AHIP EXAM WITH VERIFIED QUESTIONS AND
ANSWERS|| GUARANTEED PASS || ALREADY
GRADED A+ || LATEST VERSION 2025
Mrs. Willard wants to know generally how the benefits under Original Medicare
might compare to the benefits package of a Medicare Advantage Plan before
she starts looking at specific plans. What could you tell her? - ANSWER-
Medicare Advantage Plans may offer extra benefits that Original Medicare does
not offer such as vision, hearing, and dental services and must include a
maximum out-of-pocket limit on Part A and Part B services.
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 tell her? -
ANSWER-Mrs. Ramos 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. Kelly, age 65, is entitled to Part A but has not yet enrolled in Part B. She is
considering enrollment in a Medicare Advantage plan (Part C). What should
you advise her to do before she will be able to enroll in a Medicare Advantage
plan? - ANSWER-In order to join a Medicare Advantage plan, she also must
enroll in Part B.
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 you tell
him? - ANSWER-SNPs have special programs for enrollees with chronic
conditions, like Mr. Sinclair, and they provide prescription drug coverage that
could be very helpful as well.
Mrs. Lyons is in good health, uses a single prescription, and lives independently
in her own home. She is attracted by the idea of maintaining control over a
,Medical Savings Account (MSA) but is not sure if the plan associated with the
account will fit her needs. What specific piece of information about a Medicare
MSA plan would it be important for her to know, prior to enrolling in such a
plan? - ANSWER-All MSAs cover Part A and Part B benefits, but not Part D
prescription drug benefits, which could be obtained by also enrolling in a
separate prescription drug plan.
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? - 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.
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? -
ANSWER-C-SNP
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? - ANSWER-They
are Medicare health plans such as HMOs, PPOs, PFFS, and MSAs.
Medicare prescription drug plans are required to cover drugs in each therapeutic
category. She should be able to enroll in a Medicare prescription drug plan that
covers the medications she needs. - ANSWER-Mrs. Allen has a rare condition
for which two different brand name drugs are the only available treatment. She
is concerned that since no generic prescription drug is available and these drugs
are very high cost, she will not be able to find a Medicare Part D prescription
drug plan that covers either one of them. What should you tell her?
,An individual who is entitled to Part A or enrolled under Part B is eligible to
enroll in a Medicare prescription drug plan. As long as Mrs. Mulcahy is entitled
to Part A, she does not need to enroll under Part B before enrolling in a
prescription drug plan. - ANSWER-Mrs. Mulcahy is concerned that she may
not qualify for enrollment in a Medicare prescription drug plan because,
although she is entitled to Part A, she is not enrolled under Medicare Part B.
What should you tell her?
I, II, and III only - ANSWER-Which of the following statements about
Medicare Part D are correct?
I. Part D plans must enroll any eligible beneficiary who applies regardless of
health status except in limited circumstances.
II. Private fee-for-service (PFFS) plans are not required to use a pharmacy
network but may choose to have one.
III. Beneficiaries enrolled in a MA-Medical Savings Account (MSA) plan may
only obtain Part D benefits through a standalone PDP.
IV. Beneficiaries enrolled in a MA-PPO may obtain Part D benefits through a
standalone PDP or through their plan.
The extra help is available to beneficiaries whose income and assets do not
exceed annual limits specified by the government. - ANSWER-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?
Mr. Schultz should enroll in a Part D plan before he has a 63-day break in
coverage in order to avoid a premium penalty. - ANSWER-Mr. Shultz 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. Shultz has lost his employer group coverage within the
last two weeks. How would you advise him?
, He could check with the manufacturers of his medications to see if they offer an
assistance program to help people with limited means to obtain the medications
they need. Alternatively, he could check to see whether his state has a pharmacy
assistance program to help him with his expenses. - ANSWER-Mr. Bickford did
not quite qualify for the extra help low-income subsidy under the Medicare Part
D Prescription Drug program and he is wondering if there is any other option he
has for obtaining help with his considerable drug costs. What should you tell
him?
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
stand-alone prescription drug plan. What should you tell her? - ANSWER-She
could enroll in a PFFS plan and a stand-alone Medicare prescription drug plan.
Mrs. Lopez is enrolled in a cost plan for her Medicare benefits. She has recently
lost creditable coverage previously available through her husband's employer.
She is interested in enrolling in a Medicare Part D prescription drug plan (PDP).
What should you tell her? - ANSWER-If a Part D benefit is offered through her
plan she may choose to enroll in that plan or a standalone PDP.
Mr. Bickford did not quite qualify for the extra help low-income subsidy under
the Medicare Part D Prescription Drug program and he is wondering if there is
any other option he has for obtaining help with his considerable drug costs.
What should you tell him? - ANSWER-He could check with the manufacturers
of his medications to see if they offer an assistance program to help people with
limited means to obtain the medications they need. Alternatively, he could
check to see whether his state has a pharmacy assistance program to help him
with his expenses.
Mr. Torres has a small savings account. He would like to pay for his monthly
Part D premiums with an automatic monthly withdrawal from his savings
account until it is exhausted, and then have his premiums withheld from his
Social Security check. What should you tell him? - ANSWER-In general, he
must select a single Part D premium payment mechanism that will be used
throughout the year.
