AHIP/NUR Community Exam
: Questions and Answers, certified latest update
2025/2026 GRADED A+
Mr. Roberts 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
• Mrs. Carol 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 she 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
• Mrs. Prudence is a widow who will attain age 65 and
, enroll in Medicare in just a few weeks. She concerned
about having prescription drug coverage. Which of the
following statements provides the best advice?
• Prescription drug coverage can be obtained by
enrolling in a Medicare Advantage plan that includes
Part D coverage
• 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)
,• Mr. Romero is 64, retiring soon, and considering
enrollment in his employer-sponsored retiree group
health plan that includes drug coverage with nominal
copays. He heard about a neighbor’s MA-PD plan that
you represent and because he takes numerous
prescription drugs, he is considering signing up for it.
What should you tell him?
• Beneficiaries should check with their employer or
union group benefits administrator before changing
plans to avoid losing coverage they want to keep
• Mrs. Walters is enrolled in her state’s Medicaid program
in addition to Medicare. What should she be aware of
when considering enrollment in a Medicare Health Plan?
• Medicaid will coordinate benefits only with Medicaid
participating providers.
• Mrs. Andrews asked how a Private Fee-for-Service
(PFFS) plan might affect her access to services since
she receives some assistance for her health care costs
from the State. What should you tell her?
• Medicaid may provide additional benefits, but
Medicaid will coordinate benefits only with Medicaid
, participating providers.
• Mr. Rivera has QMB-Plus eligibility and is thus covered
by both Medicare and Medicaid. He decides to enroll in a
Medicare Advantage (MA) plan. Later in the year, Mr.
Rivera needs dentures, a service only covered under
Medicaid. What action would you recommend he take in
order to have this cost covered?
• He should go to a Medicaid provider or obtain the
services through a Medicaid manage care plan if he is
enrolled in one
• Ms. Moore plans to retire when she turns 65 in a few
months. She is in excellent health and will have
considerable income when she retires. She is concerned
that her income will make it impossible for her to qualify
for Medicare. What could you tell her to address her
concern?
• Medicare is a program for people age 65 or older and
those under age 65 with certain disabilities, end stage
renal disease or Lou Gehrig’s disease, so she will be
eligible for Medicare
• Mrs. Willard wants to know generally how the benefits
: Questions and Answers, certified latest update
2025/2026 GRADED A+
Mr. Roberts 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
• Mrs. Carol 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 she 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
• Mrs. Prudence is a widow who will attain age 65 and
, enroll in Medicare in just a few weeks. She concerned
about having prescription drug coverage. Which of the
following statements provides the best advice?
• Prescription drug coverage can be obtained by
enrolling in a Medicare Advantage plan that includes
Part D coverage
• 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)
,• Mr. Romero is 64, retiring soon, and considering
enrollment in his employer-sponsored retiree group
health plan that includes drug coverage with nominal
copays. He heard about a neighbor’s MA-PD plan that
you represent and because he takes numerous
prescription drugs, he is considering signing up for it.
What should you tell him?
• Beneficiaries should check with their employer or
union group benefits administrator before changing
plans to avoid losing coverage they want to keep
• Mrs. Walters is enrolled in her state’s Medicaid program
in addition to Medicare. What should she be aware of
when considering enrollment in a Medicare Health Plan?
• Medicaid will coordinate benefits only with Medicaid
participating providers.
• Mrs. Andrews asked how a Private Fee-for-Service
(PFFS) plan might affect her access to services since
she receives some assistance for her health care costs
from the State. What should you tell her?
• Medicaid may provide additional benefits, but
Medicaid will coordinate benefits only with Medicaid
, participating providers.
• Mr. Rivera has QMB-Plus eligibility and is thus covered
by both Medicare and Medicaid. He decides to enroll in a
Medicare Advantage (MA) plan. Later in the year, Mr.
Rivera needs dentures, a service only covered under
Medicaid. What action would you recommend he take in
order to have this cost covered?
• He should go to a Medicaid provider or obtain the
services through a Medicaid manage care plan if he is
enrolled in one
• Ms. Moore plans to retire when she turns 65 in a few
months. She is in excellent health and will have
considerable income when she retires. She is concerned
that her income will make it impossible for her to qualify
for Medicare. What could you tell her to address her
concern?
• Medicare is a program for people age 65 or older and
those under age 65 with certain disabilities, end stage
renal disease or Lou Gehrig’s disease, so she will be
eligible for Medicare
• Mrs. Willard wants to know generally how the benefits
