AHIP Medicare Final Exam Questions and Verified Answers with Rationale Latest Edition 2026/2027

AHIP Medicare Final Exam Questions and
Verified Answers with Rationale Latest
Edition 2026/2027

Section 1: Medicare Eligibility and General Coverage

Question 1

Mr. Davis is 52 years old and has recently been diagnosed with end-
stage renal disease (ESRD) and will soon begin dialysis. He is
wondering if he can obtain coverage under Medicare. What should you
tell him?

 A) He must wait until he turns 65 to apply for Medicare.
 B) He may sign up for Medicare at any time, however, coverage
usually begins on the fourth month after dialysis treatments start.
 C) He is permanently ineligible for Medicare because he is under
age 65.
 D) He will be automatically enrolled in Part A and Part B
immediately on day one of his diagnosis.

Correct Answer: B

Rationale: Individuals under age 65 who have end-stage renal disease
(ESRD) requiring dialysis or a kidney transplant are generally eligible
for Medicare. However, entitlement and coverage typically start on the
first day of the fourth month after dialysis treatments begin, unless they
participate in a home training program.

Question 2

Mr. Schmidt asks what is covered under Original Fee-for-Service (FFS)
Medicare. What could you tell him?

,  A) Part A covers professional doctor services while Part B covers
inpatient hospital care.
 B) Part A covers hospital, skilled nursing facility, hospice, and
home health services, and Part B covers professional services such
as those provided by a doctor.
 C) Original Medicare covers all prescription drugs automatically
without a standalone plan.
 D) Original Medicare covers routine dental, vision, and hearing
care nationwide.

Correct Answer: B

Rationale: Original Medicare is split into two primary parts: Part A
(Hospital Insurance) which handles inpatient stays, skilled nursing
facilities, hospice, and home health; and Part B (Medical Insurance)
which handles physician services, outpatient care, medical supplies, and
preventive services.

Question 3

Mr. Bauer is 49 years old and was declared disabled by Social Security
18 months ago. He wonders whether he can obtain Medicare coverage.
What should you tell him?

 A) He must wait until he reaches age 65 regardless of his disability
status.
 B) He is already eligible for Medicare since disability immediately
triggers open enrollment.
 C) After receiving Social Security disability payments for 24
months, he will be automatically enrolled in Medicare, regardless
of age.
 D) He must re-apply through a private insurance provider to get
standard Medicare benefits.

Correct Answer: C

,Rationale: Non-elderly individuals who qualify for Social Security
disability benefits must generally complete a 24-month waiting period.
Upon reaching the 25th month of disability benefit receipt, they are
automatically enrolled in Medicare Parts A and B.

Section 2: Medicare Advantage (MA) and Plan Types

Question 4

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?

 A) You can sell him a Medigap plan to help supplement his
Medicare Advantage out-of-pocket expenses.
 B) 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.
 C) Medigap plans are specifically structured to wrap around and
coordinate directly with Medicare Advantage networks.
 D) He can hold both simultaneously as long as he pays both
monthly premiums directly to the carrier.

Correct Answer: B

Rationale: Medicare Supplement Insurance (Medigap) policies are
designed exclusively to fill gaps in Original Fee-for-Service Medicare. It
is illegal for an agent to knowingly sell a Medigap policy to someone
enrolled in a Medicare Advantage plan.

Question 5

Mr. Wells is trying to understand the difference between Original
Medicare and Medicare Advantage. What would be a correct
description?

,  A) Medicare Advantage is a government-run supplement that
replaces Part A and Part B entirely.
 B) Medicare Advantage is a way of covering all the Original
Medicare benefits through private health insurance companies.
 C) Medicare Advantage plans are only available to individuals
who do not qualify for Social Security.
 D) Medicare Advantage provides identical provider networks and
copayments nationwide with zero variation.

Correct Answer: B

Rationale: Medicare Advantage (Part C) plans are offered by private
companies approved by Medicare. These private plans must provide all
Part A and Part B coverage mandated by Original Medicare, though they
often include extra benefits like vision, dental, or prescription drug
coverage.

Question 6

Mrs. Ramos is considering a Medicare Advantage PPO and has
questions about which providers she can go to for her health care. What
should you tell her?

 A) She must receive all care strictly from primary care physicians
inside the designated narrow network.
 B) She can obtain care from any provider who participates in
Original Medicare, but generally will have a higher cost-sharing
amount if she sees a provider who is not a part of the PPO
network.
 C) She is restricted exclusively to network hospitals and faces total
denial of coverage for out-of-network emergency visits.
 D) She cannot see specialists unless she gets a formal written
referral from her primary physician beforehand.

Correct Answer: B