AHIP Certification Practice Exam 2026 – 50 Questions with Answers,
Explanations & Structured Sections
Last Updated: February 2026
SECTION I: MEDICARE PARTS A, B, C, & D CORE RULES (Questions 1-20)
1. Mrs. Rodriguez, age 65, enrolls in Medicare Part B during her Initial Enrollment Period
(IEP) with an effective date of June 1, 2026. She has been covered under COBRA
continuation coverage from her former employer since retiring in January 2026. Which
statement regarding her enrollment is MOST accurate?
A. Her COBRA coverage is considered creditable for Part B, so she will not face a late
enrollment penalty.
B. She should have kept her COBRA coverage and delayed Part B enrollment because
COBRA is primary to Medicare for those over 65.
C. COBRA is not creditable coverage for Part B purposes, and she made the correct
decision to enroll in Part B during her IEP to avoid penalties.
D. She can maintain both COBRA and Part B indefinitely, with Medicare paying primary
and COBRA paying secondary.
Correct Answer: C
Explainer: COBRA continuation coverage is not considered creditable coverage for
Medicare Part B purposes, though it is creditable for Part D. Individuals who delay Part B
enrollment beyond their IEP while covered only by COBRA will incur a lifetime late
enrollment penalty—10% for each full 12-month period they could have had Part B but
didn't enroll. Mrs. Rodriguez correctly enrolled during her IEP to avoid this penalty.
,2. Mr. Chen, age 72, has been enrolled in a Medicare Advantage Prescription Drug
(MA-PD) plan for three years. In February 2026, he is diagnosed with End-Stage Renal
Disease (ESRD) and begins dialysis. He contacts you wanting to know his options for
changing his coverage. Which action can he FIRST take under 2026 CMS rules?
A. He can immediately switch to Original Medicare with a Medigap policy guaranteed
issue during the next Annual Election Period.
B. He can enroll in a Medicare Special Needs Plan (SNP) for ESRD beneficiaries
immediately upon diagnosis, if one is available in his service area.
C. He must remain in his current MA-PD plan until the next Medicare Advantage Open
Enrollment Period (MA OEP) in January-March 2027.
D. He can switch to Original Medicare with a guaranteed issue right for Medigap only
during his birthday month under federal law.
Correct Answer: B
Explainer: CMS allows Medicare Advantage-eligible individuals with ESRD to enroll in
MA plans, including Chronic Condition Special Needs Plans (C-SNPs) specifically
designed for ESRD beneficiaries. Upon diagnosis, Mr. Chen qualifies for a Special
Enrollment Period to join an ESRD C-SNP if available in his area. These plans provide
specialized care coordination for dialysis and transplant services.
3. During the 2026 Annual Election Period, you are meeting with Ms. Thompson, who is
considering switching from her current Medicare Advantage plan to Original Medicare
with a Part D plan. She takes five medications, including two brand-name drugs for
,rheumatoid arthritis. Under the Inflation Reduction Act's full implementation in 2026,
which statement regarding her prescription drug costs is MOST accurate?
A. She will have a $2,000 annual out-of-pocket maximum for Part D covered drugs, after
which she pays nothing for the remainder of the year.
B. Her out-of-pocket costs will be capped at $3,500 annually, with manufacturer
discounts covering 10% of costs in the catastrophic phase.
C. She will enter catastrophic coverage after $8,000 in total drug costs, paying only 5%
coinsurance thereafter with no cap.
D. The coverage gap (donut hole) will require her to pay 25% of the cost for brand-name
drugs until she reaches catastrophic coverage.
Correct Answer: A
Explainer: The Inflation Reduction Act fully implements the Part D redesign for plan year
2026. The most significant change is the elimination of the coverage gap and the
establishment of a true $2,000 annual out-of-pocket maximum for Part D covered drugs.
Once Ms. Thompson spends $2,000 out-of-pocket, she pays $0 for covered Part D drugs
for the remainder of the calendar year. This replaces the previous catastrophic coverage
structure entirely.
4. Mr. Williams, age 68, is enrolled in Medicare Part A and Part B. He has a Medicare
Advantage plan with prescription drug coverage. In March 2026, he receives a kidney
transplant and no longer requires dialysis. According to CMS rules regarding
post-transplant immunosuppressive drug coverage, which statement is CORRECT?
, A. His MA plan must cover immunosuppressive drugs at the same cost-sharing as other
Part D drugs, with no special limitations.
B. After 36 months post-transplant, Medicare coverage for immunosuppressive drugs
ends entirely, and he must pay out-of-pocket.
C. Medicare Part B covers immunosuppressive drugs for 36 months post-transplant,
after which he needs a separate Part D plan for these medications.
D. He can enroll in a Part D immunosuppressive drug discount program that provides
coverage after 36 months for a monthly premium of approximately $100.
Correct Answer: D
Explainer: The Immunosuppressive Drug Discount Program allows individuals who lose
Medicare coverage for immunosuppressive drugs 36 months post-transplant to enroll in
a discount program. For 2026, the monthly premium is approximately $97.10, providing
coverage for these critical medications that would otherwise cost thousands monthly.
5. Ms. Davis, age 66, enrolls in Medicare Part B in May 2026 with an effective date of
July 1, 2026. Her modified adjusted gross income (MAGI) from her 2024 tax return was
$120,000, placing her in the third income-related monthly adjustment amount (IRMAA)
bracket. However, she retired in March 2026 and her income has significantly
decreased. Which statement regarding her IRMAA determination is MOST accurate?
A. She must pay the IRMAA based on her 2024 income for all of 2026, with no
exceptions for life-changing events.
B. She can request a reconsideration of her IRMAA determination due to her retirement,
which is a qualifying life-changing event, using Form SSA-44.
