[STUDY GUIDE] • HIGH-YIELD PRACTICE & REVIEW EDITION
AHIP Final Exam 2026/2027 Updated
Final Exam Questions with Verified
Answers
Comprehensive Examination Question Bank • Concept Mapping
TOTAL QUESTIONS EXAM TOPICS ANSWERS
105 Questions 12 Modules 100% Verified
DOCUMENT OVERVIEW
This document contains 105 verified questions with correct answers focused on Medicare Advantage,
prescription drug plans, and related enrollment periods. Each question is designed to enhance understanding
of Medicare policies and coverage, making it suitable for exam preparation and professional certification in
health insurance.
EXAM BLUEPRINT & TOPIC DISTRIBUTION
Systematic breakdown of subject domains and exam coverage.
Topic Module Scope & Core Focus Questions Share (%)
Fundamental concepts of Medicare including Parts A and B
Medicare Basics coverage. 9 Qs 8.6%
Coverage options and eligibility criteria for Medicare
Medicare Advantage Plans Advantage plans. 9 Qs 8.6%
Details regarding Medicare Part D and prescription drug
Prescription Drug Coverage plans. 9 Qs 8.6%
Enrollment timelines and special election periods for Medicare
Enrollment Periods beneficiaries. 9 Qs 8.6%
Processes for filing appeals and grievances related to
Appeals and Grievances Medicare coverage. 9 Qs 8.6%
Understanding Medicare Savings Account (MSA) plans and
Medicare Savings Accounts their benefits. 9 Qs 8.6%
Confidential • Student Study Edition • Practice & Review Guide Page 1 of 33
,STUDENT STUDY & MASTERY EDITION PRACTICE & REVIEW GUIDE
Interactions between Medicare and Medicaid for dual-eligible
Dual Eligibility and Medicaid beneficiaries. 9 Qs 8.6%
Medigap and Supplemental Understanding Medigap plans and their relationship to
Insurance Original Medicare. 9 Qs 8.6%
Provider Participation and Provider agreements and payment structures in Medicare
Payments plans. 9 Qs 8.6%
Guidelines for marketing Medicare plans and ensuring
Marketing and Compliance compliance. 8 Qs 7.6%
Eligibility and benefits associated with Special Needs Plans
Special Needs Plans (SNPs). 8 Qs 7.6%
Cost Plans and Coverage
Options Exploring Medicare Cost plans and variations in coverage. 8 Qs 7.6%
Total Exam Coverage 12 Integrated Topic Modules 105 Qs 100.0%
TOPIC 1: MEDICARE BASICS
9 Questions • 8.6% of Exam • Fundamental concepts of Medicare including Parts A and B coverage.
QUESTION 1
Mrs. Shields is covered by Original Medicare. She sustained a hip fracture and is being
successfully treated for that condition. However, she and her physicians feel that after
her lengthy hospital stay, she will need a month or two of nursing and rehabilitative
care. What should you tell them about Original Medicare's coverage of care in a skilled
nursing facility?
Answer: Medicare will cover Mrs. Shield's skilled nursing services provided during the first 20 days of her
stay, after which she would have a copay until she has been in the facility for 100 days.
QUESTION 2
Mrs. West wears glasses and dentures and has enjoyed considerable pain relief from
arthritis through massage therapy. She is concerned about whether or not Medicare
will cover these items and services. What should you tell her?
Answer: Medicare does not cover massage therapy, or, in general, glasses or dentures.
Confidential • Student Study Edition • Practice & Review Guide Page 2 of 33
,STUDENT STUDY & MASTERY EDITION PRACTICE & REVIEW GUIDE
QUESTION 3
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?
Answer: He may sign-up for Medicare at any time however coverage usually begins on the fourth month after
dialysis treatments start.
QUESTION 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 Mr. Xi that best describes the
health coverage provided to Medicare beneficiaries?
Answer: Beneficiaries under Original Medicare have no cost-sharing for most preventive services.
QUESTION 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?
Answer: Most individuals who are citizens and age 65 or over 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.
QUESTION 6
Mr. Patel 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?
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.
Confidential • Student Study Edition • Practice & Review Guide Page 3 of 33
, STUDENT STUDY & MASTERY EDITION PRACTICE & REVIEW GUIDE
QUESTION 7
Mr. Sanchez has just turned 65 and is entitled to Part A but has not enrolled in Part B
because he has coverage through an employer plan. If he wants to enroll in a Medicare
Advantage plan, what will he have to do?
Answer: He will have to enroll in Part B.
QUESTION 8
Mrs. Radford asks whether there are any special eligibility requirements for Medicare
Advantage. What should you tell her?
Answer: Mrs. Radford must be entitled to Part A and enrolled in Part B to enroll in Medicare Advantage.
QUESTION 9
Mrs. Kelly, age 65, is entitled to Part A but has not yet enrolled in Part B. She is
considering enrollment in a Medicare Advantage plan (Part C). What should you advise
her to do before she can enroll in a Medicare Advantage plan?
Answer: To join a Medicare Advantage plan, she also must enroll in Part B.
TOPIC 2: MEDICARE ADVANTAGE PLANS
9 Questions • 8.6% of Exam • Coverage options and eligibility criteria for Medicare Advantage plans.
QUESTION 10
Mr. Singh would like drug coverage but does not want to be enrolled in a Medicare
Advantage
plan. What should you tell him?
Answer: Mr. Singh can enroll in a stand-alone prescription drug plan and continue to be covered for Part A
and Part B services through Original Fee-for-Service Medicare.
