AHIP Final Exam 2026: Practice Review
with Key Tips
Mr. Schmidt would like to plan for retirement and has asked you what is covered under Original Fee-for-
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Service (FFS) Medicare. What could you tell him? - correct answers Part A, which covers hospital, skilled
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nursing facility, hospice, and home health services and Part B, which covers professional services such as
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those provided by a doctor are covered under Original Medicare.
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Mrs. Cook is an elderly retiree. Mrs. Cook has a low fixed income. What could you tell Mrs. Cook that might be
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of assistance? - correct answers She should contact her state Medicaid agency to see if she qualifies for one of
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the several programs that can help with Medicare costs for which she is responsible.
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Mr. Moy will soon turn age 65. He is slightly younger than his wife. Mr. Moy's wife has a Medicare Advantage
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plan, but he wants to understand what coverage Medicare Supplemental insurance provides since his health
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care needs are different from his wife's needs. What could you tell Mr. Moy? - correct answers Medicare
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supplemental insurance would help cover his Part A deductible and Part B coinsurance or copayments in
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Original Fee-for-Service (FFS) Medicare as well as possibly some services that Medicare does not cover
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Mr. Vasquez is in good health and is preparing a budget in anticipation of his retirement when he turns 66. He
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wants to understand the health care costs he might be exposed to under Medicare is he were to require
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hospitalization because of an illness. In general terms, what could you tell him about his costs for inpatientV V V V V V V V V V V V V V V V V V
hospital services under Original Medicare? - correct answers Under Original Medicare, there is a single
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deductible amount due for the first 60 days of any inpatient hospital stay, after which it converts into a per-
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day coinsurance amount through day 90. After day 90, he would pay a daily amount up to 60 days over his
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lifetime, after which he would be responsible for all costs
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,Mr. Wu is eligible for Medicare. He has limited financial resources but failed to qualify for the Part D low-
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income subsidy. Where might he turn for help with his prescription drug costs? - correct answers Mr. Wu may
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still qualify for help in paying Part D costs through his State Pharmaceutical Assistance program (SPAP)
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Ms. Henderson believes that she will qualify for Medicare Coverage when she turns 65, without paying any
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premiums, because she has been working for 40 years and paying Medicare taxes. What should you tell her? -
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correct answers To obtain Part B coverage, she must pay a standard monthly premium, though it is higher for
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individuals with higher income V V V
Agent John Miller is meeting with Jerry Smith, a new prospect. Jerry is currently enrolled in Medicare Parts A
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and B. Jerry has also purchased a Medicare Supplement (Medigap) plan which he has had for several years.
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However, the plan does not provide drug benefits. How would you advise Agent John Miller to proceed? -
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correct answers Tell prospect Jerry Smith that he should consider adding a standalone Part D prescription
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drug coverage policy to his present coverage
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Madeline Martinez was widowed several years ago. Her husband worked for many years and contributed
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into the Medicare system. He also left a substantial estate which provides Madeline with an annual income of
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approximately $130,000. Madeline, who has only worked part-time for the last three years, will soon turn age V V V V V V V V V V V V V V V V V
65 and hopes to enroll in Original Medicare. She comes to you for advice. What should you tell her? - correct
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answers You should tell Madeline that she will be able to enroll in Medicare Part A without paying monthly
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premiums due to her husband's long work record and participation in the Medicare system. You should also
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tell Madeline that she will pay Part B premiums at more than the standard lowest rate but less than the highest
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rate due her substantial income
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Ms. Kumar plans to retire when she turns 65 in a few months. She is in excellent health and will have
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considerable income when she retires. She is concerned that her income will make it impossible for her to V V V V V V V V V V V V V V V V V V
qualify for Medicare. What could you tell her to address her concern? - correct answers Medicare is a program
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for people age 65 or older and those under age 65 with certain disabilities, end-stage renal disease, and Lou
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Gehrig's disease so she will be eligible for Medicare V V V V V V V V
Edward suffered from serious kidney disease. As a result. Edward became eligible for Medicare coverage due
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to end-stage renal disease (ESRD). A close relative donated their kidney and Edward successfully underwent
V V V V V V V V V V V V V V V
transplant surgery 12 months ago. Edward is now age 50 and asks you if his Medicare coverage will continue,
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what should you say? - correct answers Individuals eligible for Medicare based on ESRD generally lose
V V V V V V V V V V V V V V V V
eligibility 36 months after the month in which the individual receives a kidney transplant unless they are
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eligible for Medicare on another basis such as age or disability. Edward may, however, remain enrolled in Part
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, B but solely for coverage of immunosuppressive drugs if he has no other health care coverage that would
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cover the drugs. V V
Mrs. Thomas is 66 years old, has coverage under an employer plan, and will retire next year. She heard she
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must enroll in Part B at the beginning of the year to ensure no gap in coverage. What can you tell her? - correct
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answers She may enroll at any time while she is covered under her employer plan, but she will have a special
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eight-month enrollment period after the last month on her employer plan that differs from the standard V V V V V V V V V V V V V V V V
general enrollment period, during which she may enroll in Medicare Part B.
