LATEST AHIP FINAL EXAM VERSION 1-5 EACH VERSION CONTAINS
100 COMPLETE QUESTIONS WITH WELL ELABORATED ANSWERS
PLUS STUDY GUIDE (100% CORRECT VERIFIED SOLUTIONS)
NEWEST UPDATED VERSION 2026 EDITION |GUARANTEED PASS A+
|FULL REVISED AHIP EXAM 2026/2027
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? Correct
Answer: The Part D low income subsidy could substantially lower her overall
costs. She can apply by contacting her state Medicaid office, or calling theSocial
Security Administration
Mr. Wendt suffers from diabetes which has gotten progressively worse during the
last year. He is currently enrolled in Original Medicare (Parts A and B) and a Part
D prescription drug plan and did not enroll in a Medicare Advantage (MA) plan
during the last annual open enrollment period (AEP) which hasjust closed. Mr.
Wendt has heard certain MA plans might provide him with more specialized
coverage for his diabetes and wants to know if he must wait until the next annual
open enrollment period (AEP) before enrolling in such a plan. What should you
tell him? Correct Answer: If there is a special needs plan (SNP) in Mr. Wendt's
area that specializes in caring for individuals with diabetes, he may enroll in the
SNP at any time under a special election period (SEP)
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 herto qualify for Medicare. What could you
tell her to address her concern? Correct Answer: Medicare is aprogram 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
Mr. Schmidt would like to plan for retirement and has asked you what is covered
under Original Fee-for- Service (FFS) Medicare? What could you tell him? Correct
Answer: Part A, which covers hospital, skilled nursing facility, hospice and home
health services and Part B, which covers professional services such as those
provided by a doctor are covered under Original Medicare.
Mr. Hernandez 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?
,Correct Answer: Medicare health plans must cover all benefits availableunder
Medicare Part A and Part B. Many also cover Part D prescription drugs.
Mrs. Raskin is a widow who will attain aged 65 and enroll in Medicare in just a few
weeks. She concernedabout having prescription drug coverage. Which of the
following statements provides the best advice?
Correct Answer: Prescription drug coverage can be obtained by enrolling in a
Medicare Advantage planthat includes Part D coverage.
Mrs. Willard wants to know generally how the benefits under Original Medicare
might compare to the benefit package of a Medicare Health Plan before she starts
looking at specific plans. What could you tellher? Correct Answer: Medicare Health
Plans may offer extra benefits that Original Medicare does not
offer such as vision, hearing, and dental services and must include a maximum
out- of-pocket limit onPart A and Part B services.
Mrs. Paterson is concerned about the deductibles and co-payments associated with
Original Medicare.What can you tell her about Medigap as an option to address
this concern? Correct Answer: Medigap plans help beneficiaries cover
coinsurance, co- payments, and/or deductibles for medically necessary services.
Mrs. Gonzalez is enrolled in Original Medicare and has a Medigap policy as well,
but it provides no drugcoverage. She would like to keep the coverage she has, but
replace her existing Medigap plan with one that provides drug coverage. What
should you tell her? Correct Answer: Mrs. Gonzalez cannot purchasea Medigap
plan that covers drugs, but she could keep her Medigap policy and enroll in a Part
D prescription drug plan.
Mr. Kelly has substantial financial means. He enrolled in Original Medicare and
purchased a Medigap policy many years ago that offered prescription drug
coverage. The prescription drug coverage has not been comparable to that offered
by Medicare Part D for several years and despite notification, Mr. Kellytook no
action. Which of the following statements best describes what will occur if Mr.
Kelly now decidesto enroll in Medicare Part D? Correct Answer: He will incur a
late enrollment penalty.
Mr. Capadona would like to purchase a Medicare Advantage (MA) plan and a
Medigap plan to pick up costs not covered by that plan. What should you tell him?
Correct Answer: It is illegal for you to sell Mr. Capadona a Medigap plan if he is
enrolled in an MA plan, and besides, Medigap only works with Original Medicare.
,What impact, if any, will the Medicare Access and CHIP Reauthorization Act of
2015 (MACRA) have uponMedigap plans? Correct Answer: The Part B deductible
will no longer be covered for individuals newly eligible for Medicare starting
January 1, 2020.
