The Ultimate AHIP 2026-2027
Exam Prep Guide: 300+ Verified
Questions & Answers [Most
Recent]/Graded A+
1. Question: What recent regulatory change has impacted Medigap
plans? Answer: Starting January 1, 2020, Medigap plans sold to
individuals who are newly eligible for Medicare are no longer
allowed to cover the Part B deductible.
2. Question: Mrs. Geisler's neighbor told her to look at her Part D
options during the annual Medicare enrollment period. What could
you tell her? Answer: Part D covers prescription drugs, and she
should look at her plan options annually to ensure it still meets her
needs.
3. Question: Chen, a 65-year-old citizen who has been a US resident
for 12 years, is concerned that she won't qualify for Part A
coverage because she wasn't born in the US. What can you tell
her? Answer: Most individuals who are citizens and over age 65
are covered under Part A by virtue of having paid Medicare taxes
while working, though some may be covered as a result of paying
monthly premiums.
4. Question: 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.
5. Question: What are the types of Medicare Advantage
Plans? Answer: PPO, HMO, MSA, Cost Plan, PFFS.
6. Question: What is a Medicare-Medicaid plan? Answer: Plans that
serve both Medicare and Medicaid individuals, include Part D
coverage, and are sometimes referred to as dual eligibles.
,7. Question: When can an individual with ESRD sign up for Part A
and Part B? Answer: Individuals with ESRD may sign up at any
time. The date on which coverage begins is the fourth month after
dialysis begins.
8. Question: What is the General Enrollment Period for Medicare Part
B? Answer: Individuals who do not enroll in Part B when first
eligible can enroll during a General Enrollment Period from January
1st to March 31st each year. Coverage begins July 1st of that year.
9. Question: What is the Part A late enrollment penalty? Answer: If
you don't enroll in Part A when first eligible, you will pay a late
penalty of up to 10% unless you enroll during a Special Enrollment
Period.
10. Question: What is a Special Enrollment Period (SEP) for
individuals with group health coverage through an
employer? Answer: These individuals may enroll in Part A and/or
Part B anytime while on group coverage during an SEP that occurs
during the 8-month period following the last month of group
coverage.
11. Question: What are the Part A premium costs? Answer: It is
free if you worked 40 quarters of your life and paid Medicare taxes.
The premium is $240 for individuals or spouses who paid Medicare
taxes for 30-39 quarters, and $437 for less than 30 quarters.
12. Question: What is a characteristic of a Medicare Cost
Plan? Answer: It is a type of Medicare health plan where you must
have Part B to enroll. You can join anytime the plan is accepting
new members, and different enrollment/disenrollment periods
apply. You can get Part D Rx coverage if available, or apply for a
separate PDP.
13. Question: Can a beneficiary enrolled in an HMO or PPO plan
that does not include prescription drug coverage join a stand-
alone PDP? Answer: No, if a beneficiary enrolls in an HMO or PPO
plan that does not include prescription drug coverage, they
CANNOT join a stand-alone PDP.
14. Question: Can a beneficiary enrolled in an MA PFFS plan that
does not include a Part D benefit join a stand-alone
PDP? Answer: Yes, an individual enrolled in an MA PFFS plan that
does not include a Part D benefit may enroll in a stand-alone PDP.
,15. Question: Can a beneficiary enrolled in a Cost Plan join a
stand-alone PDP? Answer: Yes, if the Cost Plan does not offer
prescription drug benefits, the beneficiary can join a stand-alone
PDP.
16. Question: Do all SNP plans include prescription drug
coverage? Answer: Yes, all SNP plans include prescription drug
coverage.
17. Question: What are the three types of Special Needs Plans
(SNPs)? Answer: Chronic Condition (CSNP), Dual Eligible (DSNP),
and Institutionalized (ISNP).
18. Question: What is the Part D late enrollment
penalty? Answer: There is a late enrollment penalty of 1% of the
national standard premium for every month that a beneficiary
could have had Part D but didn't enroll. There is no penalty for
beneficiaries with low-income assistance or who join a Part D
within 63 days of losing creditable coverage.
19. Question: If a beneficiary drops a Medigap plan with
prescription drug coverage and enrolls in Part D, will they face a
penalty? Answer: If coverage is not creditable, the individual
dropping coverage and enrolling in Part D coverage will pay a late
enrollment penalty unless they qualify for "Extra Help" or enroll in
Part D during a Special Enrollment Period for loss of creditable
coverage. If informed non-Medicare is no longer creditable, they
will have an SEP to enroll without penalty.
20. Question: Are individuals with ESRD eligible for Medicare
Advantage? Answer: Not unless the MA Plan is a SNP plan for
people with ESRD, OR the person developed ESRD after enrolling
in an MA plan.
