AHIP 2025/2026 Final Exam Updated Questions and
Verified Answers, 100% Guarantee Pass
1. Mr. Xi will soon turn age 65 and has come to you for advice as to what services are
provided under Original Medicare. What should you tell Mr. Xi that best describes the
health coverage provided to Medicare beneficiaries?-
...Ans>> Beneficiaries under Original Medicare have no cost-sharing for most
preventive services.
2. Mr. Barker enjoys a comfortable retirement income. He recently had surgery and
expected that he would have certain services and items covered by the plan with
minimal out-of-pocket costs because his MA-PD coverage has been very good.
However, when he received the bill, he was surprised to see large charges in excess of
his maximum out-of-pocket limit that included some services and items he thought
would be fully covered. He called you to ask what he could do? What could you tell
him?
...Ans>> You can offer to review the plans appeal process to help him ask the plan to
review the coverage decision.
,3. 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?
...Ans>> He could enroll either in one of the MA plans that include prescrip- tion 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.
4. 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?
...Ans>> There are Medicare health plans such as HMOs, PPOs, PFFS, and MSAs.
5. 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 deter- mine his
eligibility?
...Ans>> You would need to ask Mr. Kelly if he is entitled to Part A, enrolled in Part B,
and if he lives in the PFFS plan's service area.
,
Verified Answers, 100% Guarantee Pass
1. Mr. Xi will soon turn age 65 and has come to you for advice as to what services are
provided under Original Medicare. What should you tell Mr. Xi that best describes the
health coverage provided to Medicare beneficiaries?-
...Ans>> Beneficiaries under Original Medicare have no cost-sharing for most
preventive services.
2. Mr. Barker enjoys a comfortable retirement income. He recently had surgery and
expected that he would have certain services and items covered by the plan with
minimal out-of-pocket costs because his MA-PD coverage has been very good.
However, when he received the bill, he was surprised to see large charges in excess of
his maximum out-of-pocket limit that included some services and items he thought
would be fully covered. He called you to ask what he could do? What could you tell
him?
...Ans>> You can offer to review the plans appeal process to help him ask the plan to
review the coverage decision.
,3. 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?
...Ans>> He could enroll either in one of the MA plans that include prescrip- tion 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.
4. 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?
...Ans>> There are Medicare health plans such as HMOs, PPOs, PFFS, and MSAs.
5. 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 deter- mine his
eligibility?
...Ans>> You would need to ask Mr. Kelly if he is entitled to Part A, enrolled in Part B,
and if he lives in the PFFS plan's service area.
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