AHIP 2026 FINAL EXAM QUESTIONS &
ANSWERS RATED 100% CORRECT
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.
Which of the following individuals is most likely to be eligible to enroll in a Part D Plan? -
Correct Answer ✔✔ Jose, a grandfather who was granted asylum and has worked in
the United States for many years.
Mrs. Castro has just turned 65, is in excellent health and has a relatively high income.
She uses no medications and sees no reason to spend money on a Medicare
prescription drug plan if she does not need the coverage. She currently does not have
creditable coverage. What could you tell her about the implications of such a decision? -
Correct Answer ✔✔ If she does not sign up for a Medicare prescription drug plan as
soon as she is eligible to do so, and if she does sign up at a later date, her premium will
be permanently increased by 1% of the national average premium for every month that
she was not covered.
Mr. Chen was still working when he first qualified for Medicare. At that time, he had
employer group coverage that was creditable. During his initial Part D eligibility period,
he decided not to enroll because he was satisfied with his drug coverage. It is now a
year later and Mr. Chen has lost his employer group coverage within the last two weeks.
How would you advise him? - Correct Answer ✔✔ Mr. Chen should enroll in a Part D
plan before he has a 63-day break in coverage in order to avoid a premium penalty.
Ms. Ramos 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 Answer ✔✔ She may fill prescriptions for
covered drugs at non-network pharmacies, but likely at a higher cost than paid at an in-
network pharmacy.
What types of tools can Medicare Part D prescription drug plans use that affect the way
their enrollees can access medications? - Correct Answer ✔✔ Part D plans do not have
to cover all medications. As a result, their formularies, or lists of covered drugs, will vary
from plan to plan. In addition, they can use cost containment techniques such as tiered
co-payments and step therapy.
ANSWERS RATED 100% CORRECT
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.
Which of the following individuals is most likely to be eligible to enroll in a Part D Plan? -
Correct Answer ✔✔ Jose, a grandfather who was granted asylum and has worked in
the United States for many years.
Mrs. Castro has just turned 65, is in excellent health and has a relatively high income.
She uses no medications and sees no reason to spend money on a Medicare
prescription drug plan if she does not need the coverage. She currently does not have
creditable coverage. What could you tell her about the implications of such a decision? -
Correct Answer ✔✔ If she does not sign up for a Medicare prescription drug plan as
soon as she is eligible to do so, and if she does sign up at a later date, her premium will
be permanently increased by 1% of the national average premium for every month that
she was not covered.
Mr. Chen was still working when he first qualified for Medicare. At that time, he had
employer group coverage that was creditable. During his initial Part D eligibility period,
he decided not to enroll because he was satisfied with his drug coverage. It is now a
year later and Mr. Chen has lost his employer group coverage within the last two weeks.
How would you advise him? - Correct Answer ✔✔ Mr. Chen should enroll in a Part D
plan before he has a 63-day break in coverage in order to avoid a premium penalty.
Ms. Ramos 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 Answer ✔✔ She may fill prescriptions for
covered drugs at non-network pharmacies, but likely at a higher cost than paid at an in-
network pharmacy.
What types of tools can Medicare Part D prescription drug plans use that affect the way
their enrollees can access medications? - Correct Answer ✔✔ Part D plans do not have
to cover all medications. As a result, their formularies, or lists of covered drugs, will vary
from plan to plan. In addition, they can use cost containment techniques such as tiered
co-payments and step therapy.
