AHIP FINAL 2026/2027 LATEST EDITION
200+ ACTUAL QUESTIONS AND CORRECT
DETAILED ANSWERS|GUARANTEED A+
PASS
Question 1: 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?
A) His Medicare coverage will end 12 months after transplant surgery, regardless of his age.
B) His Medicare coverage will continue as long as he receives follow-up care for the
transplant.
C) His Medicare coverage will end 36 months after the transplant unless he otherwise
qualifies.
D) His Medicare coverage ends immediately after transplant surgery.
Answer: C
Rationale: For individuals eligible for Medicare due to ESRD, coverage ends 36 months after a
successful kidney transplant unless they qualify for Medicare due to age or disability. Edward's
coverage will continue for 3 years post-transplant unless he turns 65 or qualifies for disability.
Question 2: 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) Only inpatient hospital services are covered.
B) Part A covers hospital, skilled nursing facility, hospice, and home health services; Part B
covers doctor and outpatient services.
C) All vision and dental care are covered without limits.
D) Prescription drugs are always covered under Original Medicare.
Answer: B
Page 1 SUCCESS!!!
, Rationale: Original Medicare consists of Part A (inpatient, SNF, hospice, home health) and Part
B (physician, outpatient, preventive care). It does not cover routine dental/vision or most
outpatient prescription drugs.
Question 3: Mr. Vasquez is in good health and is preparing a budget in anticipation of his
retirement when he turns 66. He wants to understand the health care costs he might be
exposed to under Medicare if he were to require hospitalization because of an illness. In
general terms, what could you tell him about his costs for inpatient hospital services under
Original Medicare?
A) There are no costs for inpatient hospitalization.
B) He pays a deductible for the first 60 days, then daily coinsurance rates apply.
C) He pays a flat rate regardless of length of stay.
D) He pays a premium for each hospital stay.
Answer: B
Rationale: Under Part A, Original Medicare requires payment of a deductible for each benefit
period. For days 1-60, only the deductible is required; days 61-90 require daily coinsurance;
days 91+ up to 60 "lifetime reserve days" also require higher coinsurance; after that, all costs
are out-of-pocket.
Question 4: Mrs. Foster is covered by Original Medicare. She sustained a hip fracture and is
being successfully treated for that condition. 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 covers only 3 days per benefit period.
B) Medicare covers all nursing facility care indefinitely.
C) Medicare covers 100 days per benefit period: first 20 days fully covered, next 80 days with
copay, after that, no coverage.
D) Medicare only covers outpatient rehabilitative care.
Answer: C
Rationale: After a qualifying hospital stay, Original Medicare covers skilled nursing facility care
for up to 100 days — the first 20 days at no cost to the beneficiary, days 21-100 with a daily
coinsurance, after which all costs are the patient's responsibility.
Page 2 SUCCESS!!!
, Question 5: Which of the following is covered under Medicare Part A?
A) Hospice care
B) Physician services
C) Outpatient surgery
D) Durable medical equipment
Answer: A
Rationale: Hospice care is a benefit under Part A of Medicare, available to terminally ill
individuals who elect to focus on comfort care rather than curative treatment. Coverage
includes pain relief, symptom management, and support services.
Question 6: 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?
A) He is ineligible for any further assistance.
B) State Pharmaceutical Assistance Program (SPAP) may help.
C) Only Medicaid can cover his drug costs.
D) He must pay full cost for medications.
Answer: B
Rationale: Many states offer State Pharmaceutical Assistance Programs (SPAPs) to help
residents with prescription drug costs, particularly those who do not qualify for the federal
Extra Help program (low-income subsidy).
Question 7: Ms. Kumar is approaching age 65 and is concerned that her income will make it
impossible for her to qualify for Medicare. What could you tell her to address her concern?
A) Ms. Kumar's high income will disqualify her from Medicare coverage.
B) Medicare is a program for people age 65 or older and those under age 65 with certain
disabilities, ESRD, and ALS, so she will be eligible for Medicare.
C) Only those with low income are eligible for Medicare.
D) Ms. Kumar needs to apply for Medicaid, not Medicare.
Answer: B
Page 3 SUCCESS!!!
, Rationale: Medicare eligibility is primarily based on age (65+) and certain medical conditions,
not income. While a higher income may impact premium amounts for Part B and Part D
through Income-Related Monthly Adjustment Amount (IRMAA), it does not prevent eligibility.
Question 8: 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?
A) He may sign up for Medicare at any time; however, coverage usually begins on the fourth
month after dialysis treatments start.
B) He is not eligible for Medicare until age 65.
C) He must wait 12 months after starting dialysis.
D) He can only receive Medicare if he qualifies for disability first.
Answer: A
Rationale: Medicare eligibility for ESRD begins with dialysis treatments. Coverage typically
starts on the fourth month after dialysis treatments begin, although there is a waiting period.
MODULE 2: MEDICARE HEALTH PLANS (MA & MEDIGAP)
Question 9: 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?
A) He can enroll in both MA and Medigap plans.
B) Medigap can only be used with Original Medicare, not MA plans.
C) Medigap will cover costs not included by MA plans.
