1
AHIP FINAL EXAM TEST
QUESTIONS & ANSWERS
(LATEST 2025/2026)
COMPREHENSIVE
150-QUESTION PRACTICE —
EXAM
ADVANCED/HARD
DIFFICULTY LEVEL
EXAM OVERVIEW
The AHIP (America's Health Insurance Plans) Medicare certification is mandatory for
agents marketing Medicare Advantage and Part D plans. The exam requires a 90%
passing score with a 2-hour time limit, and candidates are allowed 3 attempts per
registration. Certification opens annually on June 23 for the upcoming plan year. The
final exam consists of 50 questions from Modules 1–5.
SECTION 1: MEDICARE ELIGIBILITY AND ENROLLMENT
(Questions 1–30)
Question 1
Mrs. Chen will be 65 soon, has been a U.S. citizen for twelve years, and has been
employed full-time, paying taxes during that entire period. She is concerned she will not
, 2
qualify for Part A because she was not born in the United States. What should you tell
her?
A) She is ineligible for Part A because she has not been a citizen for at least 15 years
B) She will only qualify for Part A if she pays monthly premiums
C) Most individuals who are citizens and over age 65 are covered under Part A by virtue
of having paid Medicare taxes while working
D) She must wait until age 67 to qualify for Medicare Part A
Correct Answer: C
Rationale: Medicare eligibility for Part A is based on work history and tax contributions,
not country of birth. U.S. citizens who have worked and paid Medicare taxes for at least
40 quarters (10 years) qualify for premium-free Part A at age 65.
Question 2
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. Can he obtain
Medicare coverage?
A) No, he must be at least 62 years old to qualify for Medicare
B) Yes, he is automatically enrolled immediately upon disability declaration
C) After receiving disability payments for 24 months, he will be automatically enrolled in
Medicare, regardless of age
D) He must apply for Medicare and pay full premiums since he is under 65
Correct Answer: C
Rationale: Individuals under 65 who receive Social Security Disability Insurance (SSDI)
benefits become automatically enrolled in Medicare after receiving such payments for
24 months.
Question 3
Ms. Kumar 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 her to qualify for Medicare. What could you tell her?
, 3
A) Medicare is a means-tested program and her income will disqualify her
B) Medicare is a program for people age 65 or older and those under 65 with certain
disabilities, ESRD, and ALS, so she will be eligible regardless of income
C) She must have worked for at least 30 years to qualify regardless of age
D) She will need to purchase private insurance instead of Medicare
Correct Answer: B
Rationale: Medicare eligibility is based on age, disability status, or specific medical
conditions—not income. Part A is premium-free for those with sufficient work history,
while Part B requires a monthly premium that may be higher for higher-income
individuals.
Question 4
Juan Perez, who is turning age 65 next month, intends to work for several more years at
Smallcap, Incorporated. Smallcap has a workforce of 15 employees and offers employer-
sponsored healthcare coverage. Juan is a naturalized citizen and has contributed to the
Medicare system for over 20 years. If Juan enrolls in Medicare, how will that impact his
employer-sponsored coverage?
A) Medicare would become the primary payor of his healthcare claims and Smallcap's
plan would become secondary
B) His employer-sponsored coverage would remain the primary payor and Medicare
would be secondary
C) He is ineligible for Medicare since he was born outside the United States
D) Smallcap must continue to offer him coverage comparable to those under age 65
Correct Answer: A
Rationale: For employers with fewer than 20 employees, Medicare is primary and the
employer plan is secondary. Juan is eligible for Medicare at age 65 based on his work
history and citizenship status.
Question 5
Mrs. Ellis recently turned 66 and decided to retire and begin receiving Social Security
benefits. Shortly thereafter, she received a letter informing her that she had been
, 4
automatically enrolled in Medicare Part B. She wants to understand what this means.
What should you tell Mrs. Ellis?
A) She should disenroll if she does not want to pay the monthly premiums—there is no
disadvantage in doing so
B) She will need to pay no premiums for Part B as she qualifies for premium-free
coverage
C) Part B primarily covers physician services. She will be paying a monthly premium and,
except for many preventive and screening tests, generally will have 20% co-payments
for these services, in addition to an annual deductible
D) Part B will cover her routine dental and vision needs
Correct Answer: C
Rationale: Part B primarily covers physician services, outpatient care, and preventive
services. Beneficiaries pay a monthly premium and generally have 20% coinsurance plus
an annual deductible.
Question 6
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. What are the costs for inpatient
hospital services under Original Medicare?
A) There is no cost for the first 90 days of any inpatient hospital stay
B) 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
C) He would pay 20% of all hospital charges with no deductible
D) He would pay a flat $1,500 per day for all hospital days
Correct Answer: B
Rationale: Under Original Medicare Part A, there is a deductible for the first 60 days of
inpatient hospital care, followed by daily coinsurance for days 61–90, and additional
costs for lifetime reserve days.