Confidential • Student Study Edition • Practice & Review Guide Page 4 of 33
AHIP Final Exam 2026/2027 Updated
Final Exam Questions with Verified
Answers
Comprehensive Examination Question Bank • Concept Mapping
TOTAL QUESTIONS EXAM TOPICS ANSWERS
105 Questions 12 Modules 100% Verified
DOCUMENT OVERVIEW
This document contains 105 verified questions with correct answers focused on Medicare Advantage,
prescription drug plans, and related enrollment periods. Each question is designed to enhance understanding
of Medicare policies and coverage, making it suitable for exam preparation and professional certification in
health insurance.
EXAM BLUEPRINT & TOPIC DISTRIBUTION
Systematic breakdown of subject domains and exam coverage.
Topic Module Scope & Core Focus Questions Share (%)
Fundamental concepts of Medicare including Parts A and B
Medicare Basics coverage. 9 Qs 8.6%
Coverage options and eligibility criteria for Medicare
Medicare Advantage Plans Advantage plans. 9 Qs 8.6%
Details regarding Medicare Part D and prescription drug
Prescription Drug Coverage plans. 9 Qs 8.6%
Enrollment timelines and special election periods for Medicare
Enrollment Periods beneficiaries. 9 Qs 8.6%
Processes for filing appeals and grievances related to
Appeals and Grievances Medicare coverage. 9 Qs 8.6%
Understanding Medicare Savings Account (MSA) plans and
Medicare Savings Accounts their benefits. 9 Qs 8.6%
Confidential • Student Study Edition • Practice & Review Guide Page 1 of 33
,STUDENT STUDY & MASTERY EDITION PRACTICE & REVIEW GUIDE
Interactions between Medicare and Medicaid for dual-eligible
Dual Eligibility and Medicaid beneficiaries. 9 Qs 8.6%
Medigap and Supplemental Understanding Medigap plans and their relationship to
Insurance Original Medicare. 9 Qs 8.6%
Provider Participation and Provider agreements and payment structures in Medicare
Payments plans. 9 Qs 8.6%
Guidelines for marketing Medicare plans and ensuring
Marketing and Compliance compliance. 8 Qs 7.6%
Eligibility and benefits associated with Special Needs Plans
Special Needs Plans (SNPs). 8 Qs 7.6%
Cost Plans and Coverage
Options Exploring Medicare Cost plans and variations in coverage. 8 Qs 7.6%
Total Exam Coverage 12 Integrated Topic Modules 105 Qs 100.0%
TOPIC 1: MEDICARE BASICS
9 Questions • 8.6% of Exam • Fundamental concepts of Medicare including Parts A and B coverage.
QUESTION 1
Mrs. Shields is covered by Original Medicare. She sustained a hip fracture and is being
successfully treated for that condition. However, she and her physicians feel that after
her lengthy hospital stay, she will need a month or two of nursing and rehabilitative
care. What should you tell them about Original Medicare's coverage of care in a skilled
nursing facility?
Answer: Medicare will cover Mrs. Shield's skilled nursing services provided during the first 20 days of her
stay, after which she would have a copay until she has been in the facility for 100 days.
QUESTION 2
Mrs. West wears glasses and dentures and has enjoyed considerable pain relief from
arthritis through massage therapy. She is concerned about whether or not Medicare
will cover these items and services. What should you tell her?
Answer: Medicare does not cover massage therapy, or, in general, glasses or dentures.
Confidential • Student Study Edition • Practice & Review Guide Page 2 of 33
,STUDENT STUDY & MASTERY EDITION PRACTICE & REVIEW GUIDE
QUESTION 3
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?
Answer: He may sign-up for Medicare at any time however coverage usually begins on the fourth month after
dialysis treatments start.
QUESTION 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 Mr. Xi that best describes the
health coverage provided to Medicare beneficiaries?
Answer: Beneficiaries under Original Medicare have no cost-sharing for most preventive services.
QUESTION 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?
Answer: Most individuals who are citizens and age 65 or over 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.
QUESTION 6
Mr. Patel 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?
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.
Confidential • Student Study Edition • Practice & Review Guide Page 3 of 33
, STUDENT STUDY & MASTERY EDITION PRACTICE & REVIEW GUIDE
QUESTION 7
Mr. Sanchez has just turned 65 and is entitled to Part A but has not enrolled in Part B
because he has coverage through an employer plan. If he wants to enroll in a Medicare
Advantage plan, what will he have to do?
Answer: He will have to enroll in Part B.
QUESTION 8
Mrs. Radford asks whether there are any special eligibility requirements for Medicare
Advantage. What should you tell her?
Answer: Mrs. Radford must be entitled to Part A and enrolled in Part B to enroll in Medicare Advantage.
QUESTION 9
Mrs. Kelly, age 65, is entitled to Part A but has not yet enrolled in Part B. She is
considering enrollment in a Medicare Advantage plan (Part C). What should you advise
her to do before she can enroll in a Medicare Advantage plan?
Answer: To join a Medicare Advantage plan, she also must enroll in Part B.
TOPIC 2: MEDICARE ADVANTAGE PLANS
9 Questions • 8.6% of Exam • Coverage options and eligibility criteria for Medicare Advantage plans.
QUESTION 10
Mr. Singh would like drug coverage but does not want to be enrolled in a Medicare
Advantage
plan. What should you tell him?
Answer: Mr. Singh can enroll in a stand-alone prescription drug plan and continue to be covered for Part A
and Part B services through Original Fee-for-Service Medicare.
Confidential • Student Study Edition • Practice & Review Guide Page 4 of 33
