Ahip Test 2025 – 100 Latest Prep Questions and
Correct Detailed Answers// AHIP Exam Prep 2025-
2026 Practice Questions and Answers (100% Correct)
Mrs. Ellis recently turned 66 and decided after many years of work to retire and
begin receiving Social Security benefits. Shortly thereafter Mrs. Ellis received a
letter informing her that she has been automatically enrolled in Medicare Part B.
She wants to understand what this means. What should you tell Mrs. Quinn? -
ANSWER-Part B primarily covers physician services. She will be paying a
monthly premium and, except for many preventive screening and tests, generally
will have 20% co-payments for these services in addition to an annual deductible
Anthony Boniface turned 65 in 2024. He was not receiving Social Security or
Railroad Retirement Benefits on his 65th birthday. He was interested in obtaining
Medicare coverage and is eligible for premium-free Part A. Before he could enroll
in Medicare, his entire area was impacted by a hurricane causing massive flooding
and severe wind damage. The Federal government declared this to be a natural
disaster which has recently ended. During this period Anthony's initial enrollment
period expired. Anthony asks you how he can now obtain Medicare coverage.
What should you say? - ANSWER-Anthony is eligible for a special enrollment
period (SEP) because he missed an enrollment period due to the impact of the
Federally declared disaster. This SEP will allow Anthony to enroll in Part B up to
six months after the end of the emergency declaration. Anthony may enroll in
premium-free Part A at any time and his Part A coverage will be retroactive for up
to 6 months.
Juan Perez, who is turning age 65 next month, intends to work for several more
years at Smallcap, Incorporated. Smallcap has a workforce of 15 employees and
offers employer-sponsored healthcare coverage. Juan is a naturalized citizen and
has contributed to the Medicare system for over 20 years. Juan asks you if he will
be entitled to Medicare and if he enrolls how that will impact his employer-
sponsored healthcare coverage. How would you respond? - ANSWER-Juan is
likely to be eligible for Medicare once he turns age 65 and if he enrolls, Medicare
pg. 1
,would become the primary payor of his healthcare claims and Smallcap does not
have to continue to offer him coverage comparable to those under age 65 under its
employer-sponsored group health plan and would become a secondary payor
Mr. Capadona would like to purchase a Medicare Advantage (MA) plan and a
Medigap plan to pick up costs not covered by that plan. What should you tell him?
- ANSWER-It is illegal for you to sell Mr. Capadona a Medigap plan if he is
enrolled in an MA plan, and besides, Medigap only works with Original Medicare.
Mrs. Foster is covered by Original Medicare. She sustained a hip fracture and is
being successfully treated for that condition. However, she and her physicians feel
that after her lengthy hospital stay, she will need a month or two of nursing and
rehabilitative care. What should you tell them about Original Medicare's coverage
of care in a skilled nursing facility? - ANSWER-Medicare will cover Mrs. Foster's
skilled nursing services provided during the first 20 days of her stay, after which
she would have a copay until she has been in the facility for 100 days.
Mildred Savage enrolled in Allcare Medicare Advantage plan several years ago.
Mildred recently learned that she is suffering from inoperable cancer and has just a
few months to live. She would like to spend these final months in hospice care.
Mildred's family asks you whether hospice benefits will be paid for under the
Allcare Medicare Advantage plan. What should you say? - ANSWER-Mildred
may remain enrolled in Allcare and make a hospice election. Hospice benefits will
be paid for by Original Medicare under Part A and Allcare will continue to pay for
any non-hospice services.
Mr. Pham is a Qualified Medicare Beneficiary (QMB). He enrolls in a Medicare
Advantage HMO. Shortly thereafter, Mr. Pham visits his primary care provider
(PCP), Dr. Maria Sanchez. Mr. Pham complains of a bad cold and receives care - a
Medicare-covered service. The normal copayment is $40. How much may Dr.
Sanchez collects? - ANSWER-The minimal copayment that would apply under
Medicaid, regardless of what the plan requires of other enrollees
pg. 2
, Mr. Abbott 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-There are
Medicare health plans such as HMOs, PPOs, PFFS, and MSAs.
Mrs. Robles 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. Robles 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. Joy, age 65, is entitled to Part A but has not enrolled in Part B. She is
considering enrolling in Medicare Advantage plan (Part C). What should you
advise her to do before she can enroll in a Medicare Advantage plan? - ANSWER-
To join a Medicare Advantage plan, she also must enroll in Part B.
Henrietta Ross is an elderly individual enrolled in a fully integrated dual-eligible
(FIDE) special needs plan (SNP). Henrietta's daughter Gladys asks you to explain
what a FIDE-SNP offers her mother. What do you say? - ANSWER-FIDE-SNPs
provide individuals access to Medicare and Medicaid benefits under a single
organization that has both a Medicare Advantage and Medicaid managed care
contract with CMS
Mrs. Sanchez cares for her frail elderly mother, Maria, who lives in North
Carolina. She is worried that without additional support, her mother will need to go
into a nursing home. Mrs. Sanchez asks you if there is any Medicare plan that
might allow her mother to remain in the community rather than going into a
nursing home. How should you advise Mrs. Sanchez? - ANSWER-There are
Programs of All-Inclusive Care for the Elderly (PACE) for frail elderly
beneficiaries certified as needing a nursing home level of care but are able to live
safely in the community at the time of enrolment.
pg. 3
Correct Detailed Answers// AHIP Exam Prep 2025-
2026 Practice Questions and Answers (100% Correct)
Mrs. Ellis recently turned 66 and decided after many years of work to retire and
begin receiving Social Security benefits. Shortly thereafter Mrs. Ellis received a
letter informing her that she has been automatically enrolled in Medicare Part B.
