American Health Insurance Plans (AHIP)
Ahip-Med-2026 Medicare Advantage &
Part D Prescription Drug Plan
Certification Exam 2026-2027.
100% Complete Questions and Correct
Answers.
SECTION A: MEDICARE ADVANTAGE PLANS
1. 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?
Answer: 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.
2. Mr. Meoni's wife has a Medicare Advantage plan, but he wants to
understand what coverage Medicare Supplemental Insurance provides since
his health care needs are different from his wife's needs. What could you tell
Mr. Meoni?
Answer: Medicare Supplemental Insurance would help cover his Part A and
Part B cost sharing in Original Fee-for-Service (FFS) Medicare as well as possibly
some services that Medicare does not cover.
3. Mrs. Chen will be 65 soon, has been a citizen for twelve years, has been
employed full time, and paid taxes during that entire period. She is concerned
,that she will not qualify for coverage under part A because she was not born
in the United States. What should 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. Mr. Schmidt would like to plan for retirement and has asked you what is
covered under Original Fee-for-Service (FFS) Medicare? What could you tell
him?
Answer: 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.
5. 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, SNPs, and
MSAs.
6. Mr. Wells is trying to understand the difference between Original Medicare
and Medicare Advantage. What would be a correct description?
Answer: Medicare Advantage is a way of covering all of the Original Medicare
benefits through private health insurance companies.
7. During a sales presentation in Ms. Sullivan's home, she tells you that she
has heard about a type of Medicare health plan known as Private Fee-for-
Service (PFFS). She wants to know if this would be available to her. What
should you tell her about PFFS plans?
,Answer: A PFFS plan is one of various types of Medicare Advantage plans
offered by private entities and she may enroll in one if it is available in her area.
8. Mrs. Radford asks whether there are any special eligibility requirements
for Medicare Advantage. What should you tell her?
Answer: Mrs. Radford must be entitled to Part A and enrolled in Part B to enroll
in Medicare Advantage.
9. Mr. Castillo, a naturalized citizen, previously enrolled in Medicare Part B
but has recently stopped paying his Part B premium. He would like to enroll
in a Medicare Advantage (MA) plan and is still covered by Part A. What
should you tell him?
Answer: He is not eligible to enroll in a Medicare Advantage plan until he re-
enrolls in Medicare Part B.
10. 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?
Answer: 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.
11. 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 be charged a lower co-payment if she goes
to one of the plan's preferred providers.
, 12. 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.
13. 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 sub-populations of beneficiaries.
Given his current situation, he is unlikely to qualify and would not be able to
enroll in the SNP.
14. 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?
Answer: 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.
15. 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?
Answer: If she uses non-network providers, her doctors and hospital could
decide whether to treat her on a visit-by-visit basis.
Ahip-Med-2026 Medicare Advantage &
Part D Prescription Drug Plan
Certification Exam 2026-2027.
100% Complete Questions and Correct
Answers.
SECTION A: MEDICARE ADVANTAGE PLANS
1. 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?
Answer: 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.
2. Mr. Meoni's wife has a Medicare Advantage plan, but he wants to
understand what coverage Medicare Supplemental Insurance provides since
his health care needs are different from his wife's needs. What could you tell
Mr. Meoni?
Answer: Medicare Supplemental Insurance would help cover his Part A and
Part B cost sharing in Original Fee-for-Service (FFS) Medicare as well as possibly
some services that Medicare does not cover.
3. Mrs. Chen will be 65 soon, has been a citizen for twelve years, has been
employed full time, and paid taxes during that entire period. She is concerned
,that she will not qualify for coverage under part A because she was not born
in the United States. What should 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. Mr. Schmidt would like to plan for retirement and has asked you what is
covered under Original Fee-for-Service (FFS) Medicare? What could you tell
him?
Answer: 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.
5. 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, SNPs, and
MSAs.
6. Mr. Wells is trying to understand the difference between Original Medicare
and Medicare Advantage. What would be a correct description?
Answer: Medicare Advantage is a way of covering all of the Original Medicare
benefits through private health insurance companies.
7. During a sales presentation in Ms. Sullivan's home, she tells you that she
has heard about a type of Medicare health plan known as Private Fee-for-
Service (PFFS). She wants to know if this would be available to her. What
should you tell her about PFFS plans?
,Answer: A PFFS plan is one of various types of Medicare Advantage plans
offered by private entities and she may enroll in one if it is available in her area.
8. Mrs. Radford asks whether there are any special eligibility requirements
for Medicare Advantage. What should you tell her?
Answer: Mrs. Radford must be entitled to Part A and enrolled in Part B to enroll
in Medicare Advantage.
9. Mr. Castillo, a naturalized citizen, previously enrolled in Medicare Part B
but has recently stopped paying his Part B premium. He would like to enroll
in a Medicare Advantage (MA) plan and is still covered by Part A. What
should you tell him?
Answer: He is not eligible to enroll in a Medicare Advantage plan until he re-
enrolls in Medicare Part B.
10. 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?
Answer: 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.
11. 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 be charged a lower co-payment if she goes
to one of the plan's preferred providers.
, 12. 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.
13. 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 sub-populations of beneficiaries.
Given his current situation, he is unlikely to qualify and would not be able to
enroll in the SNP.
14. 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?
Answer: 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.
15. 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?
Answer: If she uses non-network providers, her doctors and hospital could
decide whether to treat her on a visit-by-visit basis.
