AHIP FINAL NEWEST EXAM ACTUA Q&A WITH MULTIPLE CHOICE OF
QUESTIONS AND CORRECT ANSWERS ALREADY GRADED A+ AND 100%
GUARANTEE PASS (BRAND NEW!!!!!!!!!!)
Q1: Mr. Hoffman receives some help paying for his two generic prescription drugs from his
employer's retiree coverage, but he wants to compare it to a Part D prescription drug plan.
He asks you what costs he would generally expect to encounter when enrolling into a
standard Medicare Part D prescription drug plan. What should you tell him?
Answer: He generally would pay a monthly premium, annual deductible, and per-
prescription cost-sharing.
Q2: Mrs. Larson 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?
Answer: Mrs. Larson cannot purchase a Medigap plan that covers drugs, but she
could keep her Medigap policy and enroll in a Part D prescription drug plan.
,Q3: Mary Alice, covered by Original Medicare Parts A and B with Medigap Plan A, asks if
certain items are "core benefits" covered in her plan: I. Part A hospital coinsurance, II. 365
additional lifetime days after benefits end, III. 3 pints of blood, IV. Part B deductible.
Answer: I, II, and III only.
Q4: Larry Miller has Original Medicare (Parts A and B). He is hospitalized for pneumonia in
January (3 days), for a broken leg in July (1 week), and for the flu in December. How many
Part A deductibles is he responsible for?
Answer: Larry will be responsible for three Part A deductibles.
Q5: Mrs. Walters is entitled to Part A and has medical coverage without drug coverage
through an employer retiree plan. She is not enrolled in Part B. Since the employer plan
does not cover prescription drugs, she wants to enroll in a Medicare prescription drug plan.
Will she be able to?
Answer: Yes. She must be entitled to Part A or enrolled in Part B to qualify.
Q6: Mr. Shapiro gets by on a very small amount of fixed income. He has heard there may
be extra help paying for Part D prescription drugs for Medicare beneficiaries with limited
income. He wants to know whether he might qualify. What should you tell him?
Answer: He may qualify for the Low-Income Subsidy (Extra Help) program.
Q7: Mrs. Sanders will soon turn 65. She has been a U.S. citizen for twelve years, has
worked full-time, and has paid Medicare taxes. She is concerned that she will not qualify for
Part A because she was not born in the United States. What should you tell her?
Answer: Many people qualify for premium-free Part A through their Medicare-
covered work history.
Q8: Mrs. Walters is enrolled in a standalone Part D prescription drug plan. She is
wondering if there is any cost-sharing for the shingles vaccine. What should you tell her?
Answer: There is no cost-sharing for adult vaccines recommended by ACIP.
Q9: What type of Medicare Advantage plan is a network-based plan where members
generally must choose a Primary Care Physician (PCP) and obtain referrals to see
specialists?
Answer: Health Maintenance Organization (HMO) plan.
Q10: Which government program provides health coverage primarily to low-income
individuals, families, pregnant women, and people with disabilities?
, Answer: Medicaid.
Original Medicare & Advantage Coordination (Questions 11–20)
Q11: Which part of Medicare covers outpatient medical services, physician visits, and
durable medical equipment (DME)?
Answer: Medicare Part B.
Q12: To be eligible to enroll in a Medicare Advantage (Part C) plan, what core criteria must
an individual meet?
Answer: They must be enrolled in both Part A and Part B, and live in the plan's
service area.
Q13: Mr. Davis is enrolled in a Medicare Advantage Preferred Provider Organization (PPO)
plan. Can he receive care from out-of-network providers?
Answer: Yes, but he will generally pay higher out-of-pocket costs.
Q14: Which of the following services is generally NOT covered under Original Medicare
Parts A and B?
Answer: Routine dental exams, vision care, and hearing aids.
Q15: What is the standard duration of the Initial Enrollment Period (IEP) for an individual
turning 65?
Answer: 7 months (3 months before, the month of, and 3 months after turning 65).
Q16: If a beneficiary misses their Initial Enrollment Period, during which annual window can
they sign up for Medicare Part B?
Answer: The General Enrollment Period (GEP), from January 1 to March 31.
Q17: What is the purpose of the Medicare Advantage Open Enrollment Period (MA OEP)
that runs from January 1 to March 31?
Answer: It allows individuals enrolled in an MA plan to switch to another MA plan or
return to Original Medicare.
Q18: If Mr. Green moves out of his Medicare Advantage plan's service area, what type of
enrollment window is he granted to pick a new plan?
