and enrolled in Part B to enroll in Medicare Advantage.
Which of the following statement(s) 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.
Question 2Answer - correct answer ✔✔I, II, and IV only
Mrs. Burton is a retiree with substantial income. She is enrolled in an MA-PD plan and was
disappointed with the service she received from her primary care physician because she was
told she would have to wait five weeks to get an appointment when she was feeling ill. She
called you to ask what she could do so she would not have to put up with such poor access to
care. What could you tell her? - correct answer ✔✔She could file a grievance with her plan to
complain about the lack of timeliness in getting an appointment.
Mr. Lombardi is interested in a Medicare Advantage (MA) PPO plan that you represent. It is one
of three plans operated by the same organization in Mr. Lombardi's area. The MA PPO plan does
not include drug coverage, but the other two plans do. Mr. Lombardi likes the PPO plan that
does not include drug coverage and intends to obtain his drug coverage through a stand-alone
,Medicare prescription drug plan. What should you tell him about this situation? - correct
answer ✔✔He could enroll either in one of the MA plans that include prescription drug
coverage or Original Medicare with a Medigap plan and standalone Part D prescription drug
coverage, but he cannot enroll in the MA-only PPO plan and a stand-alone prescription drug
plan.
Ms. Gibson recently lost her employer group health and drug coverage and now she wants to
enroll in a PPO that does not include drug coverage. What should you tell her about obtaining
drug coverage? - correct answer ✔✔She can enroll in the PPO, but she will not be able to
purchase a stand-alone Medicare Part D prescription drug plan.
Mr. Kelly wants to know whether he is eligible to sign up for a private fee-for-service (PFFS) plan.
What questions would you need to ask to determine his eligibility? - correct answer ✔✔You
would need to ask if Mr. Kelly if he is entitled to Part A, enrolled in Part B, and if he lives in the
PFFFS plan's service area.
Mr. Lopez has heard that he can sign up for a product called "Medicare Advantage" but is not
sure about what type of plan designs are available through this program. What should you tell
him about the types of health plans that are available through the Medicare Advantage
program? - correct answer ✔✔There are Medicare health plans such as HMOs, PPOs, PFFS, and
MSAs.
Mrs. Wang wants to know generally how the benefits under Original Medicare might compare
to the benefits package of a Medicare Advantage Plan before she starts looking at specific plans.
What could you tell her? - correct answer ✔✔Medicare Advantage Plans may offer extra
benefits that Original Medicare does not offer such as vision, hearing, and dental services. It
must include a maximum out-of-pocket limit on Part A and Part B services.
Mr. Wells is trying to understand the difference between Original Medicare and Medicare
Advantage. What would be the correct description? - correct answer ✔✔Medicare Advantage is
a way of covering all the Original Medicare benefits through private health insurance
companies.
, Mrs. Kelly, age 65, is entitled to Part A but has not yet enrolled in Part B. She is considering
enrollment in a Medicare Advantage plan (Part C). What should you advise her to do before she
can enroll in a Medicare Advantage plan? - correct answer ✔✔To join a Medicare Advantage
plan, she also must enroll in Part B.
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 answer ✔✔Dr. Brennan can charge Mary Rodgers no more than the
cost sharing specified in the PFFS plan's terms and conditions of payment which may include
balance billing up to 15% of the Medicare rate.
Mrs. Velasquez cares for her frail elderly mother, Maria, who lives in North Carolina. She is
worried that without additional support, her mother will need to go into a nursing home. Mrs.
Velasquez asks you if there is any Medicare plan that might allow her mother to remain in the
community rather than going into a nursing home. How should you advise Mrs. Velasquez? -
correct answer ✔✔There are Programs of All-Inclusive Care for the Elderly (PACE) for frail
elderly beneficiaries certified as needing a nursing home level of care but are able to live safely
in the community at the time of enrolment.
Mrs. Walters is enrolled in her state's Medicaid program in addition to Medicare. What should
she be aware of when considering enrollment in a Medicare Advantage (MA) plan? - correct
answer ✔✔She cannot enroll in an MA Medical Savings Account (MSA) plan.
Mrs. Chou likes a Private Fee-for-Service (PFFS) plan available in her area that does not include
drug coverage. She wants to enroll in the plan and enroll in a stand-alone prescription drug
plan. What should you tell her? - correct answer ✔✔She could enroll in a PFFS plan and a stand-
alone Medicare prescription drug plan.
Mr. Sanchez has just turned 65 and is entitled to Part A but has not enrolled in Part B because
he has coverage through an employer plan. If he wants to enroll in a Medicare Advantage plan,
what will he have to do? - correct answer ✔✔He will have to enroll in Part B.
