AHIP FINAL EXAM QUESTIONS
2026/2027 WITH VERIFIED ANSWERS
Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What could you tell Mrs. Park that mig
ht be of assistance? - correct answer-
She should contact her state Medicaid agency to see if she qualifies forprograms that can help with Med
icare costs for which she is responsible.
Madeline Martinez was widowed several years ago. Her husband worked for many years and contribute
d into the Medicare system. He also left a substantial estate which provides Madeline with an annual inc
ome 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 t
o you for advice. What should you tell her? - correct answer-
You should tell Madeline that she will be able to enroll in Medicare Part ABwithout paying monthly prem
iums due to her husband's long work record and participation in the Medicare system. You should also t
ell 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.
Mr. Bauer is 49 years old, but eighteen months ago he was declared disabled by the Social Security Adm
inistration and has been receiving disability payments. He is wondering whether he can obtain coverage
under Medicare. What should you tell him - correct answer-
After receivingBsuch disability payments for 24 months, he will be automatically enrolled in Medicare, re
gardlessBof age.
Mr. Schmidt would like to plan for retirement and has asked you what isBcovered under Original Fee-for-
Service (FFS) Medicare? What could you tell him? - correct answer-
Part A, which covers hospital, skilled nursingBfacility, hospice and home health services and Part B, whic
h covers professional services such as those provided by a doctor are covered under Original Medicare.
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 answer-
She may enroll at any time while she is covered under her employer plan, but she will have a special eig
ht month enrollment period that differs from the standard general enrollment period, during which she
may enroll in Medicare Part B.
Agent John Miller is meeting with Jerry Smith, a new prospect. Jerry is currently enrolled in Medicare Pa
rts A and B. Jerry has also purchased a Medicare Supplement (Medigap) plan which he has had for sever
, al years. However, the plan does not provide drug benefits. How would you advise Agent John Miller to
proceed? - correct answer-
Tell prospect Jerry Smith that he should consider adding a standalone Part D prescription drug coverage
policy to his present coverage.
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? -
correct answer-The penalty will be a permanent 10% increase in his Part B premium for every 12-
month period that passed during which he could have enrolled and did not.
Ms. Moore plans to retire when she turns 65 in a few months. She is in excellent health and will have co
nsiderable 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.
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 t
hese final months in hospice care. Mildred's family asks you whether hospice benefits will be paid for u
nder the Allcare Medicare Advantage plan. What should you say? - correct 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. Gomez notes that a Private Fee-for-
Service (PFFS) plan available in his area has an attractive premium. He wants to know if he must use doc
tors in a network as his current HMO plan requires him to do. What should you tell him? -
correct answer-
He may receive health care services from any doctor allowed to bill Medicare, as long as he shows the d
octor the plan's identification card and the doctor agrees to accept the PFFS plan's payment terms and c
onditions, which could include balance billing.
Mr. Kelly wants to know whether he isBeligible to sign up for a Private fee-for-
service (PFFS) plan. What questions would you need to ask to determine his eligibility? - correct answer-
You would need to ask Mr. Kelly if he is enrolled in Part A and Part B and if he lives in the PFFSBplan's ser
vice area.
2026/2027 WITH VERIFIED ANSWERS
Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What could you tell Mrs. Park that mig
ht be of assistance? - correct answer-
She should contact her state Medicaid agency to see if she qualifies forprograms that can help with Med
icare costs for which she is responsible.
Madeline Martinez was widowed several years ago. Her husband worked for many years and contribute
d into the Medicare system. He also left a substantial estate which provides Madeline with an annual inc
ome 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 t
o you for advice. What should you tell her? - correct answer-
You should tell Madeline that she will be able to enroll in Medicare Part ABwithout paying monthly prem
iums due to her husband's long work record and participation in the Medicare system. You should also t
ell 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.
Mr. Bauer is 49 years old, but eighteen months ago he was declared disabled by the Social Security Adm
inistration and has been receiving disability payments. He is wondering whether he can obtain coverage
under Medicare. What should you tell him - correct answer-
After receivingBsuch disability payments for 24 months, he will be automatically enrolled in Medicare, re
gardlessBof age.
Mr. Schmidt would like to plan for retirement and has asked you what isBcovered under Original Fee-for-
Service (FFS) Medicare? What could you tell him? - correct answer-
Part A, which covers hospital, skilled nursingBfacility, hospice and home health services and Part B, whic
h covers professional services such as those provided by a doctor are covered under Original Medicare.
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 answer-
She may enroll at any time while she is covered under her employer plan, but she will have a special eig
ht month enrollment period that differs from the standard general enrollment period, during which she
may enroll in Medicare Part B.
Agent John Miller is meeting with Jerry Smith, a new prospect. Jerry is currently enrolled in Medicare Pa
rts A and B. Jerry has also purchased a Medicare Supplement (Medigap) plan which he has had for sever
, al years. However, the plan does not provide drug benefits. How would you advise Agent John Miller to
proceed? - correct answer-
Tell prospect Jerry Smith that he should consider adding a standalone Part D prescription drug coverage
policy to his present coverage.
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? -
correct answer-The penalty will be a permanent 10% increase in his Part B premium for every 12-
month period that passed during which he could have enrolled and did not.
Ms. Moore plans to retire when she turns 65 in a few months. She is in excellent health and will have co
nsiderable 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.
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 t
hese final months in hospice care. Mildred's family asks you whether hospice benefits will be paid for u
nder the Allcare Medicare Advantage plan. What should you say? - correct 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. Gomez notes that a Private Fee-for-
Service (PFFS) plan available in his area has an attractive premium. He wants to know if he must use doc
tors in a network as his current HMO plan requires him to do. What should you tell him? -
correct answer-
He may receive health care services from any doctor allowed to bill Medicare, as long as he shows the d
octor the plan's identification card and the doctor agrees to accept the PFFS plan's payment terms and c
onditions, which could include balance billing.
Mr. Kelly wants to know whether he isBeligible to sign up for a Private fee-for-
service (PFFS) plan. What questions would you need to ask to determine his eligibility? - correct answer-
You would need to ask Mr. Kelly if he is enrolled in Part A and Part B and if he lives in the PFFSBplan's ser
vice area.