21. Question: What is a characteristic of an HMO-POS
plan? Answer: Some HMOs offer a Point Of Service option,
allowing enrollees to go to non-plan doctors/hospitals without
prior approval for certain services. HMO-POS may limit services out
of network or put a cap on out-of-network coverage, and cost-
sharing is generally higher than from network providers.
22. Question: What is a characteristic of a PPO
plan? Answer: You do not need a referral for out-of-network
providers, but you may pay a higher cost-sharing amount.
, 23. Question: How does a PFFS plan work? Answer: Individuals
in a PFFS plan may receive covered services from any provider who
is eligible to provide Medicare services and agrees to the plan's
terms and conditions of payment. Enrollees must inform the
provider they are a PFFS member so the provider can decide
whether to accept the terms and conditions.
24. Question: Are PFFS plans permitted to charge more than the
cost-sharing specified in the plan? Answer: No, they are not
permitted to charge more than the cost-sharing specified in the
plan. Cost-sharing may include balance billing up to 15%.
25. Question: What is an MSA plan? Answer: It is a high-
deductible plan where Medicare makes a contribution to the
beneficiary's savings account. MSA plans do not cover Part D
prescription drug benefits, so the beneficiary must enroll in a
stand-alone Part D PDP.
26. Question: Can an individual enrolled in an MA MSA plan join
a stand-alone PDP for drug benefits? Answer: Yes, an individual
enrolled in an MA MSA plan must join a stand-alone PDP plan if
they want drug benefits.
27. Question: What happens when a beneficiary who is entitled
to Medicare and Medicaid has their Medicaid coverage
ended? Answer: This would trigger an SEP to allow them to enroll
in a different plan.
28. Question: An agent is reviewing a Medicare beneficiary's
options with a drug plan that is "at risk" of losing its contract. What
can the agent say? Answer: The agent may not market a plan that
is "at risk" of losing its CMS contract. If a plan is at risk, the agent
cannot actively market it as an option, because CMS may not
permit enrollment or contract renewal if the plan's deficiencies are
not corrected.
29. Question: Mr. Bauer, 66, has limited income. His state
pharmaceutical assistance program (SPAP) pays his Part D
premiums. He is moving and will lose eligibility for SPAP. What
should you tell him? Answer: He will qualify for a Special
Enrollment Period to enroll in another Part D plan.
30. Question: Mrs. Kim, enrolled in a Medicare Advantage plan
that is ending, needs to select a new plan. What options are
Exam Prep Guide: 300+ Verified
Questions & Answers [Most
Recent]/Graded A+
1. Question: What recent regulatory change has impacted Medigap
plans? Answer: Starting January 1, 2020, Medigap plans sold to
individuals who are newly eligible for Medicare are no longer
allowed to cover the Part B deductible.
2. Question: Mrs. Geisler's neighbor told her to look at her Part D
options during the annual Medicare enrollment period. What could
you tell her? Answer: Part D covers prescription drugs, and she
should look at her plan options annually to ensure it still meets her
needs.
3. Question: Chen, a 65-year-old citizen who has been a US resident
for 12 years, is concerned that she won't qualify for Part A
coverage because she wasn't born in the US. What can you tell
her? Answer: Most individuals who are citizens and over age 65
are covered under Part A by virtue of having paid Medicare taxes
while working, though some may be covered as a result of paying
monthly premiums.
4. Question: 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.
5. Question: What are the types of Medicare Advantage
Plans? Answer: PPO, HMO, MSA, Cost Plan, PFFS.
6. Question: What is a Medicare-Medicaid plan? Answer: Plans that
serve both Medicare and Medicaid individuals, include Part D
coverage, and are sometimes referred to as dual eligibles.
,7. Question: When can an individual with ESRD sign up for Part A
and Part B? Answer: Individuals with ESRD may sign up at any
time. The date on which coverage begins is the fourth month after
dialysis begins.
8. Question: What is the General Enrollment Period for Medicare Part
B? Answer: Individuals who do not enroll in Part B when first
eligible can enroll during a General Enrollment Period from January
1st to March 31st each year. Coverage begins July 1st of that year.
9. Question: What is the Part A late enrollment penalty? Answer: If
you don't enroll in Part A when first eligible, you will pay a late
penalty of up to 10% unless you enroll during a Special Enrollment
Period.
10. Question: What is a Special Enrollment Period (SEP) for
individuals with group health coverage through an
employer? Answer: These individuals may enroll in Part A and/or
Part B anytime while on group coverage during an SEP that occurs
during the 8-month period following the last month of group
coverage.
11. Question: What are the Part A premium costs? Answer: It is
free if you worked 40 quarters of your life and paid Medicare taxes.
The premium is $240 for individuals or spouses who paid Medicare
taxes for 30-39 quarters, and $437 for less than 30 quarters.
