AHIP EXAM NEWEST TEST BANK UPDATE 2025\2026
WITH ACTUAL QUESTIONS AND CORRECT VERIFIED
ANSWERS/WELL ANALYSED ALL GRADED +
Mr. Wendt suffers from diabetes which has gotten progressively worse during
the last year. He is currently enrolled in Original Medicare (Parts A and B) and a
Part D prescription drug plan and did not enroll in a Medicare Advantage (MA)
plan during the last annual open enrollment period (AEP) which has just closed.
Mr. Wendt has heard that there are certain MA plans that might provide him
with more specialized coverage for his diabetes and wants to know if he must
wait until the next annual open enrollment period (AEP) before enrolling in
such a plan. What should you tell him? - CORRECT ANSWER-d. If there is a special
needs plan (SNP) in Mr. Wendt's area that specializes in caring for individuals
with diabetes, he may enroll in the SNP at any time under a special enrollment
period (SEP). Correct
Agent John Miller is meeting with Jerry Smith, a new prospect. Jerry is currently
enrolled in Medicare Parts A and B. Jerry has also purchased a Medicare
Supplement (Medigap) plan which he has had for several years. However, the
plan does not provide drug benefits. How would you advise Agent John Miller
to proceed? - CORRECT ANSWER-d. Tell prospect Jerry Smith that he should
consider adding a standalone Part D prescription drug coverage policy to his
present coverage.
Anita Magri will turn age 65 in August 2020. Anita intends to enroll in Original
Medicare Part A and Part B. She would also like to enroll in a Medicare
Supplement (Medigap) plan. Anita's older neighbor Mel has told her about the
Medigap Part F plan in which he is enrolled. It not only provides foreign travel
,emergency benefits but also covers his Medicare Part B deductible. Anita
comes to you for advice. What should you tell her? - CORRECT ANSWER-a. You are
sorry to disappoint Anita but a Medigap Part F plan is no longer available to
those who turn age 65 after January 1,2020. Anita might instead consider other
Medigap plans that offer foreign travel benefits but do not cover the Part B
deductible.
Mr. Wu is eligible for Medicare. He has limited financial resources but failed to
qualify for the Part D low-income subsidy. Where might he turn for help with
his prescription drug costs? - CORRECT ANSWER-b. Mr. Wu may still qualify for help
in paying Part D costs through his State Pharmaceutical Assistance Program.
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? - CORRECT
ANSWER-c. Beneficiaries under Original Medicare have no cost-sharing for most
preventive services which include immunizations such as annual flu shots.
Ms. Moore plans to retire when she turns 65 in a few months. She is in
excellent health and will have considerable income when she retires. She is
concerned that her income will make it impossible for her to qualify for
Medicare. What could you tell her to address her concern? - CORRECT ANSWER-d.
Medicare is a program for people age 65 or older and those under age 65 with
certain disabilities, end-stage renal disease, and Lou Gehrig's disease so she will
be eligible for Medicare.
What impact, if any, will recent regulatory changes have upon Medigap plans? -
CORRECT ANSWER-c. The Part B deductible will no longer be covered for
individuals newly eligible for Medicare starting January 1, 2020.
,Daniel is a middle-income Medicare beneficiary. He has chronic bronchitis,
putting him at severe risk for pneumonia. Otherwise, he has no problems
functioning. Which type of SNP is likely to be most appropriate for him? -
CORRECT ANSWER-a. C-SNP
Dr. Elizabeth Brennan does not contract with the ABC PFFS plan but accepts the
plan's terms and conditions for payment. Mary Rodgers sees Dr. Brennan for
treatment. How much may Dr. Brennan charge? - CORRECT ANSWER-b. Dr.
Brennan can charge Mary Rogers no more than the cost sharing specified in the
PFFS plan's terms and condition of payment which may include balance billing
up to 15%of the Medicare rate.
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 a number of
services and items he thought would be fully covered. He called you to ask
what he could do? What could you tell him? - CORRECT ANSWER-c. You can offer
to review the plans appeal process to help him ask the plan to review the
coverage decision.
