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AHIP 2025 Answer Guide – 100% Verified for 2024/2025

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AHIP 2025 Answer Guide – 100% Verified for 2024/2025

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  • June 11, 2024
  • December 25, 2024
  • 9
  • 2023/2024
  • Exam (elaborations)
  • Questions & answers

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  • ahip 2025 answer guide 100 verified for 202420

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3  reviews

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By: alex71 • 5 months ago

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By: TheAlphanurse • 6 months ago

GREAT DOC!! DETAILED ANSWERS. VALUE FOR MONEY HONESTLY. GOOD WORK

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By: kihumba • 6 months ago

GREAT DOCUMENT. VERIFIED EXAM QUESTIONS. GREAT VALUE FOR MONEY

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1. Which of the following is NOT a type of Medicare Advantage plan?
A) Health Maintenance Organization (HMO)
B) Preferred Provider Organization (PPO)
C) Fee-for-Service (FFS)
D) Special Needs Plan (SNP)
Answer: C) Fee-for-Service (FFS)
Rationale: Medicare Advantage plans (Part C) include HMO, PPO, and
SNP, but not Fee-for-Service. FFS is a payment system used under
Original Medicare, where the government pays a portion of each
medical service fee, rather than a Medicare Advantage plan type.


2. In the context of Medicare, what does "dual eligible" mean?
A) A person eligible for both Medicare and Medicaid
B) A person eligible for both private insurance and Medicare
C) A person eligible for only Medicare Part A
D) A person eligible for both Part A and Part B
Answer: A) A person eligible for both Medicare and Medicaid
Rationale: "Dual eligible" refers to individuals who qualify for both
Medicare and Medicaid. These individuals typically have low income
and resources and may qualify for both federal and state assistance.


3. What is the purpose of the "donut hole" in Medicare Part D?
A) To increase insurance coverage for prescription drugs
B) To limit the number of prescriptions a person can have
C) To describe the coverage gap in prescription drug plans
D) To provide free coverage for prescription drugs

,Answer: C) To describe the coverage gap in prescription drug plans
Rationale: The "donut hole" is a gap in Medicare Part D prescription
drug coverage, where the beneficiary must pay a larger portion of
prescription costs after reaching a certain limit until they qualify for
catastrophic coverage.


4. Which type of insurance plan allows members to see any doctor,
but encourages the use of a network of providers?
A) HMO
B) PPO
C) POS
D) FFS
Answer: B) PPO
Rationale: A Preferred Provider Organization (PPO) plan allows
members to see any doctor, but they are encouraged to use a network
of preferred providers to reduce out-of-pocket costs. This flexibility is
greater than that of an HMO, which requires members to use a network
of doctors.


5. In which situation would a Medicare beneficiary qualify for a
Special Needs Plan (SNP)?
A) They are over 65 and have a chronic condition
B) They have end-stage renal disease (ESRD)
C) They qualify for Medicaid and have chronic conditions
D) They are under 65 and do not have a disability
Answer: C) They qualify for Medicaid and have chronic conditions

,Rationale: Special Needs Plans (SNPs) are tailored for beneficiaries who
are dual eligible (Medicare and Medicaid), those with chronic
conditions, or individuals with specific health care needs such as ESRD.


6. What does the acronym "ACO" stand for in health insurance?
A) Accountable Care Organization
B) American Care Organization
C) Association of Certified Operators
D) Annual Coverage Option
Answer: A) Accountable Care Organization
Rationale: An Accountable Care Organization (ACO) is a group of
doctors, hospitals, and other health care providers that come together
to provide coordinated care to Medicare patients with the goal of
improving quality and reducing costs.


7. What does a "high-deductible health plan" (HDHP) typically
feature?
A) Low premiums and high out-of-pocket costs
B) Low premiums and low out-of-pocket costs
C) High premiums and low out-of-pocket costs
D) High premiums and high out-of-pocket costs
Answer: A) Low premiums and high out-of-pocket costs
Rationale: A high-deductible health plan (HDHP) is typically
characterized by lower premiums and higher deductibles, meaning that
consumers pay more out of pocket before insurance coverage kicks in.

, 8. Under the Affordable Care Act (ACA), what is a key requirement for
individual health insurance plans?
A) Plans must cover pre-existing conditions
B) Plans can deny coverage based on age
C) Plans must limit coverage to emergency care
D) Plans must exclude preventive services
Answer: A) Plans must cover pre-existing conditions
Rationale: Under the ACA, insurers are prohibited from denying
coverage based on pre-existing conditions, ensuring that individuals
cannot be excluded from coverage due to their health history.


9. What is the role of the Centers for Medicare & Medicaid Services
(CMS)?
A) To provide insurance coverage to private insurers
B) To regulate and oversee federal health programs like Medicare and
Medicaid
C) To provide free health insurance for all citizens
D) To provide insurance only for low-income individuals
Answer: B) To regulate and oversee federal health programs like
Medicare and Medicaid
Rationale: The Centers for Medicare & Medicaid Services (CMS) is a
federal agency that administers the nation’s major healthcare programs,
including Medicare, Medicaid, and the Children's Health Insurance
Program (CHIP).


10. What is the primary focus of Medicaid managed care?

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