AHIP 2026 Final EXAM Questions with
Revised Answers () 100%
Guarantee Pass.
Mr. Arias, a naturalized citizen, previously enrolled in Medicare Part B but has recently stopped paying
his Part B premium. Mr. Arias 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 ANSWERS He is
not eligible to enroll in a Medicare Advantage plan until he re-enrolls in Medicare Part B.
Mrs. Joy, age 65, is entitled to Part A but has not yet enrolled in Part B. She is considering enrolling in a
Medicare Advantage plan (Part C). What should you advise her to do before she can enroll in a Medicare
Advantage plan? - CORRECT ANSWERS To join a Medicare Advantage plan, she also must
enroll in Part B.
Mr. Kumar is considering a Medicare Advantage HMO and has questions about his ability to access
providers. What should you tell him? - CORRECT ANSWERS In most Medicare Advantage
HMOs, Mr. Kumar must generally obtain his services only from providers within the plan's network
(except in an emergency or where care is unavailable within the network).
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? - CORRECT ANSWERS 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. Lester is age 75 and enjoys a comfortable but not extremely high-income level. She wishes to enroll
in an MA MSA plan that she heard about from her neighbor. She also wants to have prescription drug
coverage since her doctor recently prescribed several expensive medications. Currently, she is enrolled
in Original Medicare and a standalone Part D plan. How would you advise Mrs. Lester? - CORRECT
ANSWERS Mrs. Lester may enroll in an MA MSA plan and remain in her current standalone
Part D prescription drug plan.
Mr. Dalton 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. Dalton would like to join that plan. What
should you tell him? - CORRECT ANSWERS 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. Anderson 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 determine his eligibility? - CORRECT ANSWERS You
would need to ask Mr. Anderson if he is entitled to Part A, enrolled in Part B, and if he lives in the PFFS
plan's service area.
Herber Noble is turning 65 next month, Herber legally entered the United States over twenty years ago
but is not a citizen. Since his entry into the country, Herber has worked at Smallcap Incorporated and
contributed to the Medicare system. Herber suffers from diabetes. He will soon retire and asks you if he
, can enroll in a Medicare Advantage plan that you represent. How would you respond? - CORRECT
ANSWERS Herber is eligible to enroll in Medicare Advantage as long as he is entitled to Part A
and enrolled in Part B. Herber should go to the Social Security website to enroll in Medicare Part A and B
if he has not done so already. Once he is enrolled, he can choose a Medicare Advantage plan.
Which of the following individuals is most likely to be eligible to enroll in a Part D Plan? - CORRECT
ANSWERS Jose, a grandfather who was granted asylum and has worked in the United States
for many years.
Mrs. Castro has just turned 65, is in excellent health and has a relatively high income. She uses no
medications and sees no reason to spend money on a Medicare prescription drug plan if she does not
need the coverage. She currently does not have creditable coverage. What could you tell her about the
implications of such a decision? - CORRECT ANSWERS If she does not sign up for a Medicare
prescription drug plan as soon as she is eligible to do so, and if she does sign up at a later date, her
premium will be permanently increased by 1% of the national average premium for every month that
she was not covered.
Mr. Chen 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. Chen has lost his employer group
coverage within the last two weeks. How would you advise him? - CORRECT ANSWERS Mr.
Chen should enroll in a Part D plan before he has a 63-day break in coverage in order to avoid a
premium penalty.
Ms. Ramos is enrolled in a Medicare Advantage plan that includes prescription drug plan (PDP)
coverage. She is traveling and wishes to fill two of the prescriptions that she has lost. How would you
advise her? - CORRECT ANSWERS She may fill prescriptions for covered drugs at non-network
pharmacies, but likely at a higher cost than paid at an in-network pharmacy.
What types of tools can Medicare Part D prescription drug plans use that affect the way their enrollees
can access medications? - CORRECT ANSWERS Part D plans do not have to cover all
medications. As a result, their formularies, or lists of covered drugs, will vary from plan to plan. In
addition, they can use cost containment techniques such as tiered co-payments and step therapy.
Mrs. Esmeralda Avila is a Medicare beneficiary enrolled in a MA-PD plan you represent. Her neighbor
recently suffered from a painful case of shingles. Mrs. Avila hopes to avoid such an illness through
vaccination. She asks you whether the cost of the shingles vaccination will be covered under the plan
you represent. What should you say? - CORRECT ANSWERS Yes, there is no cost sharing for the
shingles vaccine even in the deductible phase of her prescription drug plan because it is an adult vaccine
recommended by the Advisory Committee on Immunization Practices (AICP).
Mrs. Strickland is a new Medicare beneficiary who has just retired from retail work. She is interested in
selecting a Medicare Part D prescription drug plan. She takes several medications and is concerned that
she has not been able to identify a plan that covers all of her medications. She does not want to make
an abrupt change to new drugs that would be covered and asks what she should do. What should you
tell her? - CORRECT ANSWERS Every Part D drug plan is required to cover a single one-month
fill of her existing medications sometime during a 90-day transition period.