Mr. Castillo, a naturalized citizen, previously enrolled in Medicare Part B but has
recently stopped paying his Part B premium. Mr. Castillo 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-a. He is not
eligible to enroll in a Medicare Advantage plan until he re-enrolls in Medicare
Part B.
Mr. Gomez notes that a Private Fee-for-Service (PFFS) plan available in his area
has an attractive premium. He wants to know if he must use doctors in a
network as his current HMO plan requires him to do. What should you tell him?
- CORRECT ANSWER-c. He may receive health care services from any doctor
allowed to bill Medicare, as long as he shows the doctor the plan's
, identification card and the doctor agrees to accept the PFFS plan's payment
terms and conditions, which could include balance billing. Correct
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 Medicare Advantage
Special Needs Plan (SNP). His friend has mentioned that the SNP charges very
low cost-sharing amounts and Mr. Greco would like to join that plan. What
should you tell him? - CORRECT ANSWER-b. 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. Kumar is considering a Medicare Advantage HMO and has questions about
his ability to access providers. What should you tell him? - CORRECT ANSWER-d. In
most Medicare Advantage HMOs, Mr. Kumar must generally obtain his services
only from providers who have a contractual relationship with the plan (except
in an emergency or where care is unavailable within the network).
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? - CORRECT ANSWER-
c. They are Medicare health plans such as HMOs, PPOs, PFFS, and MSAs.
Mrs. Burton is a retiree with substantial income. She is enrolled in an MA-PD
plan and was disappointed with the service she received from her primary care
physician because she was told she would have to wait five weeks to get an
appointment when she was feeling ill. She called you to ask what she could do
so she would not have to put up with such poor access to care. What could you
tell her? - CORRECT ANSWER-b. She could file a grievance with her plan to
complain about the lack of timeliness in getting an appointment.
Mrs. Chou likes a Private Fee-for-Service (PFFS) plan available in her area that
does not include drug coverage. She wants to enroll in the plan and enroll in a
WITH ACTUAL QUESTIONS AND CORRECT VERIFIED
ANSWERS/WELL ANALYSED ALL GRADED +
Mr. Wendt suffers from diabetes which has gotten progressively worse during
the last year. He is currently enrolled in Original Medicare (Parts A and B) and a
Part D prescription drug plan and did not enroll in a Medicare Advantage (MA)
plan during the last annual open enrollment period (AEP) which has just closed.
Mr. Wendt has heard that there are certain MA plans that might provide him
with more specialized coverage for his diabetes and wants to know if he must
wait until the next annual open enrollment period (AEP) before enrolling in
such a plan. What should you tell him? - CORRECT ANSWER-d. If there is a special
needs plan (SNP) in Mr. Wendt's area that specializes in caring for individuals
with diabetes, he may enroll in the SNP at any time under a special enrollment
period (SEP). Correct
Agent John Miller is meeting with Jerry Smith, a new prospect. Jerry is currently
enrolled in Medicare Parts A and B. Jerry has also purchased a Medicare
Supplement (Medigap) plan which he has had for several years. However, the
plan does not provide drug benefits. How would you advise Agent John Miller
to proceed? - CORRECT ANSWER-d. Tell prospect Jerry Smith that he should
consider adding a standalone Part D prescription drug coverage policy to his
present coverage.
Anita Magri will turn age 65 in August 2020. Anita intends to enroll in Original
Medicare Part A and Part B. She would also like to enroll in a Medicare
Supplement (Medigap) plan. Anita's older neighbor Mel has told her about the
Medigap Part F plan in which he is enrolled. It not only provides foreign travel
,emergency benefits but also covers his Medicare Part B deductible. Anita
comes to you for advice. What should you tell her? - CORRECT ANSWER-a. You are
sorry to disappoint Anita but a Medigap Part F plan is no longer available to
those who turn age 65 after January 1,2020. Anita might instead consider other
Medigap plans that offer foreign travel benefits but do not cover the Part B
deductible.
