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AHIP Final Exam 2025/2026 | Complete Test Questions and Verified Answers | Medicare Basics & Compliance Study Guide

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This comprehensive AHIP Final Exam resource includes fully verified questions and answers covering all five core modules: Medicare Basics, Marketing Rules, Enrollment and Eligibility, Part D, and Fraud, Waste & Abuse (FWA). Updated for 2025/2026 prep, this pack is ideal for professionals aiming to meet AHIP certification standards with accuracy and efficiency. Each section is aligned with current Medicare guidelines and compliance requirements, helping you review faster, understand better, and pass with confidence. Whether you're a first-time test taker or renewing your certification, this guide offers the clarity and accuracy you need.

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1


AHIP Final Exam Test Questions and Answers
(2022/2023) Rated A+ Answers Correct/Verified

Mr., Moy’s, wife ,has ,a ,Medicare ,Advantage ,plan, ,but ,he ,wants ,to
,understand ,what coverage ,Medicare ,Supplemental ,Insurance ,provides ,since
,his ,health ,care ,needs ,are,different ,from ,his ,wife's ,needs. ,What ,could ,you
,tell ,Mr. ,Moy?correct ,answersMedicare,Supplemental ,Insurance ,would ,help
,cover ,his ,Part ,A ,and ,Part ,B ,deductibles ,or coinsurance ,in ,Original ,Fee-for-
Service ,(FFS) ,Medicare ,as ,well ,as ,possibly ,some services ,that ,Medicare

,does ,not ,cover.


Mrs. ,Peňa ,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
,answersShe ,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.


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?correct
,answersMost ,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.



pg. 1

, 2


Mrs. ,Gonzalez ,is ,enrolled ,in ,Original ,Medicare ,and ,has ,a ,Medigap ,policy
,as ,well, ,but ,it provides ,no ,drug ,coverage. ,She ,would ,like ,to ,keep ,the
,coverage ,she ,has ,but ,replace her ,existing ,Medigap ,plan ,with ,one ,that
,provides ,drug ,coverage. ,What ,should ,you ,tell ,her?correct ,answersMrs.
,Gonzalez ,cannot ,purchase ,a ,Medigap ,plan ,that ,covers ,drugs,,but ,she ,could
,keep ,her ,Medigap ,policy ,and ,enroll ,in ,a ,Part ,D ,prescription ,drug ,plan.


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?correct ,answersMedicare does ,not ,cover ,massage ,therapy, ,or,
,in ,general, ,glasses ,or ,dentures.


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
,as ,a ,result ,of ,an ,illness. ,In ,general terms, ,what ,could ,you ,tell ,him ,about
,his ,costs ,for ,inpatient ,hospital ,services
under ,Original ,Medicare?correct ,answersUnder ,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.


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
,answersTo ,obtain ,Part ,B ,coverage, she ,must ,pay ,a ,standard ,monthly
,premium, ,though ,it ,is ,higher ,for ,individuals ,with ,higher,incomes.
pg. 2

, 3




Mr. ,Alonso ,receives ,some ,help ,paying ,for ,his ,two ,generic ,prescription
,drugs ,from ,his employer's ,retiree ,coverage, ,but ,he ,wants ,to ,compare ,it ,to
,a ,Part ,D ,prescription ,drug plan. ,He ,asks ,you ,what ,costs ,he ,would
,generally ,expect ,to ,encounter ,when ,enrolling into ,a ,standard ,MedicarePart
,D ,prescription ,drug ,plan. ,What ,should ,you ,tell ,him?correct,answers ,He
,generally ,would ,pay ,a ,monthly ,premium, ,annual ,deductible, ,and ,per-
prescription ,cost-sharing.

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?correct
,answersHe ,may ,sign-up ,for ,Medicare ,at any ,time ,however ,coverage
,usually ,begins ,on ,the ,fourth ,month ,after ,dialysis ,treatments start.


Juan ,Perez, ,who ,is ,turning ,age ,65 ,next ,month, ,intends ,to ,work ,for ,several
,more ,years ,at,Smallcap, ,Incorporated. ,Smallcap ,has ,a ,workforce ,of15
,employees ,and ,offers
employer-sponsored ,healthcare ,coverage. ,Juan ,is ,a ,naturalized ,citizen ,and
,has contributed ,to ,the ,Medicare ,system ,for ,over ,20 ,years. ,Juan ,asks ,you
,if ,he ,will ,be entitled ,to ,Medicare ,and ,if ,he ,enrolls ,how ,that ,will ,impact
,his ,employer-sponsored healthcare ,coverage. ,How ,would ,you
,respond?correct ,answersJuan ,is ,likely ,to ,be eligible ,for ,Medicare ,once ,he
,turns ,age ,65 ,and ,if ,he ,enrolls ,Medicare ,would ,become ,the,primary ,payor
,of ,his ,healthcare ,claims ,and ,Smallcap ,does ,not ,have ,to ,continue ,to ,offer
him ,coverage ,comparable ,to ,those ,under ,age ,65 ,under ,its ,employer-
sponsored ,group ,health ,plan.


Ms. ,Moore ,plans ,to ,retire ,when ,she ,turns ,65 ,in ,a ,few ,months. ,She ,is ,in
pg. 3

, 4


,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?correct
,answersMedicare ,is ,a ,program ,for ,people ,age ,65 ,or ,older ,and those ,under
,age ,65 ,with ,certain ,disabilities, ,end-stage ,renal ,disease, ,and ,Lou ,Gehrig's
disease ,so ,she ,will ,be ,eligible ,for ,Medicare.


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?correct ,answersBeneficiaries ,under,Original ,Medicare ,have ,no
,cost-sharing ,for ,most ,preventive ,services ,which ,include immunizations ,such
,as ,annual ,flu ,shots.




pg. 4

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