AHIP Final Exam Practice Test Open Book. Questions with Answers
and Detailed Rationales. Based on 2025/2026 CMS Guidelines.
Topic Distribution
Topic Area
Medicare Eligibility & Enrollment
Medicare Part A & B (Original Medicare)
Medicare Advantage (Part C) Plans
Medicare Part D (Prescription Drug)
Medigap (Supplement) Plans
Enrollment Periods (IEP, AEP, SEP, MA-OEP)
Low-Income Subsidies & Assistance Programs
Marketing & Compliance Rules
Fraud, Waste & Abuse
,Questions
1. Mrs. Park is an elderly retiree with a low fixed income. What could you tell
Mrs. Park that might be of assistance?
A) She should apply for a Medicare Advantage plan with a $0 premium
B) She should contact her state Medicaid agency to see if she qualifies for
programs that can help with Medicare costs
C) She should delay enrolling in Medicare until she can afford the premiums
D) She should purchase a Medigap policy to cover her out-of-pocket costs
Answer: B
Rationale: Low-income individuals may qualify for Medicaid or Medicare Savings
Programs (MSPs) that help pay Medicare premiums, deductibles, and
coinsurance. State Medicaid agencies determine eligibility for these programs.
Option A is not universally available and doesn't address underlying cost issues.
Option C would result in late enrollment penalties. Option D requires paying
additional premiums, which is not helpful for someone with limited income.
2. Madeline Martinez was widowed several years ago. Her husband worked for
many years and contributed to the Medicare system. He left a substantial estate
providing 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. What should you tell her?
A) She is not eligible for Medicare because she did not work enough quarters
herself
B) She will be able to enroll in Medicare Part A without paying monthly premiums
due to her husband's work record, but will pay higher Part B premiums due to her
income
C) She must wait until she has worked enough quarters to qualify on her own
,record
D) She will pay standard premiums for both Part A and Part B
Answer: B
Rationale: Individuals aged 65+ are eligible for Medicare regardless of their own
work history if their spouse worked at least 40 quarters and paid Medicare taxes.
Part A is premium-free for most beneficiaries based on work history. However,
Part B and Part D premiums are income-adjusted (IRMAA) for higher-income
beneficiaries (>$103,000 single). Madeline's $130,000 income places her in a
higher premium bracket.
3. 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) After receiving disability payments for 24 months, he will be automatically
enrolled in Medicare, regardless of age
C) He can enroll immediately in Medicare Part A by paying monthly premiums
D) He must apply for Medicare through his state's Medicaid agency
Answer: B
Rationale: Individuals under 65 who have received Social Security disability
benefits for 24 months are automatically enrolled in Medicare. This includes Part
A and Part B. The 24-month waiting period begins from the date of disability
entitlement, not from when benefits are first received.
, 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?
A) Part A covers hospital, skilled nursing facility, hospice and home health
services; Part B covers professional services such as those provided by a doctor
B) Original Medicare covers all healthcare services including dental, vision, and
hearing
C) Original Medicare includes prescription drug coverage automatically
D) Original Medicare has an annual out-of-pocket maximum limit
Answer: A
Rationale: Original Medicare consists of Part A (hospital insurance) and Part B
(medical insurance). Part A covers inpatient hospital care, skilled nursing facility
care (limited), hospice, and some home health. Part B covers doctor services,
outpatient care, preventive services, and medical equipment. Original Medicare
does NOT cover dental, vision, hearing (B), prescription drugs (C requires Part D),
and has no out-of-pocket maximum (D).
5. 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?
A) She must enroll during the General Enrollment Period (January-March) to avoid
penalties
B) She may enroll at any time while covered under her employer plan, and will
have a special 8-month enrollment period after employment ends
C) She should enroll now even though she's still working
D) She cannot enroll in Part B until she actually retires
Answer: B
Rationale: Individuals covered by employer group health plans based on current
employment have a Special Enrollment Period (SEP) that allows them to enroll in
and Detailed Rationales. Based on 2025/2026 CMS Guidelines.