Explanations & Structured Sections
Last Updated: February 2026
SECTION I: MEDICARE PARTS A, B, C, & D CORE RULES (Questions 1-20)
1. Mrs. Rodriguez, age 65, enrolls in Medicare Part B during her Initial Enrollment Period
(IEP) with an effective date of June 1, 2026. She has been covered under COBRA
continuation coverage from her former employer since retiring in January 2026. Which
statement regarding her enrollment is MOST accurate?
A. Her COBRA coverage is considered creditable for Part B, so she will not face a late
enrollment penalty.
B. She should have kept her COBRA coverage and delayed Part B enrollment because
COBRA is primary to Medicare for those over 65.
C. COBRA is not creditable coverage for Part B purposes, and she made the correct
decision to enroll in Part B during her IEP to avoid penalties.
D. She can maintain both COBRA and Part B indefinitely, with Medicare paying primary
and COBRA paying secondary.
Correct Answer: C
Explainer: COBRA continuation coverage is not considered creditable coverage for
Medicare Part B purposes, though it is creditable for Part D. Individuals who delay Part B
enrollment beyond their IEP while covered only by COBRA will incur a lifetime late
enrollment penalty—10% for each full 12-month period they could have had Part B but
didn't enroll. Mrs. Rodriguez correctly enrolled during her IEP to avoid this penalty.
,2. Mr. Chen, age 72, has been enrolled in a Medicare Advantage Prescription Drug
(MA-PD) plan for three years. In February 2026, he is diagnosed with End-Stage Renal
Disease (ESRD) and begins dialysis. He contacts you wanting to know his options for
changing his coverage. Which action can he FIRST take under 2026 CMS rules?
A. He can immediately switch to Original Medicare with a Medigap policy guaranteed
issue during the next Annual Election Period.
B. He can enroll in a Medicare Special Needs Plan (SNP) for ESRD beneficiaries
immediately upon diagnosis, if one is available in his service area.
C. He must remain in his current MA-PD plan until the next Medicare Advantage Open
Enrollment Period (MA OEP) in January-March 2027.
D. He can switch to Original Medicare with a guaranteed issue right for Medigap only
during his birthday month under federal law.
Correct Answer: B
Explainer: CMS allows Medicare Advantage-eligible individuals with ESRD to enroll in
MA plans, including Chronic Condition Special Needs Plans (C-SNPs) specifically
designed for ESRD beneficiaries. Upon diagnosis, Mr. Chen qualifies for a Special
Enrollment Period to join an ESRD C-SNP if available in his area. These plans provide
specialized care coordination for dialysis and transplant services.
3. During the 2026 Annual Election Period, you are meeting with Ms. Thompson, who is
considering switching from her current Medicare Advantage plan to Original Medicare
with a Part D plan. She takes five medications, including two brand-name drugs for
,rheumatoid arthritis. Under the Inflation Reduction Act's full implementation in 2026,
which statement regarding her prescription drug costs is MOST accurate?
A. She will have a $2,000 annual out-of-pocket maximum for Part D covered drugs, after
which she pays nothing for the remainder of the year.
B. Her out-of-pocket costs will be capped at $3,500 annually, with manufacturer
discounts covering 10% of costs in the catastrophic phase.
C. She will enter catastrophic coverage after $8,000 in total drug costs, paying only 5%
coinsurance thereafter with no cap.
D. The coverage gap (donut hole) will require her to pay 25% of the cost for brand-name
drugs until she reaches catastrophic coverage.
Correct Answer: A
Explainer: The Inflation Reduction Act fully implements the Part D redesign for plan year
2026. The most significant change is the elimination of the coverage gap and the
establishment of a true $2,000 annual out-of-pocket maximum for Part D covered drugs.
Once Ms. Thompson spends $2,000 out-of-pocket, she pays $0 for covered Part D drugs
for the remainder of the calendar year. This replaces the previous catastrophic coverage
structure entirely.
4. Mr. Williams, age 68, is enrolled in Medicare Part A and Part B. He has a Medicare
Advantage plan with prescription drug coverage. In March 2026, he receives a kidney
transplant and no longer requires dialysis. According to CMS rules regarding
post-transplant immunosuppressive drug coverage, which statement is CORRECT?
, A. His MA plan must cover immunosuppressive drugs at the same cost-sharing as other
Part D drugs, with no special limitations.
B. After 36 months post-transplant, Medicare coverage for immunosuppressive drugs
ends entirely, and he must pay out-of-pocket.
C. Medicare Part B covers immunosuppressive drugs for 36 months post-transplant,
after which he needs a separate Part D plan for these medications.
D. He can enroll in a Part D immunosuppressive drug discount program that provides
coverage after 36 months for a monthly premium of approximately $100.
Correct Answer: D
Explainer: The Immunosuppressive Drug Discount Program allows individuals who lose
Medicare coverage for immunosuppressive drugs 36 months post-transplant to enroll in
a discount program. For 2026, the monthly premium is approximately $97.10, providing
coverage for these critical medications that would otherwise cost thousands monthly.
5. Ms. Davis, age 66, enrolls in Medicare Part B in May 2026 with an effective date of
July 1, 2026. Her modified adjusted gross income (MAGI) from her 2024 tax return was
$120,000, placing her in the third income-related monthly adjustment amount (IRMAA)
bracket. However, she retired in March 2026 and her income has significantly
decreased. Which statement regarding her IRMAA determination is MOST accurate?
A. She must pay the IRMAA based on her 2024 income for all of 2026, with no
exceptions for life-changing events.
B. She can request a reconsideration of her IRMAA determination due to her retirement,
which is a qualifying life-changing event, using Form SSA-44.
