AHIP FINAL EXAM TEST REAL EXAM
2025 LATEST UPDATE
Juan Hernandez is turning 65 next month, Juan legally entered the United States over twenty
years ago but is not a citizen. Since his entry into the country, Juan has worked at Smallcap
Incorporated and contributed to the Medicare system. Juan 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? ✔️✔️Juan is eligible to enroll in a Medicare Advantage as long as he is entitled
to Part A and enrolled in Part B. Juan 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.
Mr. Wells is trying to understand the difference between Original Medicare and Medicare
Advantage. What would be the correct description? ✔️✔️Medicare Advantage is a way of
covering all the Original Medicare benefits through private health insurance companies.
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 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. Quinn 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? ✔️✔️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.
Mrs. Walters is entitled to Part A and has medical coverage without drug coverage through an
employer retiree plan. She is not enrolled in Part B. Since the employer plan does not cover
prescription drugs, she wants to enroll in a Medicare prescription drug plan. Will she be able to?
✔️✔️Yes. Mrs. Walters must be entitled to Part A and/or enrolled in Part B to be eligible for
coverage under the Medicare prescription drug program.
Mrs. Fields wants to know whether applying for the Part D low-income subsidy will be worth the
time to fill out the paperwork. What could you tell her? ✔️✔️The Part D low-income subsidy
could substantially lower her overall costs. She can apply by contacting her state Medicaid office
or calling the Social Security Administration.
Mr. Torres has a small savings account. He would like to pay for his monthly Part D premiums
with an automatic monthly withdrawal from his savings account until it is exhausted, and then
have his premiums withheld from his Social Security check. What should you tell him?
✔️✔️In general, he must select a single Part D premium payment mechanism that will be used
throughout the year.
,Mr. Bickford did not quite qualify for the extra help low-income subsidy under the Medicare Part
D Prescription Drug program and he is wondering if there is any other option he has for
obtaining help with his considerable drug costs. What should you tell him? ✔️✔️He could
check with the manufacturers of his medications to see if they offer an assistance program to
help people with limited means to obtain the medications they need. Alternatively, he could
check to see whether his state has a pharmacy assistance program to help him with his expenses.
Charles McCarthy is a Medicare beneficiary who suffers from diabetes. Mr. McCarthy is
considering enrollment in a MA-PD plan that you represent. He asks you whether his insulin
costs will be covered. What should you say? ✔️✔️Mr. McCarthy's insulin costs for a one-
month supply cannot be more than $35 in any coverage phase under the prescription drug plan
beginning in 2023.
Which of the following individuals is most likely to be eligible to enroll in a Part D Plan?
✔️✔️Jose, a grandfather who was granted asylum and has worked in the United States for
many years.
Mrs. Lopez is enrolled in a cost plan for her Medicare benefits. She has recently lost creditable
coverage previously available through her husband's employer. She is interested in enrolling in a
Medicare Part D prescription drug plan (PDP). What should you tell her? ✔️✔️If a Part D
benefit is offered through her plan she may choose to enroll in that plan or a standalone PDP.
, Mr. Schultz 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. Schultz has lost his employer group coverage within the last two weeks. How would you
advise him? ✔️✔️Mr. Schultz should enroll in a Part D plan before he has a 63-day break in
coverage in order to avoid a premium penalty.
Mr. Hutchinson has drug coverage through his former employer's retiree plan. He is concerned
about the Part D premium penalty if he does not enroll in a Medicare prescription drug plan, but
does not want to purchase extra coverage that he will not need. What should you tell him?
✔️✔️If the drug coverage he has is not expected to pay, on average, at least as much as
Medicare's standard Part D coverage expects to pay, then he will need to enroll in Medicare Part
D during his initial eligibility period to avoid the late enrollment penalty.
Mr. Jacob understands that there is a standard Medicare Part D prescription drug benefit, but
when he looks at information on various plans available in his area, he sees a wide range in what
they charge for deductibles, premiums, and cost sharing. How can you explain this to him?
✔️✔️Medicare Part D drug plans may have different benefit structures, but on average, they
must all be at least as good as the standard model established by the government.
