AHIP Final Exam 2026: {2 VERSIONS} 100 Actual
Questions with Verified Answers & Detailed
Rationales (CMS Medicare Training) Instant
Download Pdf
Exam Overview:
The AHIP (America’s Health Insurance Plans) certification exam is required annually for
insurance agents to sell Medicare Advantage and Prescription Drug Plans . The exam
covers Medicare Basics, Marketing Rules, Enrollment and Eligibility, Medicare Advantage
(Part C), Part D Prescription Drug Coverage, and Fraud, Waste & Abuse (FWA) . The final
exam consists of 50 questions with a 2-hour time limit and a 90% passing score . While
the actual exam has 50 questions, this expanded guide provides 100 practice
questions covering all key topics to ensure thorough preparation .
EXAM FORMAT & REQUIREMENTS
Feature Detail
Questions 2 Versions Each 50 questions
Time Limit 2 hours
Passing Score 90%
Attempts Allowed 3 attempts
Cost (2026) $175
Format Open-book (if not seeking CE credits)
SECTION 1: MEDICARE BASICS (Questions 1-25)
,Q1. 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 .
Rationale: Individuals with ESRD become eligible for Medicare coverage regardless of age.
Coverage typically begins in the fourth month of dialysis treatments.
Q2. 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 .
Rationale: Medicare Part A eligibility is based on work history and tax contributions, not
place of birth. U.S. citizenship or permanent residency for at least 5 continuous years is
required.
Q3. 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 .
,Rationale: While Part A is premium-free for most individuals with sufficient work history,
Part B requires a monthly premium. Higher-income beneficiaries pay higher premiums
(IRMAA).
Q4. 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?
Answer: Medicare is a program for people age 65 or older and those under age 65 with
certain disabilities, end-stage renal disease, and ALS, so she will be eligible for Medicare .
Rationale: Medicare eligibility is based on age and certain medical conditions, not income.
While higher income may impact premium amounts (IRMAA), it does not prevent eligibility.
Q5. 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, which include immunizations such as annual flu shots .
Rationale: Original Medicare covers a range of preventive services with no cost-sharing,
including annual wellness visits and immunizations.
Q6. 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 covers hospital, skilled nursing facility, hospice, and home health services;
Part B covers professional services such as those provided by a doctor .
Rationale: Original Medicare consists of Part A (inpatient, SNF, hospice, home health) and
Part B (physician, outpatient, preventive care) .
Q7. 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?
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 .
Rationale: Part A requires a deductible for each benefit period. Days 1-60: deductible only;
days 61-90: daily coinsurance; days 91+ up to 60 lifetime reserve days: higher coinsurance;
after that, all costs are out-of-pocket .
Q8. A 66-year-old retiree recently began receiving Social Security benefits. She has
health coverage through her former employer's retiree plan. Which statement about
her Medicare eligibility is correct?
Answer: She is entitled to Medicare Part A and can enroll in Part B during her initial
enrollment period .
Questions with Verified Answers & Detailed
Rationales (CMS Medicare Training) Instant
Download Pdf
Exam Overview:
The AHIP (America’s Health Insurance Plans) certification exam is required annually for
insurance agents to sell Medicare Advantage and Prescription Drug Plans . The exam
covers Medicare Basics, Marketing Rules, Enrollment and Eligibility, Medicare Advantage
(Part C), Part D Prescription Drug Coverage, and Fraud, Waste & Abuse (FWA) . The final
exam consists of 50 questions with a 2-hour time limit and a 90% passing score . While
the actual exam has 50 questions, this expanded guide provides 100 practice
questions covering all key topics to ensure thorough preparation .
EXAM FORMAT & REQUIREMENTS
Feature Detail
Questions 2 Versions Each 50 questions
Time Limit 2 hours
Passing Score 90%
Attempts Allowed 3 attempts
Cost (2026) $175
Format Open-book (if not seeking CE credits)
SECTION 1: MEDICARE BASICS (Questions 1-25)
,Q1. 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 .
Rationale: Individuals with ESRD become eligible for Medicare coverage regardless of age.
Coverage typically begins in the fourth month of dialysis treatments.
Q2. 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 .
Rationale: Medicare Part A eligibility is based on work history and tax contributions, not
place of birth. U.S. citizenship or permanent residency for at least 5 continuous years is
required.
Q3. 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 .
,Rationale: While Part A is premium-free for most individuals with sufficient work history,
Part B requires a monthly premium. Higher-income beneficiaries pay higher premiums
(IRMAA).
Q4. 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?
Answer: Medicare is a program for people age 65 or older and those under age 65 with
certain disabilities, end-stage renal disease, and ALS, so she will be eligible for Medicare .
Rationale: Medicare eligibility is based on age and certain medical conditions, not income.
While higher income may impact premium amounts (IRMAA), it does not prevent eligibility.
Q5. 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, which include immunizations such as annual flu shots .
Rationale: Original Medicare covers a range of preventive services with no cost-sharing,
including annual wellness visits and immunizations.
Q6. 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 covers hospital, skilled nursing facility, hospice, and home health services;
Part B covers professional services such as those provided by a doctor .
Rationale: Original Medicare consists of Part A (inpatient, SNF, hospice, home health) and
Part B (physician, outpatient, preventive care) .
Q7. 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?
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 .
Rationale: Part A requires a deductible for each benefit period. Days 1-60: deductible only;
days 61-90: daily coinsurance; days 91+ up to 60 lifetime reserve days: higher coinsurance;
after that, all costs are out-of-pocket .
Q8. A 66-year-old retiree recently began receiving Social Security benefits. She has
health coverage through her former employer's retiree plan. Which statement about
her Medicare eligibility is correct?
Answer: She is entitled to Medicare Part A and can enroll in Part B during her initial
enrollment period .