Mr. Lopez has heard that he can sign up for a product called "Medicare
Advantage" but is not sure aboutwhat type of plan designs are available through
this program.
What should you tell him about the types of health plans that are available through
the Medicare Advantage program? Correct Answer: They areMedicare health plans
such as HMOs, PPOs, PFFS, SNPs, and MSAs.
Mr. Wells is trying to understand the difference between Original Medicare and
Medicare Advantage. What would be a correct description? Correct Answer:
Medicare Advantage is a way of covering all of the Original Medicare benefits
through private health insurance companies.
During a sales presentation in Ms. Sullivan's home, she tells you that she has heard
about a type of Medicare health plan known as Private Fee-for-Service (PFFS).
She wants to know if this would be available to her. What should you tell her
about PFFS plans? Correct Answer: A PFFS plan is one of various types of
Medicare Advantage plans offered by private entities and she may enroll in one if
it is available in her area.
Mrs. Radford asks whether there are any special eligibility requirements for
Medicare Advantage. Whatshould you tell her? Correct Answer: Mrs. Radford
must be entitled to Part A and enrolled in Part B to enroll in Medicare Advantage.
Mr. Castillo, a naturalized citizen, previously enrolled in Medicare Part B but has
recently stopped payinghis Part B premium. He would like to enroll in a Medicare
Advantage (MA) plan and is still covered by Part A. What should you tell him?
Correct Answer: He is not eligible to enroll in a Medicare Advantage plan until he
re-enrolls in Medicare Part B.
Mrs. Billings 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 Mrs. Billings have in regardto her MA plan during the next
open enrollment season? Correct Answer: 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 inher area.
Mr. Kumar is considering a Medicare Advantage HMO and has questions about his
ability to access providers. What should you tell him? Correct Answer: In most
, Medicare Advantage HMOs, Mr. Kumar must obtain his services only from
providers who have a contractual relationship with the plan (except inan
emergency).
Mrs. Ramos is considering a Medicare Advantage PPO and has questions about
which providers she cango to for her health care. What should you tell her? Correct
Answer: Mrs. Ramos can obtain care from any provider who participates in
Original Medicare, but generally will be charged a lower co-payment if she goes to
one of the plan's preferred providers.
Mr. Sinclair has diabetes and heart trouble and is generally satisfied with the care
he has received under Original Medicare, but he would like to know more about
Medicare Advantage Special Needs Plans (SNPs). What could you tell him?
Correct Answer: SNPs have special programs for enrollees with chronicconditions,
like Mr. Sinclair, and they provide prescription drug coverage that could be very
helpful as well.
Mr. Meoni's wife has a Medicare Advantage plan, but he wants to understand what
coverage Medicare Supplemental Insurance provides since his health care needs
are different from his wife's needs. What could you tell Mr.Meoni? Correct
Answer: Medicare Supplemental Insurance would help cover his Part Aand Part B
cost sharing in Original Fee-for-Service (FFS) Medicare as well as possibly some
services that Medicare does not cover.
Mrs. Chen will be 65 soon, has been a citizen for twelve years, has been employed
full time, and paid taxes during that entire period. She is concerned that she will
not qualify for coverage under part A because she was not born in the United
States. What should you tell her? Correct Answer: Most individuals who are
citizens and over age 65 are covered under Part A by virtue of having paid
Medicaretaxes while working, though some may be covered as a result of paying
monthly premiums.
Mr. Bauer is 49 years old, but eighteen months ago he was declared disabled by
the Social Security Administration and has been receiving disability payments. He
is wondering whether he can obtain coverage under Medicare. What should you
tell him? Correct Answer: After receiving such disabilitypayments for 24 months,
he will be automatically enrolled in Medicare, regardless of age.
Mr. Davis is 49 years old and has been receiving disability benefits from the Social
Security Administration for 12 months. Can you sell him a Medicare Advantage or
Part D Prescription Drug policy? Correct Answer: No, he cannot purchase a
Medicare Advantage or Part D policy because he has not received Social Security
or Railroad Retirement disability benefits for 24 months.
