AHIP 2025 Final Exam – Verified Questions and Answers
2026\2027) – Complete Exam Material for Certification Preparation
This document contains a comprehensive collection of verified questions and answers for
the AHIP 2025 Final Exam, updated for the 2025-2026 certification cycle. It covers all
major topics required for passing the Medicare training and certification exam, including
Medicare Advantage, Part D plans, fraud and abuse prevention, and marketing guidelines.
Ideal for agents and brokers preparing to recertify or certify for the first time with
confidence.
1. 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?: Mr. Wu may still qualify for help
in paying Part D costs through his State Pharmaceutical Assistance Program.
2. 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?: After receiving such disability
payments for 24 months, he will be automatically enrolled in Medicare,
regardless of age.
3. 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?: 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.
4. 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?: 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.
5. 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?: Tell prospect Jerry Smith that he should
consider adding a standalone Part D prescription drug coverage policy to his
present coverage.
6. 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?: He may
sign-up for Medicare at any time however coverage usually begins on the fourth
month after dialysis treatments start.
7. 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?: Mr. Diaz will not pay any penalty because he had continuous
coverage under his employer's plan.
8. 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?: 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.
9. 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?:
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.
10. Mrs. PeHa 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?: 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.
11. 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?: 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.
2026\2027) – Complete Exam Material for Certification Preparation
This document contains a comprehensive collection of verified questions and answers for
the AHIP 2025 Final Exam, updated for the 2025-2026 certification cycle. It covers all
major topics required for passing the Medicare training and certification exam, including
Medicare Advantage, Part D plans, fraud and abuse prevention, and marketing guidelines.
Ideal for agents and brokers preparing to recertify or certify for the first time with
confidence.
1. 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?: Mr. Wu may still qualify for help
in paying Part D costs through his State Pharmaceutical Assistance Program.
2. 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?: After receiving such disability
payments for 24 months, he will be automatically enrolled in Medicare,
regardless of age.
3. 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?: 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.
4. 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?: 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.
5. 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?: Tell prospect Jerry Smith that he should
consider adding a standalone Part D prescription drug coverage policy to his
present coverage.
6. 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?: He may
sign-up for Medicare at any time however coverage usually begins on the fourth
month after dialysis treatments start.
7. 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?: Mr. Diaz will not pay any penalty because he had continuous
coverage under his employer's plan.
8. 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?: 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.
9. 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?:
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.
10. Mrs. PeHa 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?: 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.
11. 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?: 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.