She wants to understand what this means. What should you tell Mrs. Quinn? -
ANSWER-Part B primarily covers physician services. She will be paying a
monthly premium and, except for many preventive screening and tests, generally
will have 20% co-payments for these services in addition to an annual deductible
Anthony Boniface turned 65 in 2024. He was not receiving Social Security or
Railroad Retirement Benefits on his 65th birthday. He was interested in obtaining
Medicare coverage and is eligible for premium-free Part A. Before he could enroll
in Medicare, his entire area was impacted by a hurricane causing massive flooding
and severe wind damage. The Federal government declared this to be a natural
disaster which has recently ended. During this period Anthony's initial enrollment
period expired. Anthony asks you how he can now obtain Medicare coverage.
What should you say? - ANSWER-Anthony is eligible for a special enrollment
period (SEP) because he missed an enrollment period due to the impact of the
Federally declared disaster. This SEP will allow Anthony to enroll in Part B up to
six months after the end of the emergency declaration. Anthony may enroll in
premium-free Part A at any time and his Part A coverage will be retroactive for up
to 6 months.
Juan Perez, who is turning age 65 next month, intends to work for several more
years at Smallcap, Incorporated. Smallcap has a workforce of 15 employees and
offers employer-sponsored healthcare coverage. Juan is a naturalized citizen and
has contributed to the Medicare system for over 20 years. Juan asks you if he will
be entitled to Medicare and if he enrolls how that will impact his employer-
sponsored healthcare coverage. How would you respond? - ANSWER-Juan is
likely to be eligible for Medicare once he turns age 65 and if he enrolls, Medicare
pg. 1
,would become the primary payor of his healthcare claims and Smallcap does not
have to continue to offer him coverage comparable to those under age 65 under its
employer-sponsored group health plan and would become a secondary payor
Mr. Capadona would like to purchase a Medicare Advantage (MA) plan and a
Medigap plan to pick up costs not covered by that plan. What should you tell him?
- ANSWER-It is illegal for you to sell Mr. Capadona a Medigap plan if he is
enrolled in an MA plan, and besides, Medigap only works with Original Medicare.
Mrs. Foster is covered by Original Medicare. She sustained a hip fracture and is
being successfully treated for that condition. However, she and her physicians feel
that after her lengthy hospital stay, she will need a month or two of nursing and
rehabilitative care. What should you tell them about Original Medicare's coverage
of care in a skilled nursing facility? - ANSWER-Medicare will cover Mrs. Foster's
skilled nursing services provided during the first 20 days of her stay, after which
she would have a copay until she has been in the facility for 100 days.
Mildred Savage enrolled in Allcare Medicare Advantage plan several years ago.
Mildred recently learned that she is suffering from inoperable cancer and has just a
few months to live. She would like to spend these final months in hospice care.
Mildred's family asks you whether hospice benefits will be paid for under the
Allcare Medicare Advantage plan. What should you say? - ANSWER-Mildred
may remain enrolled in Allcare and make a hospice election. Hospice benefits will
be paid for by Original Medicare under Part A and Allcare will continue to pay for
any non-hospice services.
Mr. Pham is a Qualified Medicare Beneficiary (QMB). He enrolls in a Medicare
Advantage HMO. Shortly thereafter, Mr. Pham visits his primary care provider
(PCP), Dr. Maria Sanchez. Mr. Pham complains of a bad cold and receives care - a
Medicare-covered service. The normal copayment is $40. How much may Dr.
Sanchez collects? - ANSWER-The minimal copayment that would apply under
Medicaid, regardless of what the plan requires of other enrollees
pg. 2
, Mr. Abbott 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-There are
Medicare health plans such as HMOs, PPOs, PFFS, and MSAs.
Mrs. Robles 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. Robles 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. Joy, age 65, is entitled to Part A but has not enrolled in Part B. She is
considering enrolling in Medicare Advantage plan (Part C). What should you
advise her to do before she can enroll in a Medicare Advantage plan? - ANSWER-
To join a Medicare Advantage plan, she also must enroll in Part B.
Henrietta Ross is an elderly individual enrolled in a fully integrated dual-eligible
(FIDE) special needs plan (SNP). Henrietta's daughter Gladys asks you to explain
what a FIDE-SNP offers her mother. What do you say? - ANSWER-FIDE-SNPs
provide individuals access to Medicare and Medicaid benefits under a single
organization that has both a Medicare Advantage and Medicaid managed care
contract with CMS
Mrs. Sanchez cares for her frail elderly mother, Maria, who lives in North
Carolina. She is worried that without additional support, her mother will need to go
into a nursing home. Mrs. Sanchez asks you if there is any Medicare plan that
might allow her mother to remain in the community rather than going into a
nursing home. How should you advise Mrs. Sanchez? - ANSWER-There are
Programs of All-Inclusive Care for the Elderly (PACE) for frail elderly
beneficiaries certified as needing a nursing home level of care but are able to live
safely in the community at the time of enrolment.
pg. 3