Revised Answers () 100%
Guarantee Pass.
Mr. Arias, a naturalized citizen, previously enrolled in Medicare Part B but has recently stopped paying
his Part B premium. Mr. Arias 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 ANSWERS He is
not eligible to enroll in a Medicare Advantage plan until he re-enrolls in Medicare Part B.
Mrs. Joy, age 65, is entitled to Part A but has not yet enrolled in Part B. She is considering enrolling in a
Medicare Advantage plan (Part C). What should you advise her to do before she can enroll in a Medicare
Advantage plan? - CORRECT ANSWERS To join a Medicare Advantage plan, she also must
enroll in Part B.
Mr. Kumar is considering a Medicare Advantage HMO and has questions about his ability to access
providers. What should you tell him? - CORRECT ANSWERS In most Medicare Advantage
HMOs, Mr. Kumar must generally obtain his services only from providers within the plan's network
(except in an emergency or where care is unavailable within the network).
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? - CORRECT ANSWERS 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. Lester is age 75 and enjoys a comfortable but not extremely high-income level. She wishes to enroll
in an MA MSA plan that she heard about from her neighbor. She also wants to have prescription drug
coverage since her doctor recently prescribed several expensive medications. Currently, she is enrolled
in Original Medicare and a standalone Part D plan. How would you advise Mrs. Lester? - CORRECT
ANSWERS Mrs. Lester may enroll in an MA MSA plan and remain in her current standalone
Part D prescription drug plan.
Mr. Dalton 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. Dalton would like to join that plan. What
should you tell him? - CORRECT ANSWERS 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. Anderson 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 determine his eligibility? - CORRECT ANSWERS You
would need to ask Mr. Anderson if he is entitled to Part A, enrolled in Part B, and if he lives in the PFFS
plan's service area.
Herber Noble is turning 65 next month, Herber legally entered the United States over twenty years ago
but is not a citizen. Since his entry into the country, Herber has worked at Smallcap Incorporated and
contributed to the Medicare system. Herber suffers from diabetes. He will soon retire and asks you if he
, can enroll in a Medicare Advantage plan that you represent. How would you respond? - CORRECT
ANSWERS Herber is eligible to enroll in Medicare Advantage as long as he is entitled to Part A
and enrolled in Part B. Herber should go to the Social Security website to enroll in Medicare Part A and B
if he has not done so already. Once he is enrolled, he can choose a Medicare Advantage plan.
Which of the following individuals is most likely to be eligible to enroll in a Part D Plan? - CORRECT
ANSWERS Jose, a grandfather who was granted asylum and has worked in the United States
for many years.
Mrs. Castro has just turned 65, is in excellent health and has a relatively high income. She uses no
medications and sees no reason to spend money on a Medicare prescription drug plan if she does not
need the coverage. She currently does not have creditable coverage. What could you tell her about the
implications of such a decision? - CORRECT ANSWERS If she does not sign up for a Medicare
prescription drug plan as soon as she is eligible to do so, and if she does sign up at a later date, her
premium will be permanently increased by 1% of the national average premium for every month that
she was not covered.
Mr. Chen 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. Chen has lost his employer group
coverage within the last two weeks. How would you advise him? - CORRECT ANSWERS Mr.
Chen should enroll in a Part D plan before he has a 63-day break in coverage in order to avoid a
premium penalty.
Ms. Ramos is enrolled in a Medicare Advantage plan that includes prescription drug plan (PDP)
coverage. She is traveling and wishes to fill two of the prescriptions that she has lost. How would you
advise her? - CORRECT ANSWERS She may fill prescriptions for covered drugs at non-network
pharmacies, but likely at a higher cost than paid at an in-network pharmacy.
What types of tools can Medicare Part D prescription drug plans use that affect the way their enrollees
can access medications? - CORRECT ANSWERS Part D plans do not have to cover all
medications. As a result, their formularies, or lists of covered drugs, will vary from plan to plan. In
addition, they can use cost containment techniques such as tiered co-payments and step therapy.
Mrs. Esmeralda Avila is a Medicare beneficiary enrolled in a MA-PD plan you represent. Her neighbor
recently suffered from a painful case of shingles. Mrs. Avila hopes to avoid such an illness through
vaccination. She asks you whether the cost of the shingles vaccination will be covered under the plan
you represent. What should you say? - CORRECT ANSWERS Yes, there is no cost sharing for the
shingles vaccine even in the deductible phase of her prescription drug plan because it is an adult vaccine
recommended by the Advisory Committee on Immunization Practices (AICP).
Mrs. Strickland is a new Medicare beneficiary who has just retired from retail work. She is interested in
selecting a Medicare Part D prescription drug plan. She takes several medications and is concerned that
she has not been able to identify a plan that covers all of her medications. She does not want to make
an abrupt change to new drugs that would be covered and asks what she should do. What should you
tell her? - CORRECT ANSWERS Every Part D drug plan is required to cover a single one-month
fill of her existing medications sometime during a 90-day transition period.
