AHIP EXAM STUDY GUIDE 2025 QUESTIONS WITH
ANSWERS GUARANTEE A+
✔✔Mr. Singh would like drug coverage, but does not want to be enrolled into a health
plan. What should you tell him? - ✔✔Mr. Singh can enroll in a stand-alone prescription
drug plan and continue to be covered for Part A and Part B services through Original
Fee-for-Service Medicare.
✔✔Mr. Alonso receives some help paying for his two generic prescription drugs from his
employer's retiree coverage, but he wants to compare it to a Part D prescription drug
plan. He asks you what costs he would generally expect to encounter when enrolling
into a standard Medicare Part D prescription drug plan. What should you tell him? -
✔✔He generally would pay a monthly premium, annual deductible, and per-prescription
cost sharing
✔✔Mrs. Geisler's neighbor told her she should look at her Part D options during the
annual Medicare enrollment period because features of Part D might have changed.
Mrs. Geisler can't remember what Part D is so she called you to ask what her neighbor
was talking about. What could you tell her? - ✔✔Part D covers prescription drugs and
she should look at her premiums, formulary, and cost sharing among other factors to
see if they have changed.
✔✔Mrs. Paterson is concerned about the deductibles and co-payments associated with
Original Medicare. What can you tell her about Medigap as an option to address this
concern? - ✔✔Medigap plans help beneficiaries cover coinsurance, co-payments,
and/or deductibles for medically necessary services.
✔✔Mrs. Gonzalez is enrolled in Original Medicare and has a Medigap policy as well, but
it provides no drug coverage. She would like to keep the coverage she has, but replace
her existing Medigap plan with one that provides drug coverage. What should you tell
her? - ✔✔Mrs. Gonzalez cannot purchase a Medigap plan that covers drugs, but she
could keep her Medigap policy and enroll in a Part D prescription drug plan.
✔✔Mr. Kelly has substantial financial means. He enrolled in Original Medicare and
purchased a Medigap policy many years ago that offered prescription drug coverage.
The prescription drug coverage has not been comparable to that offered by Medicare
Part D for several years and despite notification, Mr. Kelly took no action. Which of the
following statements best describes what will occur if Mr. Kelly now decides to enroll in
Medicare Part D? - ✔✔He will incur a late enrollment penalty
✔✔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? -
✔✔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.
,✔✔What impact, if any, will the Medicare Access and CHIP Reauthorization Act of 2015
(MACRA) have upon Medigap plans? - ✔✔The Part B deductible will no longer be
covered for individuals newly eligible for Medicare starting January 1, 2020.
✔✔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? - ✔✔Mr. Wu may still qualify for help in paying Part D costs
through his State Pharmaceutical Assistance Program.
✔✔Mrs. Quinn has recently turned 66 and decided after many years of work to begin
receiving Social Security benefits. Shortly thereafter Mrs. Quinn 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? - ✔✔Part B primarily
covers physician services. She will be paying a monthly premium and, with the
exception of many preventive and screening tests, generally will have 20% co-payments
for these services, in addition to an annual deductible.
✔✔Mr. Diaz continued working with his company and was insured under his employer's
group plan until he reached age 68. He has heard that there is a premium penalty for
those who did not sign up for Part B when first eligible and wants to know how much he
will have to pay. What should you tell him? - ✔✔Mr. Diaz will not pay any penalty
because he had continuous coverage under his employer's plan.
✔✔Mrs. Wolf wears glasses and dentures and has enjoyed considerable pain relief
from arthritis through acupuncture. She is concerned about whether or not Medicare will
cover these items and services. What should you tell her? - ✔✔Medicare does not
cover acupuncture, or, in general, glasses or dentures.
✔✔Mrs. Willard wants to know generally how the benefits under Original Medicare
might compare to the benefit package of a Medicare Health Plan before she starts
looking at specific plans. What could you tell her? - ✔✔Medicare Health 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. Paterson is concerned about the deductibles and co-payments associated with
Original Medicare. What can you tell her about Medigap as an option to address this
concern? - ✔✔Medigap plans help beneficiaries cover coinsurance, co-payments,
and/or deductibles for medically necessary services.
✔✔Mr. Hernandez is concerned that if he signs up for a Medicare Advantage plan, the
health plan may, at some time in the future, reduce his benefits below what is available
in Original Medicare. What should you tell him about his concern? - ✔✔Medicare health
,plans must cover all benefits available under Medicare Part A and Part B. Many also
cover Part D prescription drugs.