Topic Distribution
Topic Area
Medicare Eligibility & Enrollment
Medicare Part A & B (Original Medicare)
Medicare Advantage (Part C) Plans
Medicare Part D (Prescription Drug)
Medigap (Supplement) Plans
Enrollment Periods (IEP, AEP, SEP, MA-OEP)
Low-Income Subsidies & Assistance Programs
Marketing & Compliance Rules
Fraud, Waste & Abuse
,Questions
1. Mrs. Park is an elderly retiree with a low fixed income. What could you tell
Mrs. Park that might be of assistance?
A) She should apply for a Medicare Advantage plan with a $0 premium
B) She should contact her state Medicaid agency to see if she qualifies for
programs that can help with Medicare costs
C) She should delay enrolling in Medicare until she can afford the premiums
D) She should purchase a Medigap policy to cover her out-of-pocket costs
Answer: B
Rationale: Low-income individuals may qualify for Medicaid or Medicare Savings
Programs (MSPs) that help pay Medicare premiums, deductibles, and
coinsurance. State Medicaid agencies determine eligibility for these programs.
Option A is not universally available and doesn't address underlying cost issues.
Option C would result in late enrollment penalties. Option D requires paying
additional premiums, which is not helpful for someone with limited income.
2. Madeline Martinez was widowed several years ago. Her husband worked for
many years and contributed to the Medicare system. He left a substantial estate
providing 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. What should you tell her?
A) She is not eligible for Medicare because she did not work enough quarters
herself
B) She will be able to enroll in Medicare Part A without paying monthly premiums
due to her husband's work record, but will pay higher Part B premiums due to her
income
C) She must wait until she has worked enough quarters to qualify on her own
,record
D) She will pay standard premiums for both Part A and Part B
Answer: B
Rationale: Individuals aged 65+ are eligible for Medicare regardless of their own
work history if their spouse worked at least 40 quarters and paid Medicare taxes.
Part A is premium-free for most beneficiaries based on work history. However,
Part B and Part D premiums are income-adjusted (IRMAA) for higher-income
beneficiaries (>$103,000 single). Madeline's $130,000 income places her in a
higher premium bracket.
3. 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) After receiving disability payments for 24 months, he will be automatically
enrolled in Medicare, regardless of age
C) He can enroll immediately in Medicare Part A by paying monthly premiums
D) He must apply for Medicare through his state's Medicaid agency
Answer: B
Rationale: Individuals under 65 who have received Social Security disability
benefits for 24 months are automatically enrolled in Medicare. This includes Part
A and Part B. The 24-month waiting period begins from the date of disability
entitlement, not from when benefits are first received.
, 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?
A) Part A covers hospital, skilled nursing facility, hospice and home health
services; Part B covers professional services such as those provided by a doctor
B) Original Medicare covers all healthcare services including dental, vision, and
hearing
C) Original Medicare includes prescription drug coverage automatically
D) Original Medicare has an annual out-of-pocket maximum limit
Answer: A
Rationale: Original Medicare consists of Part A (hospital insurance) and Part B
(medical insurance). Part A covers inpatient hospital care, skilled nursing facility
care (limited), hospice, and some home health. Part B covers doctor services,
outpatient care, preventive services, and medical equipment. Original Medicare
does NOT cover dental, vision, hearing (B), prescription drugs (C requires Part D),
and has no out-of-pocket maximum (D).
5. 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?
A) She must enroll during the General Enrollment Period (January-March) to avoid
penalties
B) She may enroll at any time while covered under her employer plan, and will
have a special 8-month enrollment period after employment ends
C) She should enroll now even though she's still working
D) She cannot enroll in Part B until she actually retires
Answer: B
Rationale: Individuals covered by employer group health plans based on current
employment have a Special Enrollment Period (SEP) that allows them to enroll in