Mrs. Roberts has Original Medicare and would like to enroll in a Private Fee-for-Service (PFFS)
plan. All types of PFFS plans are available in her area. Which options could Mrs. Roberts
consider before selecting a PFFS plan? ✔️✔️A Medicare Advantage Prescription Drug (MA-
2025 LATEST UPDATE
Juan Hernandez is turning 65 next month, Juan legally entered the United States over twenty
years ago but is not a citizen. Since his entry into the country, Juan has worked at Smallcap
Incorporated and contributed to the Medicare system. Juan 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? ✔️✔️Juan is eligible to enroll in a Medicare Advantage as long as he is entitled
to Part A and enrolled in Part B. Juan 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.
Mr. Wells is trying to understand the difference between Original Medicare and Medicare
Advantage. What would be the correct description? ✔️✔️Medicare Advantage is a way of
covering all the Original Medicare benefits through private health insurance companies.
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 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. Quinn 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? ✔️✔️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.
Mrs. Walters is entitled to Part A and has medical coverage without drug coverage through an
employer retiree plan. She is not enrolled in Part B. Since the employer plan does not cover
prescription drugs, she wants to enroll in a Medicare prescription drug plan. Will she be able to?
✔️✔️Yes. Mrs. Walters must be entitled to Part A and/or enrolled in Part B to be eligible for
coverage under the Medicare prescription drug program.
Mrs. Fields wants to know whether applying for the Part D low-income subsidy will be worth the
time to fill out the paperwork. What could you tell her? ✔️✔️The Part D low-income subsidy
could substantially lower her overall costs. She can apply by contacting her state Medicaid office
or calling the Social Security Administration.
Mr. Torres has a small savings account. He would like to pay for his monthly Part D premiums
with an automatic monthly withdrawal from his savings account until it is exhausted, and then
have his premiums withheld from his Social Security check. What should you tell him?
✔️✔️In general, he must select a single Part D premium payment mechanism that will be used
throughout the year.
,Mr. Bickford did not quite qualify for the extra help low-income subsidy under the Medicare Part
D Prescription Drug program and he is wondering if there is any other option he has for
obtaining help with his considerable drug costs. What should you tell him? ✔️✔️He could
check with the manufacturers of his medications to see if they offer an assistance program to
help people with limited means to obtain the medications they need. Alternatively, he could
check to see whether his state has a pharmacy assistance program to help him with his expenses.
Charles McCarthy is a Medicare beneficiary who suffers from diabetes. Mr. McCarthy is
considering enrollment in a MA-PD plan that you represent. He asks you whether his insulin
costs will be covered. What should you say? ✔️✔️Mr. McCarthy's insulin costs for a one-
month supply cannot be more than $35 in any coverage phase under the prescription drug plan
beginning in 2023.
Which of the following individuals is most likely to be eligible to enroll in a Part D Plan?
✔️✔️Jose, a grandfather who was granted asylum and has worked in the United States for
many years.
Mrs. Lopez is enrolled in a cost plan for her Medicare benefits. She has recently lost creditable
coverage previously available through her husband's employer. She is interested in enrolling in a
Medicare Part D prescription drug plan (PDP). What should you tell her? ✔️✔️If a Part D
benefit is offered through her plan she may choose to enroll in that plan or a standalone PDP.
, Mr. Schultz 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. Schultz has lost his employer group coverage within the last two weeks. How would you
advise him? ✔️✔️Mr. Schultz should enroll in a Part D plan before he has a 63-day break in
coverage in order to avoid a premium penalty.
Mr. Hutchinson has drug coverage through his former employer's retiree plan. He is concerned
about the Part D premium penalty if he does not enroll in a Medicare prescription drug plan, but
does not want to purchase extra coverage that he will not need. What should you tell him?
✔️✔️If the drug coverage he has is not expected to pay, on average, at least as much as
Medicare's standard Part D coverage expects to pay, then he will need to enroll in Medicare Part
D during his initial eligibility period to avoid the late enrollment penalty.
Mr. Jacob understands that there is a standard Medicare Part D prescription drug benefit, but
when he looks at information on various plans available in his area, he sees a wide range in what
they charge for deductibles, premiums, and cost sharing. How can you explain this to him?
✔️✔️Medicare Part D drug plans may have different benefit structures, but on average, they
must all be at least as good as the standard model established by the government.
Mrs. Roberts has Original Medicare and would like to enroll in a Private Fee-for-Service (PFFS)
plan. All types of PFFS plans are available in her area. Which options could Mrs. Roberts
consider before selecting a PFFS plan? ✔️✔️A Medicare Advantage Prescription Drug (MA-