✔✔Mr. Bauer is 49 years old, but eighteen months ago he was declared disabled by the
Social Security Administration and has been receiving disability payments. He is
wondering whether he can obtain coverage under Medicare. What should you tell him? -
✔✔After receiving such disability payments for 24 months, he will be automatically
enrolled in Medicare, regardless of age
✔✔Mr. Schmidt would like to plan for retirement and has asked you what is covered
under Original Fee-for-Service (FFS) Medicare? - ✔✔Part A, which covers hospital,
skilled nursing facility, hospice and home health services and Part B, which covers
professional services such as those provided by a doctor are covered under Original
Medicare.
✔✔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? - ✔✔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. 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? - ✔✔They are Medicare health plans such as HMOs,
PPOs, PFFS, and MSAs.
✔✔Mr. Wells is trying to understand the difference between Original Medicare and
Medicare Advantage. What would be a correct description? - ✔✔Medicare Advantage is
a way of covering all the Original Medicare benefits through private health insurance
companies.
✔✔Mrs. Radford asks whether there are any special eligibility requirements for
Medicare Advantage. What should you tell her? - ✔✔Mrs. Radford must be entitled to
Part A and enrolled in Part B to enroll in Medicare Advantage.
✔✔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? - ✔✔He is not eligible to enroll in a Medicare Advantage plan
until he re-enrolls in Medicare Part B
, ✔✔Mrs. Billings enrolled in the ABC Medicare Advantage (MA) plan several years ago.
Her doctor recently confirmed a diagnosis of end-stage renal disease (ESRD). What
options does Mrs. Billings have in regard to her MA plan during the next open
enrollment season? - ✔✔She may remain in her ABC MA plan or enroll in a Special
Needs Plan (SNP) for individuals suffering from ESRD if one is available in her area.
✔✔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? - ✔✔C-SNP
✔✔Mr. Kumar is considering a Medicare Advantage HMO and has questions about his
ability to access providers. What should you tell him? - ✔✔In most Medicare Advantage
HMOs, Mr. Kumar must obtain his services only from providers who have a contractual
relationship with the plan (except in an emergency)
✔✔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? - ✔✔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
part of the PPO network.
✔✔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? - ✔✔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
✔✔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? -
✔✔SNPs limit enrollment to certain sub-populations of beneficiaries. Given his current
situation, he is unlikely to qualify and would not be able to enroll in the SNP.
✔✔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 like
his current HMO plan requires him to do. What should you tell him? - ✔✔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.
✔✔Mrs. Lee is discussing with you the possibility of enrolling in a Private Fee-for-
Service (PFFS) plan. As part of that discussion, what should you be sure to tell her? -
✔✔PFFS plans may choose to offer Part D benefits but are not required to do so.
ANSWERS GUARANTEE A+
✔✔Mr. Singh would like drug coverage, but does not want to be enrolled into a health
plan. What should you tell him? - ✔✔Mr. Singh can enroll in a stand-alone prescription
drug plan and continue to be covered for Part A and Part B services through Original
Fee-for-Service Medicare.
✔✔Mr. Alonso receives some help paying for his two generic prescription drugs from his
employer's retiree coverage, but he wants to compare it to a Part D prescription drug
plan. He asks you what costs he would generally expect to encounter when enrolling
into a standard Medicare Part D prescription drug plan. What should you tell him? -
✔✔He generally would pay a monthly premium, annual deductible, and per-prescription
cost sharing
✔✔Mrs. Geisler's neighbor told her she should look at her Part D options during the
annual Medicare enrollment period because features of Part D might have changed.
Mrs. Geisler can't remember what Part D is so she called you to ask what her neighbor
was talking about. What could you tell her? - ✔✔Part D covers prescription drugs and
she should look at her premiums, formulary, and cost sharing among other factors to
see if they have changed.
✔✔Mrs. Paterson is concerned about the deductibles and co-payments associated with
Original Medicare. What can you tell her about Medigap as an option to address this
concern? - ✔✔Medigap plans help beneficiaries cover coinsurance, co-payments,
and/or deductibles for medically necessary services.
✔✔Mrs. Gonzalez is enrolled in Original Medicare and has a Medigap policy as well, but
it provides no drug coverage. She would like to keep the coverage she has, but replace
her existing Medigap plan with one that provides drug coverage. What should you tell
her? - ✔✔Mrs. Gonzalez cannot purchase a Medigap plan that covers drugs, but she
could keep her Medigap policy and enroll in a Part D prescription drug plan.
✔✔Mr. Kelly has substantial financial means. He enrolled in Original Medicare and
purchased a Medigap policy many years ago that offered prescription drug coverage.
The prescription drug coverage has not been comparable to that offered by Medicare
Part D for several years and despite notification, Mr. Kelly took no action. Which of the
following statements best describes what will occur if Mr. Kelly now decides to enroll in
Medicare Part D? - ✔✔He will incur a late enrollment penalty
✔✔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? -
✔✔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.
