AHIP Final Exam Practice Test
(200 Questions and Answers 100% Correct)
1.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 ANSThey areMedicare health
plans such as HMOs, PPOs, PFFS, SNPs, and MSAs
2.(W) Mr. Wells is trying to understand the difference between Original
Medicare and Medicare Advantage. What would be a correct description?-
:Medicare Advantage is a way of covering all of the Original Medicare benefits
through private health insurance companies.
3.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-Ser-vice
(PFFS). She wants to know if this would be available to her.What shouldyou tell
her about PFFS plans ANSA PFFS plan is one of various types of MedicareAdvantage
plans offered by private entities and she may enroll in one if it is availablein her area.
4.(W) Mrs. Radford asks whether there are any special eligibility requirementsfor
Medicare Advantage. What should you tell her ANSMrs. Radford must be entitled toAHIP questions.pdf file:///C:/Users/BADLANDS/Downloads/AHIP%20questions.pdf
1 of 56 07/27/24, 03:31 AM Part A and enrolled in Part B to enroll in Medicare Advantage
5.Mr. Castillo, a naturalized citizen, previously enrolled in Medicare Part B buthas
recently stopped paying his Part B premium. He would like to enroll in a Medicare
Advantage (MA) plan and is still covered by Part A.What should youtell him ANS
He is not eligible to enroll in a Medicare Advantage plan until he re-enrollsin Medicare
Part B
6.(W) Mrs. Billings enrolled in the ABC Medicare Advantage (MA) plan several
years ago. Her doctor recently confirmed a diagnosis of end-stage renal disease
(ESRD).What options does Mrs. Billings have in regard to her MA planduring the
next open enrollment season ANSShe may remain in her ABC MA planor enroll in a
Special Needs Plan (SNP) for individuals suffering from ESRD if one is available in her
area
7.Mr. Kumar is considering a Medicare Advantage HMO and has questions about
his ability to access providers. What should you tell him ANSIn most Medicare
Advantage HMOs, Mr. Kumar must obtain his services only from providerswho have a
contractual relationship with the plan (except in an emergency).
8.Mrs. Ramos is considering a Medicare Advantage PPO and has questions about
which providers she can go to for her health care. What should you tellher ANS
Mrs. Ramos can obtain care from any provider who participates in Original Medicare,
but generally will be charged a lower co-payment if she goes to one of the plan's
preferred providers.AHIP questions.pdf file:///C:/Users/BADLANDS/Downloads/AHIP%20questions.pdf
2 of 56 07/27/24, 03:31 AM 9.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 youtell him
ANSSNPs have special programs for enrollees with chronic conditions, like Mr. Sinclair,
and they provide prescription drug coverage that could be very helpfulas well
10. (W) Mr. Greco is in excellent health, lives in his own home, and has a sizeable
income from his investments. He has a friend enrolled in a MedicareAdvantage
Special Needs Plan (SNP). His friend has mentioned that the SNPcharges very low
cost-sharing amounts and Mr. Greco would like to join thatplan.What should you
tell him ANSSNPs limit enrollment to certain sub-populationsof beneficiaries. Given his
current situation, he is unlikely to qualify and would not be able to enroll in the SNP.
11. (W) Mrs. Chen will be 65 soon, has been a citizen for twelve years, has been
employed full time, and paid taxes during that entire period. She is concernedthat
she will not qualify for coverage under part A because she was not born in the
United States. What should you tell her ANSMost individuals who are citizens and
over age 65 are covered under Part A by virtue of having paid Medicare taxes while
working, though some may be covered as a result of paying monthly premiums.
12. (W) Mr. Bauer is 49 years old, but eighteen months ago he was declared dis-abled
by the Social Security Administration and has been receiving disabilitypayments.
He is wondering whether he can obtain coverage under Medicare.What should you
tell him ANSAfter receiving such disability payments for 24 months, he will be
automatically enrolled in Medicare, regardless of age.AHIP questions.pdf file:///C:/Users/BADLANDS/Downloads/AHIP%20questions.pdf
3 of 56 07/27/24, 03:31 AM 13. (W) Mr. Davis is 49 years old and has been receiving disability benefits fromthe
Social Security Administration for 12 months. Can you sell him a Medicare
Advantage or Part D Prescription Drug policy ANSNo, he cannot purchase a
Medicare Advantage or Part D policy because he has not received Social Securityor
Railroad Retirement disability benefits for 24 months.
14. (W) Ms. Henderson believes that she will qualify for Medicare coverage when
she turns 65, without paying any premiums, because she has been working for 40
years and paying Medicare taxes.What should you tell her ANSInorder to obtain
Part B coverage, she must pay a standard monthly premium, thoughit is higher for
individuals with higher incomes
15. (W) Mr. Diaz continued working with his company and was insured underhis
employer's group plan until he reached age 68. He has heard that there is a
premium penalty for those who did not sign up for Part B when first eligible and
wants to know how much he will have to pay.What should youAHIP questions.pdf file:///C:/Users/BADLANDS/Downloads/AHIP%20questions.pdf
4 of 56 07/27/24, 03:31 AM
(200 Questions and Answers 100% Correct)
1.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 ANSThey areMedicare health
plans such as HMOs, PPOs, PFFS, SNPs, and MSAs
2.(W) Mr. Wells is trying to understand the difference between Original
Medicare and Medicare Advantage. What would be a correct description?-
:Medicare Advantage is a way of covering all of the Original Medicare benefits
through private health insurance companies.
