2026 AHIP Final Exam Complete
Questions With Verified Answers
\.Mr. Wu is eligible for Medicare. He has limited financial resources but failed to qualify for the
Part D low-income subsidy. Where might he turn for help with his prescription drug costs? -
Answer- Mr. Wu may still qualify for help in paying Part D costs through his State
Pharmaceutical Assistance Program.
\.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. He is wondering whether
he can obtain coverage under Medicare. What should you tell him? - Answer- After receiving
such disability payments for 24 months, he will be automatically enrolled in Medicare,
regardless of age.
\.Mildred Savage enrolled in Allcare Medicare Advantage plan several years ago. Mildred
recently learned that she is suffering from inoperable cancer and has just a few months to live.
She would like to spend these final months in hospice care. Mildred's family asks you whether
hospice benefits will be paid for under the Allcare Medicare Advantage plan. What should you
say? - Answer- Mildred may remain enrolled in Allcare and make a hospice election. Hospice
benefits will be paid for by Original Medicare under Part A and Allcare will continue to pay for
any non-hospice services.
\.Mr. Schmidt would like to plan for retirement and has asked you what is covered under
Original Fee-for-Service (FFS) Medicare. What could you tell him? - Answer- Part A, which
covers hospital, skilled nursing facility, hospice, and home health services and Part B, which
covers professional services such as those provided by a doctor are covered under Original
Medicare.
,\.Agent John Miller is meeting with Jerry Smith, a new prospect. Jerry is currently enrolled in
Medicare Parts A and B. Jerry has also purchased a Medicare Supplement (Medigap) plan which
he has had for several years. However, the plan does not provide drug benefits. How would you
advise Agent John Miller to proceed? - Answer- Tell prospect Jerry Smith that he should
consider adding a standalone Part D prescription drug coverage policy to his present coverage.
\.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.
\.Mr. Diaz continued working with his company and was insured under his employer's group
plan until he reached age 68. He has heard that there is a premium penalty for those who did
not sign up for Part B when first eligible and wants to know how much he will have to pay. What
should you tell him? - Answer- Mr. Diaz will not pay any penalty because he had continuous
coverage under his employer's plan.
\.Madeline Martinez was widowed several years ago. Her husband worked for many years and
contributed into the Medicare system. He also left a substantial estate which provides Madeline
with an annual income of approximately $130,000. Madeline, who has only worked part-time
for the last three years, will soon turn age 65 and hopes to enroll in Original Medicare. She
comes to you for advice. What should you tell her? - Answer- You should tell Madeline that
she will be able to enroll in Medicare Part A without paying monthly premiums due to her
husband's long work record and participation in the Medicare system. You should also tell
Madeline that she will pay Part B premiums at more than the standard lowest rate but less than
the highest rate due her substantial income.
\.Edward IP suffered from serious kidney disease. As a result. Edward became eligible for
Medicare coverage due to end-stage renal disease (ESRD). A close relative donated their kidney
and Edward successfully underwent transplant surgery 12 months ago. Edward is now age 50
and asks you if his Medicare coverage will continue, what should you say? - Answer-
Individuals eligible for Medicare based on ESRD generally lose eligibility 36 months after the
month in which the individual receives a kidney transplant unless they are eligible for Medicare
on another basis such as age or disability. Edward may, however, remain enrolled in Part B but
, solely for coverage of immunosuppressive drugs if he has no other health care coverage that
would cover the drugs.
\.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? - Answer- She 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.
\.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? - Answer- 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.
\.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? - Answer- To obtain Part B coverage, she must pay a
standard monthly premium, though it is higher for individuals with higher incomes.
\.Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What could you tell Mrs. Park
that might be of assistance? - Answer- She should contact her state Medicaid agency to see if
she qualifies for one of several programs that can help with Medicare costs for which she is
responsible.
\.Shirly Thomas was enrolled in Medicaid during the Public Health Emergency (PHE). This
coverage has recently been terminated due to the end of the PHE. While Shirley was enrolled in
Medicaid, she missed an opportunity to enroll in Medicare and now wants Part B. Which of the
following statements best describes Shirley's ability to now enroll in Medicare Part B? - Answer-
Shirley is eligible for a Special Enrollment Period (SEP) for up to six months after the
termination of her Medicaid coverage. Under this SEP, Shirley can choose retroactive coverage
back to the date of termination from Medicaid or coverage beginning the month after the
month of enrollment.