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Ms. Lewis has aggressive cancer and would like to know if Medicare will cover hospice services in case she
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needs them. What should you tell her? - correct answers Medicare covers hospice services, and they will be
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available for her V V
Mr. Bauer is 49 years old, but eighteen months ago he was declared disabled by the Social Security
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Administration and has been receiving disability payments. He is wondering whether he can obtain coverage V V V V V V V V V V V V V V V
under Medicare. What should you tell him? - correct answers After receiving such disability payments for 24
V V V V V V V V V V V V V V V V V
months, he will be automatically enrolled in Medicare, regardless of age
V V V V V V V V V V
Mr. Singh would like drug coverage but does not want to be enrolled in a Medicare Advantage plan. What
V V V V V V V V V V V V V V V V V V V
should you tell him? - correct answers Mr. Singh can enroll in a stand-alone prescription drug plan and
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continue to be covered for Part A and Part B services through Original Fee-for-Service Medicare.
V V V V V V V V V V V V V V
Mrs. Ellis recently turned 66 and decided after many years of work to retire and begin receiving Social Security
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benefits. Shortly thereafter Mrs. Ellis received a letter informing her that she has been automatically enrolled
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in Medicare Part B. She wants to understand what this means. What should you tell Mrs. Quinn? - correct
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answers Part B primarily covers physician services. She will be paying a monthly premium and, except for
V V V V V V V V V V V V V V V V V
many preventive screening and tests, generally will have 20% co-payments for these services in addition to an
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annual deductible V
Anthony Boniface turned 65 in 2024. He was not receiving Social Security or Railroad Retirement Benefits on
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his 65th birthday. He was interested in obtaining Medicare coverage and is eligible for premium-free Part A.
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Before he could enroll in Medicare, his entire area was impacted by a hurricane causing massive flooding and
V V V V V V V V V V V V V V V V V V
severe wind damage. The Federal government declared this to be a natural disaster which has recently
V V V V V V V V V V V V V V V V
ended. During this period Anthony's initial enrollment period expired. Anthony asks you how he can now
V V V V V V V V V V V V V V V V
obtain Medicare coverage. What should you say? - correct answers Anthony is eligible for a special
V V V V V V V V V V V V V V V V
enrollment period (SEP) because he missed an enrollment period due to the impact of the Federally declared
V V V V V V V V V V V V V V V V V
disaster. This SEP will allow Anthony to enroll in Part B up to six months after the end of the emergency
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with Key Tips
Mr. Schmidt would like to plan for retirement and has asked you what is covered under Original Fee-for-
V V V V V V V V V V V V V V V V V
Service (FFS) Medicare. What could you tell him? - correct answers Part A, which covers hospital, skilled
V V V V V V V V V V V V V V V V V
nursing facility, hospice, and home health services and Part B, which covers professional services such as
V V V V V V V V V V V V V V V V
those provided by a doctor are covered under Original Medicare.
V V V V V V V V V
Mrs. Cook is an elderly retiree. Mrs. Cook has a low fixed income. What could you tell Mrs. Cook that might be
V V V V V V V V V V V V V V V V V V V V V V
of assistance? - correct answers She should contact her state Medicaid agency to see if she qualifies for one of
V V V V V V V V V V V V V V V V V V V V
the several programs that can help with Medicare costs for which she is responsible.