12. Question: What is a characteristic of a Medicare Cost
Plan? Answer: It is a type of Medicare health plan where you must
have Part B to enroll. You can join anytime the plan is accepting
new members, and different enrollment/disenrollment periods
apply. You can get Part D Rx coverage if available, or apply for a
separate PDP.
13. Question: Can a beneficiary enrolled in an HMO or PPO plan
that does not include prescription drug coverage join a stand-
alone PDP? Answer: No, if a beneficiary enrolls in an HMO or PPO
plan that does not include prescription drug coverage, they
CANNOT join a stand-alone PDP.
14. Question: Can a beneficiary enrolled in an MA PFFS plan that
does not include a Part D benefit join a stand-alone
PDP? Answer: Yes, an individual enrolled in an MA PFFS plan that
does not include a Part D benefit may enroll in a stand-alone PDP.
,15. Question: Can a beneficiary enrolled in a Cost Plan join a
stand-alone PDP? Answer: Yes, if the Cost Plan does not offer
prescription drug benefits, the beneficiary can join a stand-alone
PDP.
16. Question: Do all SNP plans include prescription drug
coverage? Answer: Yes, all SNP plans include prescription drug
coverage.
17. Question: What are the three types of Special Needs Plans
(SNPs)? Answer: Chronic Condition (CSNP), Dual Eligible (DSNP),
and Institutionalized (ISNP).
18. Question: What is the Part D late enrollment
penalty? Answer: There is a late enrollment penalty of 1% of the
national standard premium for every month that a beneficiary
could have had Part D but didn't enroll. There is no penalty for
beneficiaries with low-income assistance or who join a Part D
within 63 days of losing creditable coverage.
19. Question: If a beneficiary drops a Medigap plan with
prescription drug coverage and enrolls in Part D, will they face a
penalty? Answer: If coverage is not creditable, the individual
dropping coverage and enrolling in Part D coverage will pay a late
enrollment penalty unless they qualify for "Extra Help" or enroll in
Part D during a Special Enrollment Period for loss of creditable
coverage. If informed non-Medicare is no longer creditable, they
will have an SEP to enroll without penalty.
20. Question: Are individuals with ESRD eligible for Medicare
Advantage? Answer: Not unless the MA Plan is a SNP plan for
people with ESRD, OR the person developed ESRD after enrolling
in an MA plan.
21. Question: What is a characteristic of an HMO-POS
plan? Answer: Some HMOs offer a Point Of Service option,
allowing enrollees to go to non-plan doctors/hospitals without
prior approval for certain services. HMO-POS may limit services out
of network or put a cap on out-of-network coverage, and cost-
sharing is generally higher than from network providers.
22. Question: What is a characteristic of a PPO
plan? Answer: You do not need a referral for out-of-network
providers, but you may pay a higher cost-sharing amount.
, 23. Question: How does a PFFS plan work? Answer: Individuals
in a PFFS plan may receive covered services from any provider who
is eligible to provide Medicare services and agrees to the plan's
terms and conditions of payment. Enrollees must inform the
provider they are a PFFS member so the provider can decide
whether to accept the terms and conditions.
24. Question: Are PFFS plans permitted to charge more than the
cost-sharing specified in the plan? Answer: No, they are not
permitted to charge more than the cost-sharing specified in the
plan. Cost-sharing may include balance billing up to 15%.
25. Question: What is an MSA plan? Answer: It is a high-
deductible plan where Medicare makes a contribution to the
beneficiary's savings account. MSA plans do not cover Part D
prescription drug benefits, so the beneficiary must enroll in a
stand-alone Part D PDP.
26. Question: Can an individual enrolled in an MA MSA plan join
a stand-alone PDP for drug benefits? Answer: Yes, an individual
enrolled in an MA MSA plan must join a stand-alone PDP plan if
they want drug benefits.
27. Question: What happens when a beneficiary who is entitled
to Medicare and Medicaid has their Medicaid coverage
ended? Answer: This would trigger an SEP to allow them to enroll
in a different plan.
28. Question: An agent is reviewing a Medicare beneficiary's
options with a drug plan that is "at risk" of losing its contract. What
can the agent say? Answer: The agent may not market a plan that
is "at risk" of losing its CMS contract. If a plan is at risk, the agent
cannot actively market it as an option, because CMS may not
permit enrollment or contract renewal if the plan's deficiencies are
not corrected.
29. Question: Mr. Bauer, 66, has limited income. His state
pharmaceutical assistance program (SPAP) pays his Part D
premiums. He is moving and will lose eligibility for SPAP. What
should you tell him? Answer: He will qualify for a Special
Enrollment Period to enroll in another Part D plan.
30. Question: Mrs. Kim, enrolled in a Medicare Advantage plan
that is ending, needs to select a new plan. What options are