QUESTIONS AND CORRECT ANSWERS ALREADY GRADED A+ AND 100%
GUARANTEE PASS (BRAND NEW!!!!!!!!!!)
Q1: Mr. Hoffman receives some help paying for his two generic prescription drugs from his
employer's retiree coverage, but he wants to compare it to a Part D prescription drug plan.
He asks you what costs he would generally expect to encounter when enrolling into a
standard Medicare Part D prescription drug plan. What should you tell him?
Answer: He generally would pay a monthly premium, annual deductible, and per-
prescription cost-sharing.
Q2: Mrs. Larson 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?
Answer: Mrs. Larson cannot purchase a Medigap plan that covers drugs, but she
could keep her Medigap policy and enroll in a Part D prescription drug plan.
,Q3: Mary Alice, covered by Original Medicare Parts A and B with Medigap Plan A, asks if
certain items are "core benefits" covered in her plan: I. Part A hospital coinsurance, II. 365
additional lifetime days after benefits end, III. 3 pints of blood, IV. Part B deductible.
Answer: I, II, and III only.
Q4: Larry Miller has Original Medicare (Parts A and B). He is hospitalized for pneumonia in
January (3 days), for a broken leg in July (1 week), and for the flu in December. How many
Part A deductibles is he responsible for?
Answer: Larry will be responsible for three Part A deductibles.
Q5: Mrs. Walters is entitled to Part A and has medical coverage without drug coverage
through an employer retiree plan. She is not enrolled in Part B. Since the employer plan
does not cover prescription drugs, she wants to enroll in a Medicare prescription drug plan.
Will she be able to?
Answer: Yes. She must be entitled to Part A or enrolled in Part B to qualify.
Q6: Mr. Shapiro gets by on a very small amount of fixed income. He has heard there may
be extra help paying for Part D prescription drugs for Medicare beneficiaries with limited
income. He wants to know whether he might qualify. What should you tell him?
Answer: He may qualify for the Low-Income Subsidy (Extra Help) program.
Q7: Mrs. Sanders will soon turn 65. She has been a U.S. citizen for twelve years, has
worked full-time, and has paid Medicare taxes. She is concerned that she will not qualify for
Part A because she was not born in the United States. What should you tell her?
Answer: Many people qualify for premium-free Part A through their Medicare-
covered work history.
Q8: Mrs. Walters is enrolled in a standalone Part D prescription drug plan. She is
wondering if there is any cost-sharing for the shingles vaccine. What should you tell her?
Answer: There is no cost-sharing for adult vaccines recommended by ACIP.
Q9: What type of Medicare Advantage plan is a network-based plan where members
generally must choose a Primary Care Physician (PCP) and obtain referrals to see
specialists?
Answer: Health Maintenance Organization (HMO) plan.
Q10: Which government program provides health coverage primarily to low-income
individuals, families, pregnant women, and people with disabilities?
, Answer: Medicaid.
Original Medicare & Advantage Coordination (Questions 11–20)
Q11: Which part of Medicare covers outpatient medical services, physician visits, and
durable medical equipment (DME)?
Answer: Medicare Part B.
Q12: To be eligible to enroll in a Medicare Advantage (Part C) plan, what core criteria must
an individual meet?
Answer: They must be enrolled in both Part A and Part B, and live in the plan's
service area.
Q13: Mr. Davis is enrolled in a Medicare Advantage Preferred Provider Organization (PPO)
plan. Can he receive care from out-of-network providers?
Answer: Yes, but he will generally pay higher out-of-pocket costs.
Q14: Which of the following services is generally NOT covered under Original Medicare
Parts A and B?
Answer: Routine dental exams, vision care, and hearing aids.
Q15: What is the standard duration of the Initial Enrollment Period (IEP) for an individual
turning 65?
Answer: 7 months (3 months before, the month of, and 3 months after turning 65).
Q16: If a beneficiary misses their Initial Enrollment Period, during which annual window can
they sign up for Medicare Part B?
Answer: The General Enrollment Period (GEP), from January 1 to March 31.
Q17: What is the purpose of the Medicare Advantage Open Enrollment Period (MA OEP)
that runs from January 1 to March 31?
Answer: It allows individuals enrolled in an MA plan to switch to another MA plan or
return to Original Medicare.
Q18: If Mr. Green moves out of his Medicare Advantage plan's service area, what type of
enrollment window is he granted to pick a new plan?