100 COMPLETE QUESTIONS WITH WELL ELABORATED ANSWERS
PLUS STUDY GUIDE (100% CORRECT VERIFIED SOLUTIONS)
NEWEST UPDATED VERSION 2026 EDITION |GUARANTEED PASS A+
|FULL REVISED AHIP EXAM 2026/2027
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? Correct
Answer: The Part D low income subsidy could substantially lower her overall
costs. She can apply by contacting her state Medicaid office, or calling theSocial
Security Administration
Mr. Wendt suffers from diabetes which has gotten progressively worse during the
last year. He is currently enrolled in Original Medicare (Parts A and B) and a Part
D prescription drug plan and did not enroll in a Medicare Advantage (MA) plan
during the last annual open enrollment period (AEP) which hasjust closed. Mr.
Wendt has heard certain MA plans might provide him with more specialized
coverage for his diabetes and wants to know if he must wait until the next annual
open enrollment period (AEP) before enrolling in such a plan. What should you
tell him? Correct Answer: If there is a special needs plan (SNP) in Mr. Wendt's
area that specializes in caring for individuals with diabetes, he may enroll in the
SNP at any time under a special election period (SEP)
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 herto qualify for Medicare. What could you
tell her to address her concern? Correct Answer: Medicare is aprogram 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
Mr. Schmidt would like to plan for retirement and has asked you what is covered
under Original Fee-for- Service (FFS) Medicare? What could you tell him? Correct
Answer: Part A, which covers hospital, skilled nursing facility, hospice and home
health services and Part B, which covers professional services such as those
provided by a doctor are covered under Original Medicare.
Mr. Hernandez 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?
,Correct Answer: Medicare health plans must cover all benefits availableunder
Medicare Part A and Part B. Many also cover Part D prescription drugs.
Mrs. Raskin is a widow who will attain aged 65 and enroll in Medicare in just a few
weeks. She concernedabout having prescription drug coverage. Which of the
following statements provides the best advice?
Correct Answer: Prescription drug coverage can be obtained by enrolling in a
Medicare Advantage planthat includes Part D coverage.
Mrs. Willard wants to know generally how the benefits under Original Medicare
might compare to the benefit package of a Medicare Health Plan before she starts
looking at specific plans. What could you tellher? Correct Answer: Medicare Health
Plans may offer extra benefits that Original Medicare does not
offer such as vision, hearing, and dental services and must include a maximum
out- of-pocket limit onPart A and Part B services.
Mrs. Paterson is concerned about the deductibles and co-payments associated with
Original Medicare.What can you tell her about Medigap as an option to address
this concern? Correct Answer: Medigap plans help beneficiaries cover
coinsurance, co- payments, and/or deductibles for medically necessary services.
Mrs. Gonzalez is enrolled in Original Medicare and has a Medigap policy as well,
but it provides no drugcoverage. She would like to keep the coverage she has, but
replace her existing Medigap plan with one that provides drug coverage. What
should you tell her? Correct Answer: Mrs. Gonzalez cannot purchasea Medigap
plan that covers drugs, but she could keep her Medigap policy and enroll in a Part
D prescription drug plan.
Mr. Kelly has substantial financial means. He enrolled in Original Medicare and
purchased a Medigap policy many years ago that offered prescription drug
coverage. The prescription drug coverage has not been comparable to that offered
by Medicare Part D for several years and despite notification, Mr. Kellytook no
action. Which of the following statements best describes what will occur if Mr.
Kelly now decidesto enroll in Medicare Part D? Correct Answer: He will incur a
late enrollment penalty.
Mr. Capadona would like to purchase a Medicare Advantage (MA) plan and a
Medigap plan to pick up costs not covered by that plan. What should you tell him?
Correct Answer: It is illegal for you to sell Mr. Capadona a Medigap plan if he is
enrolled in an MA plan, and besides, Medigap only works with Original Medicare.
,What impact, if any, will the Medicare Access and CHIP Reauthorization Act of
2015 (MACRA) have uponMedigap plans? Correct Answer: The Part B deductible
will no longer be covered for individuals newly eligible for Medicare starting
January 1, 2020.