3.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-Ser-vice
(PFFS). She wants to know if this would be available to her.What shouldyou tell
her about PFFS plans ANSA PFFS plan is one of various types of MedicareAdvantage
plans offered by private entities and she may enroll in one if it is availablein her area.
4.(W) Mrs. Radford asks whether there are any special eligibility requirementsfor
Medicare Advantage. What should you tell her ANSMrs. Radford must be entitled toAHIP questions.pdf file:///C:/Users/BADLANDS/Downloads/AHIP%20questions.pdf
1 of 56 07/27/24, 03:31 AM Part A and enrolled in Part B to enroll in Medicare Advantage
5.Mr. Castillo, a naturalized citizen, previously enrolled in Medicare Part B buthas
recently stopped paying his Part B premium. He would like to enroll in a Medicare
Advantage (MA) plan and is still covered by Part A.What should youtell him ANS
He is not eligible to enroll in a Medicare Advantage plan until he re-enrollsin Medicare
Part B
6.(W) Mrs. Billings enrolled in the ABC Medicare Advantage (MA) plan several
years ago. Her doctor recently confirmed a diagnosis of end-stage renal disease
(ESRD).What options does Mrs. Billings have in regard to her MA planduring the
next open enrollment season ANSShe may remain in her ABC MA planor enroll in a
Special Needs Plan (SNP) for individuals suffering from ESRD if one is available in her
area
7.Mr. Kumar is considering a Medicare Advantage HMO and has questions about
his ability to access providers. What should you tell him ANSIn most Medicare
Advantage HMOs, Mr. Kumar must obtain his services only from providerswho have a
contractual relationship with the plan (except in an emergency).
8.Mrs. Ramos is considering a Medicare Advantage PPO and has questions about
which providers she can go to for her health care. What should you tellher ANS
Mrs. Ramos can obtain care from any provider who participates in Original Medicare,
but generally will be charged a lower co-payment if she goes to one of the plan's
preferred providers.AHIP questions.pdf file:///C:/Users/BADLANDS/Downloads/AHIP%20questions.pdf
2 of 56 07/27/24, 03:31 AM 9.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 youtell him
ANSSNPs have special programs for enrollees with chronic conditions, like Mr. Sinclair,
and they provide prescription drug coverage that could be very helpfulas well
10. (W) Mr. Greco is in excellent health, lives in his own home, and has a sizeable
income from his investments. He has a friend enrolled in a MedicareAdvantage
Special Needs Plan (SNP). His friend has mentioned that the SNPcharges very low
cost-sharing amounts and Mr. Greco would like to join thatplan.What should you
tell him ANSSNPs limit enrollment to certain sub-populationsof beneficiaries. Given his
current situation, he is unlikely to qualify and would not be able to enroll in the SNP.
11. (W) Mrs. Chen will be 65 soon, has been a citizen for twelve years, has been
employed full time, and paid taxes during that entire period. She is concernedthat
she will not qualify for coverage under part A because she was not born in the
United States. What should you tell her ANSMost individuals who are citizens and
over age 65 are covered under Part A by virtue of having paid Medicare taxes while
working, though some may be covered as a result of paying monthly premiums.
12. (W) Mr. Bauer is 49 years old, but eighteen months ago he was declared dis-abled
by the Social Security Administration and has been receiving disabilitypayments.
He is wondering whether he can obtain coverage under Medicare.What should you
tell him ANSAfter receiving such disability payments for 24 months, he will be
automatically enrolled in Medicare, regardless of age.AHIP questions.pdf file:///C:/Users/BADLANDS/Downloads/AHIP%20questions.pdf
3 of 56 07/27/24, 03:31 AM 13. (W) Mr. Davis is 49 years old and has been receiving disability benefits fromthe
Social Security Administration for 12 months. Can you sell him a Medicare
Advantage or Part D Prescription Drug policy ANSNo, he cannot purchase a
Medicare Advantage or Part D policy because he has not received Social Securityor
Railroad Retirement disability benefits for 24 months.
14. (W) Ms. Henderson believes that she will qualify for Medicare coverage when
she turns 65, without paying any premiums, because she has been working for 40
years and paying Medicare taxes.What should you tell her ANSInorder to obtain
Part B coverage, she must pay a standard monthly premium, thoughit is higher for
individuals with higher incomes
15. (W) Mr. Diaz continued working with his company and was insured underhis
employer's group plan until he reached age 68. He has heard that there is a
premium penalty for those who did not sign up for Part B when first eligible and
wants to know how much he will have to pay.What should youAHIP questions.pdf file:///C:/Users/BADLANDS/Downloads/AHIP%20questions.pdf
4 of 56 07/27/24, 03:31 AM