,✔✔What impact, if any, will the Medicare Access and CHIP Reauthorization Act of 2015
(MACRA) have upon Medigap plans? - ✔✔The Part B deductible will no longer be
covered for individuals newly eligible for Medicare starting January 1, 2020.
✔✔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? - ✔✔Mr. Wu may still qualify for help in paying Part D costs
through his State Pharmaceutical Assistance Program.
✔✔Mrs. Quinn has recently turned 66 and decided after many years of work to begin
receiving Social Security benefits. Shortly thereafter Mrs. Quinn 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? - ✔✔Part B primarily
covers physician services. She will be paying a monthly premium and, with the
exception of many preventive and screening tests, generally will have 20% co-payments
for these services, in addition to an annual deductible.
✔✔Mr. Diaz continued working with his company and was insured under his employer's
group plan until he reached age 68. He has heard that there is a premium penalty for
those who did not sign up for Part B when first eligible and wants to know how much he
will have to pay. What should you tell him? - ✔✔Mr. Diaz will not pay any penalty
because he had continuous coverage under his employer's plan.
✔✔Mrs. Wolf wears glasses and dentures and has enjoyed considerable pain relief
from arthritis through acupuncture. She is concerned about whether or not Medicare will
cover these items and services. What should you tell her? - ✔✔Medicare does not
cover acupuncture, or, in general, glasses or dentures.
✔✔Mrs. Willard wants to know generally how the benefits under Original Medicare
might compare to the benefit package of a Medicare Health Plan before she starts
looking at specific plans. What could you tell her? - ✔✔Medicare Health 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. Paterson is concerned about the deductibles and co-payments associated with
Original Medicare. What can you tell her about Medigap as an option to address this
concern? - ✔✔Medigap plans help beneficiaries cover coinsurance, co-payments,
and/or deductibles for medically necessary services.
✔✔Mr. Hernandez is concerned that if he signs up for a Medicare Advantage plan, the
health plan may, at some time in the future, reduce his benefits below what is available
in Original Medicare. What should you tell him about his concern? - ✔✔Medicare health
,plans must cover all benefits available under Medicare Part A and Part B. Many also
cover Part D prescription drugs.
✔✔Mr. Bauer is 49 years old, but eighteen months ago he was declared disabled by the
Social Security Administration and has been receiving disability payments. He is
wondering whether he can obtain coverage under Medicare. What should you tell him? -
✔✔After receiving such disability payments for 24 months, he will be automatically
enrolled in Medicare, regardless of age
✔✔Mr. Schmidt would like to plan for retirement and has asked you what is covered
under Original Fee-for-Service (FFS) Medicare? - ✔✔Part A, which covers hospital,
skilled nursing facility, hospice and home health services and Part B, which covers
professional services such as those provided by a doctor are covered under Original
Medicare.
✔✔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? - ✔✔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. 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? - ✔✔They are Medicare health plans such as HMOs,
PPOs, PFFS, and MSAs.
✔✔Mr. Wells is trying to understand the difference between Original Medicare and
Medicare Advantage. What would be a correct description? - ✔✔Medicare Advantage is
a way of covering all the Original Medicare benefits through private health insurance
companies.
✔✔Mrs. Radford asks whether there are any special eligibility requirements for
Medicare Advantage. What should you tell her? - ✔✔Mrs. Radford must be entitled to
Part A and enrolled in Part B to enroll in Medicare Advantage.
✔✔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? - ✔✔He is not eligible to enroll in a Medicare Advantage plan
until he re-enrolls in Medicare Part B
, ✔✔Mrs. Billings enrolled in the ABC Medicare Advantage (MA) plan several years ago.
Her doctor recently confirmed a diagnosis of end-stage renal disease (ESRD). What
options does Mrs. Billings have in regard to her MA plan during the next open
enrollment season? - ✔✔She may remain in her ABC MA plan or enroll in a Special
Needs Plan (SNP) for individuals suffering from ESRD if one is available in her area.
✔✔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? - ✔✔C-SNP
✔✔Mr. Kumar is considering a Medicare Advantage HMO and has questions about his
ability to access providers. What should you tell him? - ✔✔In most Medicare Advantage
HMOs, Mr. Kumar must obtain his services only from providers who have a contractual
relationship with the plan (except in an emergency)
✔✔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? - ✔✔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
part of the PPO network.
✔✔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? - ✔✔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
✔✔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? -
✔✔SNPs limit enrollment to certain sub-populations of beneficiaries. Given his current
situation, he is unlikely to qualify and would not be able to enroll in the SNP.
✔✔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 like
his current HMO plan requires him to do. What should you tell him? - ✔✔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.
✔✔Mrs. Lee is discussing with you the possibility of enrolling in a Private Fee-for-
Service (PFFS) plan. As part of that discussion, what should you be sure to tell her? -
✔✔PFFS plans may choose to offer Part D benefits but are not required to do so.