AHIP FINAL EXAM TEST
QUESTIONS & ANSWERS
(LATEST 2025/2026)
COMPREHENSIVE
150-QUESTION PRACTICE —
EXAM
ADVANCED/HARD
DIFFICULTY LEVEL
EXAM OVERVIEW
The AHIP (America's Health Insurance Plans) Medicare certification is mandatory for
agents marketing Medicare Advantage and Part D plans. The exam requires a 90%
passing score with a 2-hour time limit, and candidates are allowed 3 attempts per
registration. Certification opens annually on June 23 for the upcoming plan year. The
final exam consists of 50 questions from Modules 1–5.
SECTION 1: MEDICARE ELIGIBILITY AND ENROLLMENT
(Questions 1–30)
Question 1
Mrs. Chen will be 65 soon, has been a U.S. citizen for twelve years, and has been
employed full-time, paying taxes during that entire period. She is concerned she will not
, 2
qualify for Part A because she was not born in the United States. What should you tell
her?
A) She is ineligible for Part A because she has not been a citizen for at least 15 years
B) She will only qualify for Part A if she pays monthly premiums
C) Most individuals who are citizens and over age 65 are covered under Part A by virtue
of having paid Medicare taxes while working
D) She must wait until age 67 to qualify for Medicare Part A
Correct Answer: C
Rationale: Medicare eligibility for Part A is based on work history and tax contributions,
not country of birth. U.S. citizens who have worked and paid Medicare taxes for at least
40 quarters (10 years) qualify for premium-free Part A at age 65.
Question 2
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. Can he obtain
Medicare coverage?
A) No, he must be at least 62 years old to qualify for Medicare
B) Yes, he is automatically enrolled immediately upon disability declaration
C) After receiving disability payments for 24 months, he will be automatically enrolled in
Medicare, regardless of age
D) He must apply for Medicare and pay full premiums since he is under 65
Correct Answer: C
Rationale: Individuals under 65 who receive Social Security Disability Insurance (SSDI)
benefits become automatically enrolled in Medicare after receiving such payments for
24 months.
Question 3
Ms. Kumar 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 her to qualify for Medicare. What could you tell her?
, 3
A) Medicare is a means-tested program and her income will disqualify her
B) Medicare is a program for people age 65 or older and those under 65 with certain
disabilities, ESRD, and ALS, so she will be eligible regardless of income
C) She must have worked for at least 30 years to qualify regardless of age
D) She will need to purchase private insurance instead of Medicare
Correct Answer: B
Rationale: Medicare eligibility is based on age, disability status, or specific medical
conditions—not income. Part A is premium-free for those with sufficient work history,
while Part B requires a monthly premium that may be higher for higher-income
individuals.
Question 4
Juan Perez, who is turning age 65 next month, intends to work for several more years at
Smallcap, Incorporated. Smallcap has a workforce of 15 employees and offers employer-
sponsored healthcare coverage. Juan is a naturalized citizen and has contributed to the
Medicare system for over 20 years. If Juan enrolls in Medicare, how will that impact his
employer-sponsored coverage?
A) Medicare would become the primary payor of his healthcare claims and Smallcap's
plan would become secondary
B) His employer-sponsored coverage would remain the primary payor and Medicare
would be secondary
C) He is ineligible for Medicare since he was born outside the United States
D) Smallcap must continue to offer him coverage comparable to those under age 65
Correct Answer: A
Rationale: For employers with fewer than 20 employees, Medicare is primary and the
employer plan is secondary. Juan is eligible for Medicare at age 65 based on his work
history and citizenship status.
Question 5
Mrs. Ellis recently turned 66 and decided to retire and begin receiving Social Security
benefits. Shortly thereafter, she received a letter informing her that she had been
, 4
automatically enrolled in Medicare Part B. She wants to understand what this means.
What should you tell Mrs. Ellis?
A) She should disenroll if she does not want to pay the monthly premiums—there is no
disadvantage in doing so
B) She will need to pay no premiums for Part B as she qualifies for premium-free
coverage
C) Part B primarily covers physician services. She will be paying a monthly premium and,
except for many preventive and screening tests, generally will have 20% co-payments
for these services, in addition to an annual deductible
D) Part B will cover her routine dental and vision needs
Correct Answer: C
Rationale: Part B primarily covers physician services, outpatient care, and preventive
services. Beneficiaries pay a monthly premium and generally have 20% coinsurance plus
an annual deductible.
Question 6
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. What are the costs for inpatient
hospital services under Original Medicare?
A) There is no cost for the first 90 days of any inpatient hospital stay
B) 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
C) He would pay 20% of all hospital charges with no deductible
D) He would pay a flat $1,500 per day for all hospital days
Correct Answer: B
Rationale: Under Original Medicare Part A, there is a deductible for the first 60 days of
inpatient hospital care, followed by daily coinsurance for days 61–90, and additional
costs for lifetime reserve days.
