AHIP Final Exam 2026/2027 – Latest
Updated Study Guide, Practice Questions
& Answers with Rationales
Mr. Arias, a naturalized citizen, previously enrolled in Medicare Part B but has
recently stopped paying his Part B premium. Mr. Arias is still covered by Part A.
He would like to enroll in a Medicare Advantage (MA) plan and is still covered by
Part A. What should you tell him? - correct answer-He is not eligible to enroll in a
Medicare Advantage plan until he re-enrolls in Medicare Part B.
Mrs. Joy, age 65, is entitled to Part A but has not yet enrolled in Part B. She is
considering enrolling 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.
Mr. Kumar is considering a Medicare Advantage HMO and has questions about his
ability to access providers. What should you tell him? - correct answer-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).
Mrs. Robles 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? -
correct answer-Mrs. Robles can obtain care from any provider who participates in
Original Medicare, but generally will have a higher cost-sharing amount if she sees
a provider who/that is not a part of the PPO network.
, Mrs. Lester is age 75 and enjoys a comfortable but not extremely high-income
level. She wishes to enroll in an MA MSA plan that she heard about from her
neighbor. She also wants to have prescription drug coverage since her doctor
recently prescribed several expensive medications. Currently, she is enrolled in
Original Medicare and a standalone Part D plan. How would you advise Mrs.
Lester? - correct answer-Mrs. Lester may enroll in an MA MSA plan and remain in
her current standalone Part D prescription drug plan.
Mr. Dalton is in excellent health, lives in his own home, and has a sizeable income
from his investments. He has a friend enrolled in a Medicare Advantage Special
Needs Plan (SNP). His friend has mentioned that the SNP charges very low cost-
sharing amounts and Mr. Dalton would like to join that plan. What should you tell
him? - correct answer-SNPs limit enrollment to certain subpopulations of
beneficiaries. Given his current situation, he is unlikely to qualify and would not
be able to enroll in the SNP.
Mr. Anderson 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 Mr. Anderson if he is entitled
to Part A, enrolled in Part B, and if he lives in the PFFS plan's service area.
Herber Noble is turning 65 next month, Herber legally entered the United States
over twenty years ago but is not a citizen. Since his entry into the country, Herber
has worked at Smallcap Incorporated and contributed to the Medicare system.
Herber suffers from diabetes. He will soon retire and asks you if he can enroll in a
Medicare Advantage plan that you represent. How would you respond? - correct
answer-Herber is eligible to enroll in Medicare Advantage as long as he is entitled
to Part A and enrolled in Part B. Herber should go to the Social Security website to
enroll in Medicare Part A and B if he has not done so already. Once he is enrolled,
he can choose a Medicare Advantage plan.
Updated Study Guide, Practice Questions
& Answers with Rationales
Mr. Arias, a naturalized citizen, previously enrolled in Medicare Part B but has
recently stopped paying his Part B premium. Mr. Arias is still covered by Part A.
He would like to enroll in a Medicare Advantage (MA) plan and is still covered by
Part A. What should you tell him? - correct answer-He is not eligible to enroll in a
Medicare Advantage plan until he re-enrolls in Medicare Part B.
Mrs. Joy, age 65, is entitled to Part A but has not yet enrolled in Part B. She is
considering enrolling 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.
Mr. Kumar is considering a Medicare Advantage HMO and has questions about his
ability to access providers. What should you tell him? - correct answer-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).
Mrs. Robles 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? -
correct answer-Mrs. Robles can obtain care from any provider who participates in
Original Medicare, but generally will have a higher cost-sharing amount if she sees
a provider who/that is not a part of the PPO network.
, Mrs. Lester is age 75 and enjoys a comfortable but not extremely high-income
level. She wishes to enroll in an MA MSA plan that she heard about from her
neighbor. She also wants to have prescription drug coverage since her doctor
recently prescribed several expensive medications. Currently, she is enrolled in
Original Medicare and a standalone Part D plan. How would you advise Mrs.
Lester? - correct answer-Mrs. Lester may enroll in an MA MSA plan and remain in
her current standalone Part D prescription drug plan.
Mr. Dalton is in excellent health, lives in his own home, and has a sizeable income
from his investments. He has a friend enrolled in a Medicare Advantage Special
Needs Plan (SNP). His friend has mentioned that the SNP charges very low cost-
sharing amounts and Mr. Dalton would like to join that plan. What should you tell
him? - correct answer-SNPs limit enrollment to certain subpopulations of
beneficiaries. Given his current situation, he is unlikely to qualify and would not
be able to enroll in the SNP.
Mr. Anderson 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 Mr. Anderson if he is entitled
to Part A, enrolled in Part B, and if he lives in the PFFS plan's service area.
Herber Noble is turning 65 next month, Herber legally entered the United States
over twenty years ago but is not a citizen. Since his entry into the country, Herber
has worked at Smallcap Incorporated and contributed to the Medicare system.
Herber suffers from diabetes. He will soon retire and asks you if he can enroll in a
Medicare Advantage plan that you represent. How would you respond? - correct
answer-Herber is eligible to enroll in Medicare Advantage as long as he is entitled
to Part A and enrolled in Part B. Herber should go to the Social Security website to
enroll in Medicare Part A and B if he has not done so already. Once he is enrolled,
he can choose a Medicare Advantage plan.