POSSIBLE QUESTIONS & VERIFIED
CORRECT ANSWERS
Mrs. Radford asks whether there are any special eligibility requirements for Medicare
Advantage. What should you tell her? - correct answer ✔✔Mrs. Radford must be entitled to
Part A and enrolled in Part B to enroll in Medicare Advantage.
Which of the following statement(s) 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.
Question 2Answer - correct answer ✔✔I, II, and IV only
Mrs. Burton is a retiree with substantial income. She is enrolled in an MA-PD plan and was
disappointed with the service she received from her primary care physician because she was
told she would have to wait five weeks to get an appointment when she was feeling ill. She
called you to ask what she could do so she would not have to put up with such poor access to
care. What could you tell her? - correct answer ✔✔She could file a grievance with her plan to
complain about the lack of timeliness in getting an appointment.
Mr. Lombardi is interested in a Medicare Advantage (MA) PPO plan that you represent. It is one
of three plans operated by the same organization in Mr. Lombardi's area. The MA PPO plan does
not include drug coverage, but the other two plans do. Mr. Lombardi likes the PPO plan that
does not include drug coverage and intends to obtain his drug coverage through a stand-alone
,Medicare prescription drug plan. What should you tell him about this situation? - correct
answer ✔✔He could enroll either in one of the MA plans that include prescription drug
coverage or Original Medicare with a Medigap plan and standalone Part D prescription drug
coverage, but he cannot enroll in the MA-only PPO plan and a stand-alone prescription drug
plan.
Ms. Gibson recently lost her employer group health and drug coverage and now she wants to
enroll in a PPO that does not include drug coverage. What should you tell her about obtaining
drug coverage? - correct answer ✔✔She can enroll in the PPO, but she will not be able to
purchase a stand-alone Medicare Part D prescription drug plan.
Mr. Kelly wants to know whether he is eligible to sign up for a private fee-for-service (PFFS) plan.
What questions would you need to ask to determine his eligibility? - correct answer ✔✔You
would need to ask if Mr. Kelly if he is entitled to Part A, enrolled in Part B, and if he lives in the
PFFFS plan's service area.
Mr. Lopez has heard that he can sign up for a product called "Medicare Advantage" but is not
sure about what type of plan designs are available through this program. What should you tell
him about the types of health plans that are available through the Medicare Advantage
program? - correct answer ✔✔There are Medicare health plans such as HMOs, PPOs, PFFS, and
MSAs.
Mrs. Wang wants to know generally how the benefits under Original Medicare might compare
to the benefits package of a Medicare Advantage Plan before she starts looking at specific plans.
What could you tell her? - correct answer ✔✔Medicare Advantage Plans may offer extra
benefits that Original Medicare does not offer such as vision, hearing, and dental services. It
must include a maximum out-of-pocket limit on Part A and Part B services.
Mr. Wells is trying to understand the difference between Original Medicare and Medicare
Advantage. What would be the correct description? - correct answer ✔✔Medicare Advantage is
a way of covering all the Original Medicare benefits through private health insurance
companies.
, Mrs. Kelly, age 65, is entitled to Part A but has not yet enrolled in Part B. She is considering
enrollment in a Medicare Advantage plan (Part C). What should you advise her to do before she
can enroll in a Medicare Advantage plan? - correct answer ✔✔To join a Medicare Advantage
plan, she also must enroll in Part B.
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 answer ✔✔Dr. Brennan can charge Mary Rodgers no more than the
cost sharing specified in the PFFS plan's terms and conditions of payment which may include
balance billing up to 15% of the Medicare rate.
Mrs. Velasquez cares for her frail elderly mother, Maria, who lives in North Carolina. She is
worried that without additional support, her mother will need to go into a nursing home. Mrs.
Velasquez asks you if there is any Medicare plan that might allow her mother to remain in the
community rather than going into a nursing home. How should you advise Mrs. Velasquez? -
correct answer ✔✔There are Programs of All-Inclusive Care for the Elderly (PACE) for frail
elderly beneficiaries certified as needing a nursing home level of care but are able to live safely
in the community at the time of enrolment.
Mrs. Walters is enrolled in her state's Medicaid program in addition to Medicare. What should
she be aware of when considering enrollment in a Medicare Advantage (MA) plan? - correct
answer ✔✔She cannot enroll in an MA Medical Savings Account (MSA) plan.
Mrs. Chou likes a Private Fee-for-Service (PFFS) plan available in her area that does not include
drug coverage. She wants to enroll in the plan and enroll in a stand-alone prescription drug
plan. What should you tell her? - correct answer ✔✔She could enroll in a PFFS plan and a stand-
alone Medicare prescription drug plan.
Mr. Sanchez has just turned 65 and is entitled to Part A but has not enrolled in Part B because
he has coverage through an employer plan. If he wants to enroll in a Medicare Advantage plan,
what will he have to do? - correct answer ✔✔He will have to enroll in Part B.
