AHIP Exam 2026 Modules 1–5
– Final Exam and FWA
Comprehensive Study Guide
What happens after Mr. Bauer has received disability payments for 24 months? -
ANSWER-He will be automatically enrolled in Medicare, regardless of age.
Why did Edward become eligible for Medicare coverage? - ANSWER-Due to end-
stage renal disease (ESRD).
How long does Medicare coverage generally last for individuals eligible based on
ESRD after a kidney transplant? - ANSWER-Eligibility generally lasts for 36 months
after the month in which the individual receives a kidney transplant.
What can Edward do regarding Part B coverage after his kidney transplant? -
ANSWER-He may remain enrolled in Part B solely for coverage of
immunosuppressive drugs if he has no other health care coverage for those drugs.
What special enrollment option does Anthony have after missing his initial
enrollment period due to a disaster? - ANSWER-He is eligible for a special
enrollment period (SEP) to enroll in Part B up to six months after the end of the
emergency declaration.
,When can Anthony enroll in premium-free Part A? - ANSWER-He may enroll in
premium-free Part A at any time, with coverage retroactive for up to 6 months.
What should you tell Mr. Capadona about purchasing a Medigap plan while
enrolled in a Medicare Advantage plan? - ANSWER-It is illegal to sell him a
Medigap plan if he is enrolled in an MA plan, as Medigap only works with Original
Medicare.
Will Mildred's hospice care be covered under her Allcare Medicare Advantage
plan? - ANSWER-Yes, hospice benefits will be paid for by Original Medicare under
Part A, and Allcare will continue to pay for any non-hospice services.
What must Ms. Henderson do to obtain Part B coverage? - ANSWER-She must pay
a standard monthly premium, which may be higher for individuals with higher
incomes.
What assistance can Mrs. Cook seek due to her low fixed income? - ANSWER-She
should contact her state Medicaid agency to see if she qualifies for programs that
help with Medicare costs.
What does Medicare Supplemental Insurance cover for Mr. Moy? - ANSWER-It
helps cover his Part A deductible and Part B coinsurance or copayments in Original
Fee-for-Service (FFS) Medicare.
What is Juan Perez's situation regarding Medicare as he turns 65? - ANSWER-He
intends to work for several more years at Smallcap, which offers employer-
sponsored healthcare coverage.
,What is the eligibility requirement for premium-free Part A? - ANSWER-Individuals
must have worked and paid Medicare taxes for a sufficient period, typically 40
quarters.
What happens if an individual does not enroll in Medicare during their initial
enrollment period? - ANSWER-They may qualify for a special enrollment period if
they missed it due to certain circumstances, such as a natural disaster.
How does Medicare coverage differ for individuals based on age versus disability?
- ANSWER-Individuals under 65 can qualify for Medicare due to disability after 24
months of receiving disability payments, while those 65 and older qualify based
on age.
What is the role of Medigap insurance? - ANSWER-Medigap insurance helps cover
costs not covered by Original Medicare, such as deductibles and coinsurance.
What is the maximum duration of Medicare coverage after a kidney transplant for
those eligible due to ESRD? - ANSWER-36 months after the month of the
transplant.
What should individuals do if they are unsure about their Medicare eligibility? -
ANSWER-They should contact the Social Security Administration or their state
Medicaid agency for guidance.
, What is the significance of a Federally declared disaster in relation to Medicare
enrollment? - ANSWER-It allows individuals who missed their enrollment period
to qualify for a special enrollment period.
What is the difference between Medicare Advantage and Original Medicare
regarding coverage? - ANSWER-Medicare Advantage plans may offer additional
benefits but cannot be combined with Medigap plans.
What is the importance of immunosuppressive drug coverage for kidney
transplant patients? - ANSWER-It is critical for preventing organ rejection and
maintaining health post-transplant.
How does income affect the premium for Part B coverage? - ANSWER-Individuals
with higher incomes may pay a higher monthly premium for Part B.
What is Juan likely entitled to when he turns age 65 regarding Medicare? -
ANSWER-Juan is likely to be eligible for Medicare.
How would enrolling in Medicare impact Juan's employer-sponsored healthcare
coverage? - ANSWER-If Juan enrolls, Medicare becomes the primary payor of his
healthcare claims, and his employer's plan becomes a secondary payor.
What eligibility criteria does Ms. Kumar meet for Medicare despite her concerns
about income? - ANSWER-Medicare is available for people age 65 or older, so Ms.
