AHIP Final Exam Latest (2025/2026) | 50 Verified
Questions and Correct Answers | A+ Graded
SECTION 1: ORIGINAL MEDICARE (PARTS A & B)
Understanding the fundamentals of Original Medicare is critical, as it forms the
basis for all other plan types.
Question 1
Mrs. Shields is covered by Original Medicare. She sustained a hip fracture and is
being successfully treated. However, she and her physicians feel that after her
lengthy hospital stay, she will need a month or two of nursing and rehabilitative
care. What should you tell them about Original Medicare's coverage of care in a
skilled nursing facility?
A) Medicare will cover the full cost of her stay for up to 100 days.
B) Medicare will cover her skilled nursing services for the first 20 days with no
cost-sharing, after which she would have a daily copay until day 100.
C) Medicare does not cover skilled nursing facility care.
D) Medicare will cover her stay only if she is admitted directly from home, not
from a hospital.
Answer;-: B
Rationale: Original Medicare covers the first 20 days of a skilled nursing facility
(SNF) stay in full. For days 21 through 100, there is a significant daily coinsurance
amount for which the beneficiary is responsible .
Question 2
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?
A) The penalty will be a permanent 10% increase in his Part B premium for every
12-month period he was eligible but did not enroll.
B) He will not pay any penalty because he had continuous coverage under his
employer's plan.
C) The penalty is a one-time fee of $500.
D) He will pay a 15% penalty for the first year only.
Answer;-: B
Rationale: A Part B late enrollment penalty can be avoided if the beneficiary had
creditable coverage from a current employer's group health plan. Since Mr. Diaz
was covered by his employer's plan, he qualifies for a Special Enrollment Period
and will not incur a penalty .
SECTION 2: ENROLLMENT PERIODS & ELIGIBILITY
These questions test your knowledge of "when" beneficiaries can enroll and the
specific rules that apply.
Question 3
Mrs. Peña 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?
A) She must enroll during the General Enrollment Period (January 1 – March 31)
to avoid a gap.
B) She will have an eight-month Special Enrollment Period to enroll in Part B after
her employment or group coverage ends.
C) She can only enroll during her Initial Enrollment Period, which has already
passed.
D) She must wait until the next Annual Enrollment Period.
Answer;-: B
Rationale: Individuals who have group health coverage based on current
employment are eligible for an 8-month Special Enrollment Period (SEP) to sign
, up for Part B after the employment ends or the group coverage ends, whichever
happens first. This prevents a coverage gap .
Question 4
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?
A) He is not eligible for Medicare until age 65.
B) He can enroll in Medicare immediately because he is disabled.
C) After receiving disability payments for 24 months, he will be automatically
enrolled in Medicare, regardless of age.
D) He must purchase a private health insurance plan.
Answer;-: C
Rationale: Individuals under 65 who have received Social Security disability
benefits for 24 months are automatically entitled to Medicare. Mr. Bauer is 18
months in, so he will be eligible in 6 more months .
SECTION 3: MEDICARE ADVANTAGE & PART D
These questions cover the specifics of Medicare Advantage (Part C) and
Prescription Drug Plans (Part D), which are the products you will be selling.
Question 5
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 doctors in a network
as his current HMO plan requires. What should you tell him?
A) Yes, PFFS plans require you to choose a Primary Care Physician and get
referrals.
B) No, you can see any doctor who accepts Medicare, as long as the doctor agrees
to the plan's payment terms.
C) PFFS plans do not exist anymore.
D) He can only see doctors who are employed by the hospital system.
Answer;-: B
Rationale: A key feature of PFFS plans is network flexibility. Unlike HMOs, they
Questions and Correct Answers | A+ Graded
SECTION 1: ORIGINAL MEDICARE (PARTS A & B)
Understanding the fundamentals of Original Medicare is critical, as it forms the
basis for all other plan types.
Question 1
Mrs. Shields is covered by Original Medicare. She sustained a hip fracture and is
being successfully treated. However, she and her physicians feel that after her
lengthy hospital stay, she will need a month or two of nursing and rehabilitative
care. What should you tell them about Original Medicare's coverage of care in a
skilled nursing facility?
A) Medicare will cover the full cost of her stay for up to 100 days.
B) Medicare will cover her skilled nursing services for the first 20 days with no
cost-sharing, after which she would have a daily copay until day 100.
C) Medicare does not cover skilled nursing facility care.
D) Medicare will cover her stay only if she is admitted directly from home, not
from a hospital.
Answer;-: B
Rationale: Original Medicare covers the first 20 days of a skilled nursing facility
(SNF) stay in full. For days 21 through 100, there is a significant daily coinsurance
amount for which the beneficiary is responsible .
Question 2
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?
A) The penalty will be a permanent 10% increase in his Part B premium for every
12-month period he was eligible but did not enroll.
B) He will not pay any penalty because he had continuous coverage under his
employer's plan.
C) The penalty is a one-time fee of $500.
D) He will pay a 15% penalty for the first year only.
Answer;-: B
Rationale: A Part B late enrollment penalty can be avoided if the beneficiary had
creditable coverage from a current employer's group health plan. Since Mr. Diaz
was covered by his employer's plan, he qualifies for a Special Enrollment Period
and will not incur a penalty .
SECTION 2: ENROLLMENT PERIODS & ELIGIBILITY
These questions test your knowledge of "when" beneficiaries can enroll and the
specific rules that apply.
Question 3
Mrs. Peña 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?
A) She must enroll during the General Enrollment Period (January 1 – March 31)
to avoid a gap.
B) She will have an eight-month Special Enrollment Period to enroll in Part B after
her employment or group coverage ends.
C) She can only enroll during her Initial Enrollment Period, which has already
passed.
D) She must wait until the next Annual Enrollment Period.
Answer;-: B
Rationale: Individuals who have group health coverage based on current
employment are eligible for an 8-month Special Enrollment Period (SEP) to sign
, up for Part B after the employment ends or the group coverage ends, whichever
happens first. This prevents a coverage gap .
Question 4
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?
A) He is not eligible for Medicare until age 65.
B) He can enroll in Medicare immediately because he is disabled.
C) After receiving disability payments for 24 months, he will be automatically
enrolled in Medicare, regardless of age.
D) He must purchase a private health insurance plan.
Answer;-: C
Rationale: Individuals under 65 who have received Social Security disability
benefits for 24 months are automatically entitled to Medicare. Mr. Bauer is 18
months in, so he will be eligible in 6 more months .
SECTION 3: MEDICARE ADVANTAGE & PART D
These questions cover the specifics of Medicare Advantage (Part C) and
Prescription Drug Plans (Part D), which are the products you will be selling.
Question 5
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 doctors in a network
as his current HMO plan requires. What should you tell him?
A) Yes, PFFS plans require you to choose a Primary Care Physician and get
referrals.
B) No, you can see any doctor who accepts Medicare, as long as the doctor agrees
to the plan's payment terms.
C) PFFS plans do not exist anymore.
D) He can only see doctors who are employed by the hospital system.
Answer;-: B
Rationale: A key feature of PFFS plans is network flexibility. Unlike HMOs, they