ANSWERS|| GUARANTEED PASS || ALREADY
GRADED A+ || LATEST VERSION 2025
Mrs. Willard wants to know generally how the benefits under Original Medicare
might compare to the benefits package of a Medicare Advantage Plan before
she starts looking at specific plans. What could you tell her? - ANSWER-
Medicare Advantage Plans may offer extra benefits that Original Medicare does
not offer such as vision, hearing, and dental services and must include a
maximum out-of-pocket limit on Part A and Part B services.
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 tell her? -
ANSWER-Mrs. Ramos 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. Kelly, age 65, is entitled to Part A but has not yet enrolled in Part B. She is
considering enrollment in a Medicare Advantage plan (Part C). What should
you advise her to do before she will be able to enroll in a Medicare Advantage
plan? - ANSWER-In order to join a Medicare Advantage plan, she also must
enroll in Part B.
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 you tell
him? - ANSWER-SNPs have special programs for enrollees with chronic
conditions, like Mr. Sinclair, and they provide prescription drug coverage that
could be very helpful as well.
Mrs. Lyons is in good health, uses a single prescription, and lives independently
in her own home. She is attracted by the idea of maintaining control over a
,Medical Savings Account (MSA) but is not sure if the plan associated with the
account will fit her needs. What specific piece of information about a Medicare
MSA plan would it be important for her to know, prior to enrolling in such a
plan? - ANSWER-All MSAs cover Part A and Part B benefits, but not Part D
prescription drug benefits, which could be obtained by also enrolling in a
separate prescription drug plan.
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? - 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.
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? -
ANSWER-C-SNP
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? - ANSWER-They
are Medicare health plans such as HMOs, PPOs, PFFS, and MSAs.
Medicare prescription drug plans are required to cover drugs in each therapeutic
category. She should be able to enroll in a Medicare prescription drug plan that
covers the medications she needs. - ANSWER-Mrs. Allen has a rare condition
for which two different brand name drugs are the only available treatment. She
is concerned that since no generic prescription drug is available and these drugs
are very high cost, she will not be able to find a Medicare Part D prescription
drug plan that covers either one of them. What should you tell her?
,An individual who is entitled to Part A or enrolled under Part B is eligible to
enroll in a Medicare prescription drug plan. As long as Mrs. Mulcahy is entitled
to Part A, she does not need to enroll under Part B before enrolling in a
prescription drug plan. - ANSWER-Mrs. Mulcahy is concerned that she may
not qualify for enrollment in a Medicare prescription drug plan because,
although she is entitled to Part A, she is not enrolled under Medicare Part B.
What should you tell her?
I, II, and III only - ANSWER-Which of the following statements about
Medicare Part D are correct?
I. Part D plans must enroll any eligible beneficiary who applies regardless of
health status except in limited circumstances.
II. Private fee-for-service (PFFS) plans are not required to use a pharmacy
network but may choose to have one.
III. Beneficiaries enrolled in a MA-Medical Savings Account (MSA) plan may
only obtain Part D benefits through a standalone PDP.
IV. Beneficiaries enrolled in a MA-PPO may obtain Part D benefits through a
standalone PDP or through their plan.
The extra help is available to beneficiaries whose income and assets do not
exceed annual limits specified by the government. - ANSWER-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?
Mr. Schultz should enroll in a Part D plan before he has a 63-day break in
coverage in order to avoid a premium penalty. - ANSWER-Mr. Shultz 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. Shultz has lost his employer group coverage within the
last two weeks. How would you advise him?
, He could check with the manufacturers of his medications to see if they offer an
assistance program to help people with limited means to obtain the medications
they need. Alternatively, he could check to see whether his state has a pharmacy
assistance program to help him with his expenses. - ANSWER-Mr. Bickford did
not quite qualify for the extra help low-income subsidy under the Medicare Part
D Prescription Drug program and he is wondering if there is any other option he
has for obtaining help with his considerable drug costs. What should you tell
him?
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
stand-alone prescription drug plan. What should you tell her? - ANSWER-She
could enroll in a PFFS plan and a stand-alone Medicare prescription drug plan.
Mrs. Lopez is enrolled in a cost plan for her Medicare benefits. She has recently
lost creditable coverage previously available through her husband's employer.
She is interested in enrolling in a Medicare Part D prescription drug plan (PDP).
What should you tell her? - ANSWER-If a Part D benefit is offered through her
plan she may choose to enroll in that plan or a standalone PDP.
Mr. Bickford did not quite qualify for the extra help low-income subsidy under
the Medicare Part D Prescription Drug program and he is wondering if there is
any other option he has for obtaining help with his considerable drug costs.
What should you tell him? - ANSWER-He could check with the manufacturers
of his medications to see if they offer an assistance program to help people with
limited means to obtain the medications they need. Alternatively, he could
check to see whether his state has a pharmacy assistance program to help him
with his expenses.
Mr. Torres has a small savings account. He would like to pay for his monthly
Part D premiums with an automatic monthly withdrawal from his savings
account until it is exhausted, and then have his premiums withheld from his
Social Security check. What should you tell him? - ANSWER-In general, he
must select a single Part D premium payment mechanism that will be used
throughout the year.