Mr. Lopez has heard that he can sign up for a product called "Medicare
Advantage" but is not sure aboutwhat type of plan designs are available through
this program.
What should you tell him about the types of health plans that are available through
the Medicare Advantage program? Correct Answer: They areMedicare health plans
such as HMOs, PPOs, PFFS, SNPs, and MSAs.
Mr. Wells is trying to understand the difference between Original Medicare and
Medicare Advantage. What would be a correct description? Correct Answer:
Medicare Advantage is a way of covering all of the Original Medicare benefits
through private health insurance companies.
During a sales presentation in Ms. Sullivan's home, she tells you that she has heard
about a type of Medicare health plan known as Private Fee-for-Service (PFFS).
She wants to know if this would be available to her. What should you tell her
about PFFS plans? Correct Answer: A PFFS plan is one of various types of
Medicare Advantage plans offered by private entities and she may enroll in one if
it is available in her area.
Mrs. Radford asks whether there are any special eligibility requirements for
Medicare Advantage. Whatshould you tell her? Correct Answer: Mrs. Radford
must be entitled to Part A and enrolled in Part B to enroll in Medicare Advantage.
Mr. Castillo, a naturalized citizen, previously enrolled in Medicare Part B but has
recently stopped payinghis Part B premium. He would like to enroll in a Medicare
Advantage (MA) plan and is still covered by Part A. What should you tell him?
Correct Answer: He is not eligible to enroll in a Medicare Advantage plan until he
re-enrolls in Medicare Part B.
Mrs. Billings 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 Mrs. Billings have in regardto her MA plan during the next
open enrollment season? Correct Answer: 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 inher area.
Mr. Kumar is considering a Medicare Advantage HMO and has questions about his
ability to access providers. What should you tell him? Correct Answer: In most
, Medicare Advantage HMOs, Mr. Kumar must obtain his services only from
providers who have a contractual relationship with the plan (except inan
emergency).
Mrs. Ramos is considering a Medicare Advantage PPO and has questions about
which providers she cango to for her health care. What should you tell her? Correct
Answer: Mrs. Ramos can obtain care from any provider who participates in
Original Medicare, but generally will be charged a lower co-payment if she goes to
one of the plan's preferred providers.
Mr. Sinclair has diabetes and heart trouble and is generally satisfied with the care
he has received under Original Medicare, but he would like to know more about
Medicare Advantage Special Needs Plans (SNPs). What could you tell him?
Correct Answer: SNPs have special programs for enrollees with chronicconditions,
like Mr. Sinclair, and they provide prescription drug coverage that could be very
helpful as well.
Mr. Meoni's wife has a Medicare Advantage plan, but he wants to understand what
coverage Medicare Supplemental Insurance provides since his health care needs
are different from his wife's needs. What could you tell Mr.Meoni? Correct
Answer: Medicare Supplemental Insurance would help cover his Part Aand Part B
cost sharing in Original Fee-for-Service (FFS) Medicare as well as possibly some
services that Medicare does not cover.
Mrs. Chen will be 65 soon, has been a citizen for twelve years, has been employed
full time, and paid taxes during that entire period. She is concerned that she will
not qualify for coverage under part A because she was not born in the United
States. What should you tell her? Correct Answer: Most individuals who are
citizens and over age 65 are covered under Part A by virtue of having paid
Medicaretaxes while working, though some may be covered as a result of paying
monthly premiums.
Mr. Bauer is 49 years old, but eighteen months ago he was declared disabled by
the Social Security Administration and has been receiving disability payments. He
is wondering whether he can obtain coverage under Medicare. What should you
tell him? Correct Answer: After receiving such disabilitypayments for 24 months,
he will be automatically enrolled in Medicare, regardless of age.
Mr. Davis is 49 years old and has been receiving disability benefits from the Social
Security Administration for 12 months. Can you sell him a Medicare Advantage or
Part D Prescription Drug policy? Correct Answer: No, he cannot purchase a
Medicare Advantage or Part D policy because he has not received Social Security
or Railroad Retirement disability benefits for 24 months.
