AHIP FINAL EXAM NEWEST 2026 VERSION QUESTIONS WITH CORRECT
SOLUTIONS GRADED A+
Mr. Wu may still qualify for help in paying Part D costs through his State Pharmaceutical
Assistance Program. ANSWER >> 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?
After receiving such disability payments for 24 months, he will be automatically enrolled
in Medicare, regardless of age. ANSWER >> 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?
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. ANSWER >> 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?
1
,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. ANSWER >> 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?
Tell prospect Jerry Smith that he should consider adding a standalone Part D
prescription drug coverage policy to his present coverage. ANSWER >> 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?
He may sign-up for Medicare at any time however coverage usually begins on the fourth
month after dialysis treatments start. ANSWER >> 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?
Mr. Diaz will not pay any penalty because he had continuous coverage under his
employer's plan. ANSWER >> 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?
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. ANSWER >> 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?
2
, 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. ANSWER >> 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?
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. ANSWER >> 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?
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. ANSWER >> 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?
To obtain Part B coverage, she must pay a standard monthly premium, though it is
higher for individuals with higher incomes. ANSWER >> 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?
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. ANSWER >>
Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What could you tell
Mrs. Park that might be of assistance?
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
3
SOLUTIONS GRADED A+
Mr. Wu may still qualify for help in paying Part D costs through his State Pharmaceutical
Assistance Program. ANSWER >> 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?
After receiving such disability payments for 24 months, he will be automatically enrolled
in Medicare, regardless of age. ANSWER >> 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?
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. ANSWER >> 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?
1
,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. ANSWER >> 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?
Tell prospect Jerry Smith that he should consider adding a standalone Part D
prescription drug coverage policy to his present coverage. ANSWER >> 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?
He may sign-up for Medicare at any time however coverage usually begins on the fourth
month after dialysis treatments start. ANSWER >> 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?
Mr. Diaz will not pay any penalty because he had continuous coverage under his
employer's plan. ANSWER >> 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?
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. ANSWER >> 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?
2
, 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. ANSWER >> 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?
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. ANSWER >> 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?
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. ANSWER >> 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?
To obtain Part B coverage, she must pay a standard monthly premium, though it is
higher for individuals with higher incomes. ANSWER >> 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?
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. ANSWER >>
Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What could you tell
Mrs. Park that might be of assistance?
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
3