Questions With Verified Answers
\.Mr. Wu is eligible for Medicare. He has limited financial resources but failed to qualify for the
Part D low-income subsidy. Where might he turn for help with his prescription drug costs? -
Answer- Mr. Wu may still qualify for help in paying Part D costs through his State
Pharmaceutical Assistance Program.
\.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. He is wondering whether
he can obtain coverage under Medicare. What should you tell him? - Answer- After receiving
such disability payments for 24 months, he will be automatically enrolled in Medicare,
regardless of age.
\.Mildred Savage enrolled in Allcare Medicare Advantage plan several years ago. Mildred
recently learned that she is suffering from inoperable cancer and has just a few months to live.
She would like to spend these final months in hospice care. Mildred's family asks you whether
hospice benefits will be paid for under the Allcare Medicare Advantage plan. What should you
say? - Answer- Mildred may remain enrolled in Allcare and make a hospice election. Hospice
benefits will be paid for by Original Medicare under Part A and Allcare will continue to pay for
any non-hospice services.
\.Mr. Schmidt would like to plan for retirement and has asked you what is covered under
Original Fee-for-Service (FFS) Medicare. What could you tell him? - Answer- Part A, which
covers hospital, skilled nursing facility, hospice, and home health services and Part B, which
covers professional services such as those provided by a doctor are covered under Original
Medicare.
,\.Agent John Miller is meeting with Jerry Smith, a new prospect. Jerry is currently enrolled in
Medicare Parts A and B. Jerry has also purchased a Medicare Supplement (Medigap) plan which
he has had for several years. However, the plan does not provide drug benefits. How would you
advise Agent John Miller to proceed? - Answer- Tell prospect Jerry Smith that he should
consider adding a standalone Part D prescription drug coverage policy to his present coverage.
\.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.
\.Mr. Diaz continued working with his company and was insured under his employer's group
plan until he reached age 68. He has heard that there is a premium penalty for those who did
not sign up for Part B when first eligible and wants to know how much he will have to pay. What
should you tell him? - Answer- Mr. Diaz will not pay any penalty because he had continuous
coverage under his employer's plan.
\.Madeline Martinez was widowed several years ago. Her husband worked for many years and
contributed into the Medicare system. He also left a substantial estate which provides Madeline
with an annual income of approximately $130,000. Madeline, who has only worked part-time
for the last three years, will soon turn age 65 and hopes to enroll in Original Medicare. She
comes to you for advice. What should you tell her? - Answer- You should tell Madeline that
she will be able to enroll in Medicare Part A without paying monthly premiums due to her
husband's long work record and participation in the Medicare system. You should also tell
Madeline that she will pay Part B premiums at more than the standard lowest rate but less than
the highest rate due her substantial income.
\.Edward IP suffered from serious kidney disease. As a result. Edward became eligible for
Medicare coverage due to end-stage renal disease (ESRD). A close relative donated their kidney
and Edward successfully underwent transplant surgery 12 months ago. Edward is now age 50
and asks you if his Medicare coverage will continue, what should you say? - Answer-
Individuals eligible for Medicare based on ESRD generally lose eligibility 36 months after the
month in which the individual receives a kidney transplant unless they are eligible for Medicare
on another basis such as age or disability. Edward may, however, remain enrolled in Part B but
, solely for coverage of immunosuppressive drugs if he has no other health care coverage that
would cover the drugs.
\.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? - Answer- She 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.
\.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? - Answer- 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.
\.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? - Answer- To obtain Part B coverage, she must pay a
standard monthly premium, though it is higher for individuals with higher incomes.
\.Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What could you tell Mrs. Park
that might be of assistance? - Answer- She should contact her state Medicaid agency to see if
she qualifies for one of several programs that can help with Medicare costs for which she is
responsible.
\.Shirly Thomas was enrolled in Medicaid during the Public Health Emergency (PHE). This
coverage has recently been terminated due to the end of the PHE. While Shirley was enrolled in
Medicaid, she missed an opportunity to enroll in Medicare and now wants Part B. Which of the
following statements best describes Shirley's ability to now enroll in Medicare Part B? - Answer-
Shirley is eligible for a Special Enrollment Period (SEP) for up to six months after the
termination of her Medicaid coverage. Under this SEP, Shirley can choose retroactive coverage
back to the date of termination from Medicaid or coverage beginning the month after the
month of enrollment.