V V V V V V V V V V V V V
Mr. Moy will soon turn age 65. He is slightly younger than his wife. Mr. Moy's wife has a Medicare Advantage
V V V V V V V V V V V V V V V V V V V V V
plan, but he wants to understand what coverage Medicare Supplemental insurance provides since his health
V V V V V V V V V V V V V V V
care needs are different from his wife's needs. What could you tell Mr. Moy? - correct answers Medicare
V V V V V V V V V V V V V V V V V V
supplemental insurance would help cover his Part A deductible and Part B coinsurance or copayments in
V V V V V V V V V V V V V V V V
Original Fee-for-Service (FFS) Medicare as well as possibly some services that Medicare does not cover
V V V V V V V V V V V V V V
Mr. Vasquez is in good health and is preparing a budget in anticipation of his retirement when he turns 66. He
V V V V V V V V V V V V V V V V V V V V V
wants to understand the health care costs he might be exposed to under Medicare is he were to require
V V V V V V V V V V V V V V V V V V V
hospitalization because of an illness. In general terms, what could you tell him about his costs for inpatientV V V V V V V V V V V V V V V V V V
hospital services under Original Medicare? - correct answers Under Original Medicare, there is a single
V V V V V V V V V V V V V V V
deductible amount due for the first 60 days of any inpatient hospital stay, after which it converts into a per-
V V V V V V V V V V V V V V V V V V V
day coinsurance amount through day 90. After day 90, he would pay a daily amount up to 60 days over his
V V V V V V V V V V V V V V V V V V V V V
lifetime, after which he would be responsible for all costs
V V V V V V V V V
,Mr. Wu is eligible for Medicare. He has limited financial resources but failed to qualify for the Part D low-
V V V V V V V V V V V V V V V V V V V
income subsidy. Where might he turn for help with his prescription drug costs? - correct answers Mr. Wu may
V V V V V V V V V V V V V V V V V V V
still qualify for help in paying Part D costs through his State Pharmaceutical Assistance program (SPAP)
V V V V V V V V V V V V V V V
Ms. Henderson believes that she will qualify for Medicare Coverage when she turns 65, without paying any
V V V V V V V V V V V V V V V V V
premiums, because she has been working for 40 years and paying Medicare taxes. What should you tell her? -
V V V V V V V V V V V V V V V V V V V
correct answers To obtain Part B coverage, she must pay a standard monthly premium, though it is higher for
V V V V V V V V V V V V V V V V V V V
individuals with higher income V V V
Agent John Miller is meeting with Jerry Smith, a new prospect. Jerry is currently enrolled in Medicare Parts A
V V V V V V V V V V V V V V V V V V V
and B. Jerry has also purchased a Medicare Supplement (Medigap) plan which he has had for several years.
V V V V V V V V V V V V V V V V V V
However, the plan does not provide drug benefits. How would you advise Agent John Miller to proceed? -
V V V V V V V V V V V V V V V V V V
correct answers Tell prospect Jerry Smith that he should consider adding a standalone Part D prescription
V V V V V V V V V V V V V V V V
drug coverage policy to his present coverage
V V V V V V
Madeline Martinez was widowed several years ago. Her husband worked for many years and contributed
V V V V V V V V V V V V V V V
into the Medicare system. He also left a substantial estate which provides Madeline with an annual income of
V V V V V V V V V V V V V V V V V V
approximately $130,000. Madeline, who has only worked part-time for the last three years, will soon turn age V V V V V V V V V V V V V V V V V
65 and hopes to enroll in Original Medicare. She comes to you for advice. What should you tell her? - correct
V V V V V V V V V V V V V V V V V V V V V
answers You should tell Madeline that she will be able to enroll in Medicare Part A without paying monthly
V V V V V V V V V V V V V V V V V V V
premiums due to her husband's long work record and participation in the Medicare system. You should also
V V V V V V V V V V V V V V V V V
tell Madeline that she will pay Part B premiums at more than the standard lowest rate but less than the highest
V V V V V V V V V V V V V V V V V V V V
rate due her substantial income
V V V V V
Ms. Kumar plans to retire when she turns 65 in a few months. She is in excellent health and will have
V V V V V V V V V V V V V V V V V V V V V
considerable income when she retires. She is concerned that her income will make it impossible for her to V V V V V V V V V V V V V V V V V V
qualify for Medicare. What could you tell her to address her concern? - correct answers Medicare is a program
V V V V V V V V V V V V V V V V V V V
for people age 65 or older and those under age 65 with certain disabilities, end-stage renal disease, and Lou
V V V V V V V V V V V V V V V V V V V