Kumar will be eligible regardless of her income.
– Final Exam and FWA
Comprehensive Study Guide
What happens after Mr. Bauer has received disability payments for 24 months? -
ANSWER-He will be automatically enrolled in Medicare, regardless of age.
Why did Edward become eligible for Medicare coverage? - ANSWER-Due to end-
stage renal disease (ESRD).
How long does Medicare coverage generally last for individuals eligible based on
ESRD after a kidney transplant? - ANSWER-Eligibility generally lasts for 36 months
after the month in which the individual receives a kidney transplant.
What can Edward do regarding Part B coverage after his kidney transplant? -
ANSWER-He may remain enrolled in Part B solely for coverage of
immunosuppressive drugs if he has no other health care coverage for those drugs.
What special enrollment option does Anthony have after missing his initial
enrollment period due to a disaster? - ANSWER-He is eligible for a special
enrollment period (SEP) to enroll in Part B up to six months after the end of the
emergency declaration.
,When can Anthony enroll in premium-free Part A? - ANSWER-He may enroll in
premium-free Part A at any time, with coverage retroactive for up to 6 months.
What should you tell Mr. Capadona about purchasing a Medigap plan while
enrolled in a Medicare Advantage plan? - ANSWER-It is illegal to sell him a
Medigap plan if he is enrolled in an MA plan, as Medigap only works with Original
Medicare.
Will Mildred's hospice care be covered under her Allcare Medicare Advantage
plan? - ANSWER-Yes, hospice benefits will be paid for by Original Medicare under
Part A, and Allcare will continue to pay for any non-hospice services.
What must Ms. Henderson do to obtain Part B coverage? - ANSWER-She must pay
a standard monthly premium, which may be higher for individuals with higher
incomes.
What assistance can Mrs. Cook seek due to her low fixed income? - ANSWER-She
should contact her state Medicaid agency to see if she qualifies for programs that
help with Medicare costs.
What does Medicare Supplemental Insurance cover for Mr. Moy? - ANSWER-It
helps cover his Part A deductible and Part B coinsurance or copayments in Original
Fee-for-Service (FFS) Medicare.
What is Juan Perez's situation regarding Medicare as he turns 65? - ANSWER-He
intends to work for several more years at Smallcap, which offers employer-
sponsored healthcare coverage.
,What is the eligibility requirement for premium-free Part A? - ANSWER-Individuals
must have worked and paid Medicare taxes for a sufficient period, typically 40
quarters.
What happens if an individual does not enroll in Medicare during their initial
enrollment period? - ANSWER-They may qualify for a special enrollment period if
they missed it due to certain circumstances, such as a natural disaster.
How does Medicare coverage differ for individuals based on age versus disability?
- ANSWER-Individuals under 65 can qualify for Medicare due to disability after 24
months of receiving disability payments, while those 65 and older qualify based
on age.
What is the role of Medigap insurance? - ANSWER-Medigap insurance helps cover
costs not covered by Original Medicare, such as deductibles and coinsurance.
What is the maximum duration of Medicare coverage after a kidney transplant for
those eligible due to ESRD? - ANSWER-36 months after the month of the
transplant.
What should individuals do if they are unsure about their Medicare eligibility? -
ANSWER-They should contact the Social Security Administration or their state
Medicaid agency for guidance.
, What is the significance of a Federally declared disaster in relation to Medicare
enrollment? - ANSWER-It allows individuals who missed their enrollment period
to qualify for a special enrollment period.
What is the difference between Medicare Advantage and Original Medicare
regarding coverage? - ANSWER-Medicare Advantage plans may offer additional
benefits but cannot be combined with Medigap plans.
What is the importance of immunosuppressive drug coverage for kidney
transplant patients? - ANSWER-It is critical for preventing organ rejection and
maintaining health post-transplant.
How does income affect the premium for Part B coverage? - ANSWER-Individuals
with higher incomes may pay a higher monthly premium for Part B.
What is Juan likely entitled to when he turns age 65 regarding Medicare? -
ANSWER-Juan is likely to be eligible for Medicare.
How would enrolling in Medicare impact Juan's employer-sponsored healthcare
coverage? - ANSWER-If Juan enrolls, Medicare becomes the primary payor of his
healthcare claims, and his employer's plan becomes a secondary payor.
What eligibility criteria does Ms. Kumar meet for Medicare despite her concerns
about income? - ANSWER-Medicare is available for people age 65 or older, so Ms.
Kumar will be eligible regardless of her income.
