AHIP 2026 FINAL EXAM QUESTIONS
WITH 100% CORRECT ANSWERS;
VERIFIED; LATEST UPDATE
1. 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? - correct answer- The minimal
copayment that would apply under Medicaid, regardless
of what the plan requires of other enrollees.
1. 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? - correct
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.
1. 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? -
correct 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.
1. 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? -
correct 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? -
correct 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.
Agent Marvin Millner wants to reach out to his current
clients for referrals. What advice would you give to
Marvin? - correct answer- Marvin should
consult with the health plans he represents to determine
whether those plans impose requirements around
beneficiary referrals.
Another agent you know has engaged in misconduct that
has been verified by the plan she represented. What sort
of penalty might the plan impose on this individual? -
correct answer- The plan may withhold
commission, require retraining, report the misconduct to
WITH 100% CORRECT ANSWERS;
VERIFIED; LATEST UPDATE
1. 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? - correct answer- The minimal
copayment that would apply under Medicaid, regardless
of what the plan requires of other enrollees.
1. 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? - correct
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.
1. 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? -
correct 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.
1. 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? -
correct 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? -
correct 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.
Agent Marvin Millner wants to reach out to his current
clients for referrals. What advice would you give to
Marvin? - correct answer- Marvin should
consult with the health plans he represents to determine
whether those plans impose requirements around
beneficiary referrals.
Another agent you know has engaged in misconduct that
has been verified by the plan she represented. What sort
of penalty might the plan impose on this individual? -
correct answer- The plan may withhold
commission, require retraining, report the misconduct to