Mr. Wu is eligible for Medicare. He has limited financial resources but failed to
qualify for the Part D low-income subsidy. Where might he turn for help with
his prescription drug costs? - CORRECT ANSWER-b. Mr. Wu may still qualify for help
in paying Part D costs through his State Pharmaceutical Assistance Program.
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? - CORRECT
ANSWER-c. Beneficiaries under Original Medicare have no cost-sharing for most
preventive services which include immunizations such as annual flu shots.
Ms. Moore plans to retire when she turns 65 in a few months. She is in
excellent health and will have considerable income when she retires. She is
concerned that her income will make it impossible for her to qualify for
Medicare. What could you tell her to address her concern? - CORRECT ANSWER-d.
Medicare is a program for people age 65 or older and those under age 65 with
certain disabilities, end-stage renal disease, and Lou Gehrig's disease so she will
be eligible for Medicare.
What impact, if any, will recent regulatory changes have upon Medigap plans? -
CORRECT ANSWER-c. The Part B deductible will no longer be covered for
individuals newly eligible for Medicare starting January 1, 2020.
,Daniel is a middle-income Medicare beneficiary. He has chronic bronchitis,
putting him at severe risk for pneumonia. Otherwise, he has no problems
functioning. Which type of SNP is likely to be most appropriate for him? -
CORRECT ANSWER-a. C-SNP
Dr. Elizabeth Brennan does not contract with the ABC PFFS plan but accepts the
plan's terms and conditions for payment. Mary Rodgers sees Dr. Brennan for
treatment. How much may Dr. Brennan charge? - CORRECT ANSWER-b. Dr.
Brennan can charge Mary Rogers no more than the cost sharing specified in the
PFFS plan's terms and condition of payment which may include balance billing
up to 15%of the Medicare rate.
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 a number of
services and items he thought would be fully covered. He called you to ask
what he could do? What could you tell him? - CORRECT ANSWER-c. You can offer
to review the plans appeal process to help him ask the plan to review the
coverage decision.
Mr. Castillo, a naturalized citizen, previously enrolled in Medicare Part B but has
recently stopped paying his Part B premium. Mr. Castillo 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-a. He is not
eligible to enroll in a Medicare Advantage plan until he re-enrolls in Medicare
Part B.
Mr. Gomez notes that a Private Fee-for-Service (PFFS) plan available in his area
has an attractive premium. He wants to know if he must use doctors in a
network as his current HMO plan requires him to do. What should you tell him?
- CORRECT ANSWER-c. He may receive health care services from any doctor
allowed to bill Medicare, as long as he shows the doctor the plan's
, identification card and the doctor agrees to accept the PFFS plan's payment
terms and conditions, which could include balance billing. Correct
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 Medicare Advantage
Special Needs Plan (SNP). His friend has mentioned that the SNP charges very
low cost-sharing amounts and Mr. Greco would like to join that plan. What
should you tell him? - CORRECT ANSWER-b. 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. Kumar is considering a Medicare Advantage HMO and has questions about
his ability to access providers. What should you tell him? - CORRECT ANSWER-d. In
most Medicare Advantage HMOs, Mr. Kumar must generally obtain his services
only from providers who have a contractual relationship with the plan (except
in an emergency or where care is unavailable within the network).
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? - CORRECT ANSWER-
c. They are Medicare health plans such as HMOs, PPOs, PFFS, and MSAs.
Mrs. Burton is a retiree with substantial income. She is enrolled in an MA-PD
plan and was disappointed with the service she received from her primary care
physician because she was told she would have to wait five weeks to get an
appointment when she was feeling ill. She called you to ask what she could do
so she would not have to put up with such poor access to care. What could you
tell her? - CORRECT ANSWER-b. She could file a grievance with her plan to
complain about the lack of timeliness in getting an appointment.
Mrs. Chou likes a Private Fee-for-Service (PFFS) plan available in her area that
does not include drug coverage. She wants to enroll in the plan and enroll in a
