AHIP 2026 FINAL EXAM
QUESTIONS AND
VERIFIED ANSWERS
, AHIP 2026 FINAL EXAM QUESTIONS AND VERIFIED
ANSWERS
-. Mr. Pham is a Qualified Medicare Beneficiary (QMB). He enrolls in a Medicare Advantage
HMO. Shortly thereafter, Mr. Pham visits his primary care provider (PCP), Dr. Maria Sanchez.
Mr. Pham complains of a bad cold and receives care - a Medicare-covered service. The normal
copayment is $40. How much may Dr. Sanchez collects? - Answer-The minimal copayment that
would apply under Medicaid, regardless of what the plan requires of other enrollees.
-. Mr. Vasquez is in good health and is preparing a budget in anticipation of his retirement when
he turns 66. He wants to understand the health care costs he might be exposed to under
Medicare if he were to require hospitalization because of an illness. In general terms, what
could you tell him about his costs for inpatient hospital services under Original Medicare? -
Answer-Under Original Medicare, there is a single deductible amount due for the first 60 days of
any inpatient hospital stay, after which it converts into a per-day coinsurance amount through
day 90. After day 90, he would pay a daily amount up to 60 days over his lifetime, after which he
would be responsible for all costs.
-. Mrs. Thomas is 66 years old, has coverage under an employer plan, and will retire next year.
She heard she must enroll in Part B at the beginning of the year to ensure no gap in coverage.
What can you tell her? - Answer-She may enroll at any time while she is covered under her
employer plan, but she will have a special eight-month enrollment period after the last month on
her employer plan that differs from the standard general enrollment period, during which she
may enroll in Medicare Part B.
-. Ms. Henderson believes that she will qualify for Medicare Coverage when she turns 65,
without paying any premiums, because she has been working for 40 years and paying Medicare
taxes. What should you tell her? - Answer-To obtain Part B coverage, she must pay a standard
monthly premium, though it is higher for individuals with higher incomes.
ABC is a Medicare Advantage (MA) plan sponsor. It would like to use its enrollees' information
to market non-health related products such as life insurance and annuities. Which statement
best describes ABC's obligation to its enrollees regarding marketing such products? - Answer-It
must obtain a HIPAA compliant authorization from an enrollee that indicates the plan or plan
sponsor may use their information for marketing purposes.
QUESTIONS AND
VERIFIED ANSWERS
, AHIP 2026 FINAL EXAM QUESTIONS AND VERIFIED
ANSWERS
-. Mr. Pham is a Qualified Medicare Beneficiary (QMB). He enrolls in a Medicare Advantage
HMO. Shortly thereafter, Mr. Pham visits his primary care provider (PCP), Dr. Maria Sanchez.
Mr. Pham complains of a bad cold and receives care - a Medicare-covered service. The normal
copayment is $40. How much may Dr. Sanchez collects? - Answer-The minimal copayment that
would apply under Medicaid, regardless of what the plan requires of other enrollees.
-. Mr. Vasquez is in good health and is preparing a budget in anticipation of his retirement when
he turns 66. He wants to understand the health care costs he might be exposed to under
Medicare if he were to require hospitalization because of an illness. In general terms, what
could you tell him about his costs for inpatient hospital services under Original Medicare? -
Answer-Under Original Medicare, there is a single deductible amount due for the first 60 days of
any inpatient hospital stay, after which it converts into a per-day coinsurance amount through
day 90. After day 90, he would pay a daily amount up to 60 days over his lifetime, after which he
would be responsible for all costs.
-. Mrs. Thomas is 66 years old, has coverage under an employer plan, and will retire next year.
She heard she must enroll in Part B at the beginning of the year to ensure no gap in coverage.
What can you tell her? - Answer-She may enroll at any time while she is covered under her
employer plan, but she will have a special eight-month enrollment period after the last month on
her employer plan that differs from the standard general enrollment period, during which she
may enroll in Medicare Part B.
-. Ms. Henderson believes that she will qualify for Medicare Coverage when she turns 65,
without paying any premiums, because she has been working for 40 years and paying Medicare
taxes. What should you tell her? - Answer-To obtain Part B coverage, she must pay a standard
monthly premium, though it is higher for individuals with higher incomes.
ABC is a Medicare Advantage (MA) plan sponsor. It would like to use its enrollees' information
to market non-health related products such as life insurance and annuities. Which statement
best describes ABC's obligation to its enrollees regarding marketing such products? - Answer-It
must obtain a HIPAA compliant authorization from an enrollee that indicates the plan or plan
sponsor may use their information for marketing purposes.
