AHIP 2026 - GENERAL COMPLIANCE FINAL EXAM WITH 100% ACCURATE
ANSWERS
Section 1: Medicare Basics and Eligibility (Questions 1-25)
1. Edward suffered from serious kidney disease. As a result, Edward became
eligible for Medicare coverage due to end-stage renal disease (ESRD). A close
relative donated their kidney and Edward successfully underwent transplant
surgery 12 months ago. Edward is now age 50 and asks you if his Medicare
coverage will continue. What should you say?
A) His Medicare coverage will end 12 months after transplant surgery, regardless
of his age
B) His Medicare coverage will continue as long as he receives follow-up care for
the transplant
C) His Medicare coverage will end 36 months after the transplant unless he
otherwise qualifies
D) His Medicare coverage ends immediately after transplant surgery
Answer: C
Rationale: For individuals eligible for Medicare due to ESRD, coverage ends 36
months after a successful kidney transplant unless they qualify for Medicare due
to age or disability. Edward's coverage will continue for 3 years post-transplant
unless he turns 65 or qualifies for disability .
,2. Mrs. 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?
A) She will qualify for premium-free Part A but must pay a standard monthly
premium for Part B
B) She will qualify for both Part A and Part B without paying any premiums
C) She will not qualify for any Medicare coverage without paying premiums
D) She must pay premiums for both Part A and Part B regardless of work history
Answer: A
Rationale: Most individuals who are citizens and over age 65 are covered under
Part A by virtue of having paid Medicare taxes while working. However, Part B
requires payment of a standard monthly premium, which is higher for individuals
with higher incomes .
3. Ms. Kumar is 66 years old, 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?
,A) Ms. Kumar's high income will disqualify her from Medicare coverage
B) Medicare is a program for people age 65 or older and those under age 65 with
certain disabilities, ESRD, and ALS, so she will be eligible for Medicare
C) Only those with low income are eligible for Medicare
D) Ms. Kumar needs to apply for Medicaid, not Medicare
Answer: B
Rationale: Medicare eligibility is primarily based on age (65+) and certain medical
conditions, not income. While a higher income may impact premium amounts for
Part B and Part D (Income-Related Monthly Adjustment Amount, IRMAA), it does
not prevent eligibility .
4. Mr. Xi will soon turn age 65 and has come to you for advice as to what services
are provided under Original Medicare. What should you tell him that best
describes the health coverage provided to Medicare beneficiaries?
A) Beneficiaries under Original Medicare have no cost-sharing for most preventive
services, which include immunizations such as annual flu shots
B) Original Medicare covers all healthcare services with no out-of-pocket costs
C) Original Medicare only covers hospital stays and emergency services
, D) Original Medicare requires prior authorization for all services
Answer: A
Rationale: Beneficiaries under Original Medicare have no cost-sharing for most
preventive services, which include immunizations such as annual flu shots. This is
an important feature of Medicare coverage that encourages preventive care .
5. 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?
A) She will not qualify for Part A because she was not born in the United States
B) Most individuals who are citizens and over age 65 are covered under Part A by
virtue of having paid Medicare taxes while working, though some may be covered
as a result of paying monthly premiums
C) She must wait 5 more years before she can qualify for Medicare
D) She must apply for citizenship before she can qualify for Medicare
Answer: B
ANSWERS
Section 1: Medicare Basics and Eligibility (Questions 1-25)
1. Edward suffered from serious kidney disease. As a result, Edward became
eligible for Medicare coverage due to end-stage renal disease (ESRD). A close
relative donated their kidney and Edward successfully underwent transplant
surgery 12 months ago. Edward is now age 50 and asks you if his Medicare
coverage will continue. What should you say?
A) His Medicare coverage will end 12 months after transplant surgery, regardless
of his age
B) His Medicare coverage will continue as long as he receives follow-up care for
the transplant
C) His Medicare coverage will end 36 months after the transplant unless he
otherwise qualifies
D) His Medicare coverage ends immediately after transplant surgery
Answer: C
Rationale: For individuals eligible for Medicare due to ESRD, coverage ends 36
months after a successful kidney transplant unless they qualify for Medicare due
to age or disability. Edward's coverage will continue for 3 years post-transplant
unless he turns 65 or qualifies for disability .
,2. Mrs. 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?
A) She will qualify for premium-free Part A but must pay a standard monthly
premium for Part B
B) She will qualify for both Part A and Part B without paying any premiums
C) She will not qualify for any Medicare coverage without paying premiums
D) She must pay premiums for both Part A and Part B regardless of work history
Answer: A
Rationale: Most individuals who are citizens and over age 65 are covered under
Part A by virtue of having paid Medicare taxes while working. However, Part B
requires payment of a standard monthly premium, which is higher for individuals
with higher incomes .
3. Ms. Kumar is 66 years old, 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?
,A) Ms. Kumar's high income will disqualify her from Medicare coverage
B) Medicare is a program for people age 65 or older and those under age 65 with
certain disabilities, ESRD, and ALS, so she will be eligible for Medicare
C) Only those with low income are eligible for Medicare
D) Ms. Kumar needs to apply for Medicaid, not Medicare
Answer: B
Rationale: Medicare eligibility is primarily based on age (65+) and certain medical
conditions, not income. While a higher income may impact premium amounts for
Part B and Part D (Income-Related Monthly Adjustment Amount, IRMAA), it does
not prevent eligibility .
4. Mr. Xi will soon turn age 65 and has come to you for advice as to what services
are provided under Original Medicare. What should you tell him that best
describes the health coverage provided to Medicare beneficiaries?
A) Beneficiaries under Original Medicare have no cost-sharing for most preventive
services, which include immunizations such as annual flu shots
B) Original Medicare covers all healthcare services with no out-of-pocket costs
C) Original Medicare only covers hospital stays and emergency services
, D) Original Medicare requires prior authorization for all services
Answer: A
Rationale: Beneficiaries under Original Medicare have no cost-sharing for most
preventive services, which include immunizations such as annual flu shots. This is
an important feature of Medicare coverage that encourages preventive care .
5. 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?
A) She will not qualify for Part A because she was not born in the United States
B) Most individuals who are citizens and over age 65 are covered under Part A by
virtue of having paid Medicare taxes while working, though some may be covered
as a result of paying monthly premiums
C) She must wait 5 more years before she can qualify for Medicare
D) She must apply for citizenship before she can qualify for Medicare
Answer: B