Gehrig's disease so she will be eligible for Medicare V V V V V V V V
Edward suffered from serious kidney disease. As a result. Edward became eligible for Medicare coverage due
V V V V V V V V V V V V V V V V
to end-stage renal disease (ESRD). A close relative donated their kidney and Edward successfully underwent
V V V V V V V V V V V V V V V
transplant surgery 12 months ago. Edward is now age 50 and asks you if his Medicare coverage will continue,
V V V V V V V V V V V V V V V V V V V
what should you say? - correct answers Individuals eligible for Medicare based on ESRD generally lose
V V V V V V V V V V V V V V V V
eligibility 36 months after the month in which the individual receives a kidney transplant unless they are
V V V V V V V V V V V V V V V V V
eligible for Medicare on another basis such as age or disability. Edward may, however, remain enrolled in Part
V V V V V V V V V V V V V V V V V V
, B but solely for coverage of immunosuppressive drugs if he has no other health care coverage that would
V V V V V V V V V V V V V V V V V V
cover the drugs. V V
Mrs. Thomas is 66 years old, has coverage under an employer plan, and will retire next year. She heard she
V V V V V V V V V V V V V V V V V V V V
must enroll in Part B at the beginning of the year to ensure no gap in coverage. What can you tell her? - correct
V V V V V V V V V V V V V V V V V V V V V V V V
answers She may enroll at any time while she is covered under her employer plan, but she will have a special
V V V V V V V V V V V V V V V V V V V V V
eight-month enrollment period after the last month on her employer plan that differs from the standard V V V V V V V V V V V V V V V V
general enrollment period, during which she may enroll in Medicare Part B.
V V V V V V V V V V V
Ms. Lewis has aggressive cancer and would like to know if Medicare will cover hospice services in case she
V V V V V V V V V V V V V V V V V V V
needs them. What should you tell her? - correct answers Medicare covers hospice services, and they will be
V V V V V V V V V V V V V V V V V V
available for her V V
Mr. Bauer is 49 years old, but eighteen months ago he was declared disabled by the Social Security
V V V V V V V V V V V V V V V V V V
Administration and has been receiving disability payments. He is wondering whether he can obtain coverage V V V V V V V V V V V V V V V
under Medicare. What should you tell him? - correct answers After receiving such disability payments for 24
V V V V V V V V V V V V V V V V V
months, he will be automatically enrolled in Medicare, regardless of age
V V V V V V V V V V
Mr. Singh would like drug coverage but does not want to be enrolled in a Medicare Advantage plan. What
V V V V V V V V V V V V V V V V V V V
should you tell him? - correct answers Mr. Singh can enroll in a stand-alone prescription drug plan and
V V V V V V V V V V V V V V V V V V
continue to be covered for Part A and Part B services through Original Fee-for-Service Medicare.
V V V V V V V V V V V V V V
Mrs. Ellis recently turned 66 and decided after many years of work to retire and begin receiving Social Security
V V V V V V V V V V V V V V V V V V V
benefits. Shortly thereafter Mrs. Ellis received a letter informing her that she has been automatically enrolled
V V V V V V V V V V V V V V V V
in Medicare Part B. She wants to understand what this means. What should you tell Mrs. Quinn? - correct
V V V V V V V V V V V V V V V V V V V
answers Part B primarily covers physician services. She will be paying a monthly premium and, except for
V V V V V V V V V V V V V V V V V
many preventive screening and tests, generally will have 20% co-payments for these services in addition to an
V V V V V V V V V V V V V V V V V
annual deductible V
Anthony Boniface turned 65 in 2024. He was not receiving Social Security or Railroad Retirement Benefits on
V V V V V V V V V V V V V V V V V
his 65th birthday. He was interested in obtaining Medicare coverage and is eligible for premium-free Part A.
V V V V V V V V V V V V V V V V V
Before he could enroll in Medicare, his entire area was impacted by a hurricane causing massive flooding and
V V V V V V V V V V V V V V V V V V
severe wind damage. The Federal government declared this to be a natural disaster which has recently
V V V V V V V V V V V V V V V V
ended. During this period Anthony's initial enrollment period expired. Anthony asks you how he can now
V V V V V V V V V V V V V V V V
obtain Medicare coverage. What should you say? - correct answers Anthony is eligible for a special
V V V V V V V V V V V V V V V V
enrollment period (SEP) because he missed an enrollment period due to the impact of the Federally declared
V V V V V V V V V V V V V V V V V
disaster. This SEP will allow Anthony to enroll in Part B up to six months after the end of the emergency
V V V V V V V V V V V V V V V V V V V V V
