AHIP FINAL EXAM 2026 – UPDATED
QUESTIONS AND 100% CORRECT
ANSWERS GRADED A+
Ms. Moore 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 to address
her concern? Correct Answer Medicare 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.
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 Answer Mrs. 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. 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 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.
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 Answer Beneficiaries under
Original Medicare have no cost-sharing for most preventive
services which include immunizations such as annual flu shots.
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 Answer Medicare
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.
Anthony Boniface turned 65 in 2023. He was not receiving Social
Security or Railroad Retirement Benefits on his 65th birthday. He
was interested in obtaining Medicare coverage and is eligible for
premium-free Part A. Before he could enroll in Medicare, his
entire area was impacted by a hurricane causing massive flooding
and severe wind damage. The Federal government declared this
to be a natural disaster which has recently ended. During this
period Anthony's initial enrollment period expired. Anthony asks
you how he can now obtain Medicare coverage. What should you
,say? Correct Answer Anthony is eligible for a special enrollment
period (SEP) because he missed an enrollment period due to the
impact of the Federally declared disaster. This SEP will allow
Anthony to enroll in Part B up to six months after the end of the
emergency declaration. Anthony may enroll in premium-free Part
A at any time and his Part A coverage will be retroactive for up to
6 months.
Mr. Barker enjoys a comfortable retirement income. He recently
had surgery and expected that he would have certain services
and items covered by the plan with minimal out-of-pocket costs
because his MA-PD coverage has been very good. However,
when he received the bill, he was surprised to see large charges
in excess of his maximum out-of-pocket limit that included some
services and items he thought would be fully covered. He called
you to ask what he could do? What could you tell him? Correct
Answer You can offer to review the plans appeal process to help
him ask the plan to review the coverage decision.
Mr. Romero is 64, retiring soon, and considering enrollment in his
employer-sponsored retiree group health plan that includes drug
coverage with nominal copays. He heard about a neighbor's MA-
PD plan that you represent and because he takes numerous
prescription drugs, he is considering signing up for it. What should
you tell him? Correct Answer He should compare the benefits in
his employer-sponsored retiree group health plan with the
benefits in his neighbor's MA-PD plan to determine which one will
provide sufficient coverage for his prescription needs.
, Daniel is a middle-income Medicare beneficiary. He has chronic
bronchitis, putting him at severe risk for pneumonia. Otherwise,
he has no problems functioning. Which type of SNP is likely to be
most appropriate for him? Correct Answer C-SNP
Mrs. Chi is age 75 and enjoys a comfortable but not extremely
high-income level. She wishes to enroll in a MA MSA plan that
she heard about from her neighbor. She also wants to have
prescription drug coverage since her doctor recently prescribed
several expensive medications. Currently, she is enrolled in
Original Medicare and a standalone Part D plan. How would you
advise Mrs. Chi? Correct Answer Mrs. Chi may enroll in a MA
MSA plan and remain in her current standalone Part D
prescription drug plan.
Mr. Greco is in excellent health, lives in his own home, and has a
sizeable income from his investments. He has a friend enrolled in
a Medicare Advantage Special Needs Plan (SNP). His friend has
mentioned that the SNP charges very low cost-sharing amounts
and Mr. Greco would like to join that plan. What should you tell
him? Correct Answer SNPs limit enrollment to certain
subpopulations of beneficiaries. Given his current situation, he is
unlikely to qualify and would not be able to enroll in the SNP.
Mr. Sinclair has diabetes and heart trouble and is generally
satisfied with the care he has received under Original Medicare,
QUESTIONS AND 100% CORRECT
ANSWERS GRADED A+
Ms. Moore 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 to address
her concern? Correct Answer Medicare 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.
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 Answer Mrs. 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. 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 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.
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 Answer Beneficiaries under
Original Medicare have no cost-sharing for most preventive
services which include immunizations such as annual flu shots.
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 Answer Medicare
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.
Anthony Boniface turned 65 in 2023. He was not receiving Social
Security or Railroad Retirement Benefits on his 65th birthday. He
was interested in obtaining Medicare coverage and is eligible for
premium-free Part A. Before he could enroll in Medicare, his
entire area was impacted by a hurricane causing massive flooding
and severe wind damage. The Federal government declared this
to be a natural disaster which has recently ended. During this
period Anthony's initial enrollment period expired. Anthony asks
you how he can now obtain Medicare coverage. What should you
,say? Correct Answer Anthony is eligible for a special enrollment
period (SEP) because he missed an enrollment period due to the
impact of the Federally declared disaster. This SEP will allow
Anthony to enroll in Part B up to six months after the end of the
emergency declaration. Anthony may enroll in premium-free Part
A at any time and his Part A coverage will be retroactive for up to
6 months.
Mr. Barker enjoys a comfortable retirement income. He recently
had surgery and expected that he would have certain services
and items covered by the plan with minimal out-of-pocket costs
because his MA-PD coverage has been very good. However,
when he received the bill, he was surprised to see large charges
in excess of his maximum out-of-pocket limit that included some
services and items he thought would be fully covered. He called
you to ask what he could do? What could you tell him? Correct
Answer You can offer to review the plans appeal process to help
him ask the plan to review the coverage decision.
Mr. Romero is 64, retiring soon, and considering enrollment in his
employer-sponsored retiree group health plan that includes drug
coverage with nominal copays. He heard about a neighbor's MA-
PD plan that you represent and because he takes numerous
prescription drugs, he is considering signing up for it. What should
you tell him? Correct Answer He should compare the benefits in
his employer-sponsored retiree group health plan with the
benefits in his neighbor's MA-PD plan to determine which one will
provide sufficient coverage for his prescription needs.
, Daniel is a middle-income Medicare beneficiary. He has chronic
bronchitis, putting him at severe risk for pneumonia. Otherwise,
he has no problems functioning. Which type of SNP is likely to be
most appropriate for him? Correct Answer C-SNP
Mrs. Chi is age 75 and enjoys a comfortable but not extremely
high-income level. She wishes to enroll in a MA MSA plan that
she heard about from her neighbor. She also wants to have
prescription drug coverage since her doctor recently prescribed
several expensive medications. Currently, she is enrolled in
Original Medicare and a standalone Part D plan. How would you
advise Mrs. Chi? Correct Answer Mrs. Chi may enroll in a MA
MSA plan and remain in her current standalone Part D
prescription drug plan.
Mr. Greco is in excellent health, lives in his own home, and has a
sizeable income from his investments. He has a friend enrolled in
a Medicare Advantage Special Needs Plan (SNP). His friend has
mentioned that the SNP charges very low cost-sharing amounts
and Mr. Greco would like to join that plan. What should you tell
him? Correct Answer SNPs limit enrollment to certain
subpopulations of beneficiaries. Given his current situation, he is
unlikely to qualify and would not be able to enroll in the SNP.
Mr. Sinclair has diabetes and heart trouble and is generally
satisfied with the care he has received under Original Medicare,