D) He does not need any plan.
Answer: B
Rationale: Federal law prohibits the sale of Medigap policies to individuals enrolled in
Medicare Advantage, since Medigap supplements only Original Medicare (Part A and Part B),
not Medicare Advantage plans.
Question 10: A Medicare Advantage plan is evaluating its network adequacy for a new PPO
product in a rural county. The plan must ensure that at least one of each provider type is
available within certain time and distance standards. Which provider type is subject to the
strictest time and distance standard under CMS regulations?
Page 4 SUCCESS!!!
200+ ACTUAL QUESTIONS AND CORRECT
DETAILED ANSWERS|GUARANTEED A+
PASS
Question 1: 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?
A) His Medicare coverage will end 12 months after transplant surgery, regardless of his age.
B) His Medicare coverage will continue as long as he receives follow-up care for the
transplant.
C) His Medicare coverage will end 36 months after the transplant unless he otherwise
qualifies.
D) His Medicare coverage ends immediately after transplant surgery.
Answer: C
Rationale: For individuals eligible for Medicare due to ESRD, coverage ends 36 months after a
successful kidney transplant unless they qualify for Medicare due to age or disability. Edward's
coverage will continue for 3 years post-transplant unless he turns 65 or qualifies for disability.
Question 2: 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) Only inpatient hospital services are covered.
B) Part A covers hospital, skilled nursing facility, hospice, and home health services; Part B
covers doctor and outpatient services.
C) All vision and dental care are covered without limits.
D) Prescription drugs are always covered under Original Medicare.
Answer: B
Page 1 SUCCESS!!!
, Rationale: Original Medicare consists of Part A (inpatient, SNF, hospice, home health) and Part
B (physician, outpatient, preventive care). It does not cover routine dental/vision or most
outpatient prescription drugs.
Question 3: Mr. Vasquez is in good health and is preparing a budget in anticipation of his
retirement when he turns 66. He wants to understand the health care costs he might be
exposed to under Medicare if he were to require hospitalization because of an illness. In
general terms, what could you tell him about his costs for inpatient hospital services under
Original Medicare?
A) There are no costs for inpatient hospitalization.
B) He pays a deductible for the first 60 days, then daily coinsurance rates apply.
C) He pays a flat rate regardless of length of stay.
D) He pays a premium for each hospital stay.
Answer: B
Rationale: Under Part A, Original Medicare requires payment of a deductible for each benefit
period. For days 1-60, only the deductible is required; days 61-90 require daily coinsurance;
days 91+ up to 60 "lifetime reserve days" also require higher coinsurance; after that, all costs
are out-of-pocket.
Question 4: Mrs. Foster is covered by Original Medicare. She sustained a hip fracture and is
being successfully treated for that condition. 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 covers only 3 days per benefit period.
B) Medicare covers all nursing facility care indefinitely.
C) Medicare covers 100 days per benefit period: first 20 days fully covered, next 80 days with
copay, after that, no coverage.
D) Medicare only covers outpatient rehabilitative care.
Answer: C
Rationale: After a qualifying hospital stay, Original Medicare covers skilled nursing facility care
for up to 100 days — the first 20 days at no cost to the beneficiary, days 21-100 with a daily
coinsurance, after which all costs are the patient's responsibility.
Page 2 SUCCESS!!!
, Question 5: Which of the following is covered under Medicare Part A?
A) Hospice care
B) Physician services
C) Outpatient surgery
D) Durable medical equipment
Answer: A
Rationale: Hospice care is a benefit under Part A of Medicare, available to terminally ill
individuals who elect to focus on comfort care rather than curative treatment. Coverage
includes pain relief, symptom management, and support services.
Question 6: 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?
A) He is ineligible for any further assistance.
B) State Pharmaceutical Assistance Program (SPAP) may help.
C) Only Medicaid can cover his drug costs.
D) He must pay full cost for medications.
Answer: B
Rationale: Many states offer State Pharmaceutical Assistance Programs (SPAPs) to help
residents with prescription drug costs, particularly those who do not qualify for the federal
Extra Help program (low-income subsidy).
Question 7: Ms. Kumar is approaching age 65 and is concerned that her income will make it
impossible for her to qualify for Medicare. What could you tell her to address her concern?
A) Ms. Kumar's high income will disqualify her from Medicare coverage.
B) Medicare is a program for people age 65 or older and those under age 65 with certain
disabilities, ESRD, and ALS, so she will be eligible for Medicare.
C) Only those with low income are eligible for Medicare.
D) Ms. Kumar needs to apply for Medicaid, not Medicare.
Answer: B
Page 3 SUCCESS!!!
, Rationale: Medicare eligibility is primarily based on age (65+) and certain medical conditions,
not income. While a higher income may impact premium amounts for Part B and Part D
through Income-Related Monthly Adjustment Amount (IRMAA), it does not prevent eligibility.
Question 8: 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?
A) He may sign up for Medicare at any time; however, coverage usually begins on the fourth
month after dialysis treatments start.
B) He is not eligible for Medicare until age 65.
C) He must wait 12 months after starting dialysis.
D) He can only receive Medicare if he qualifies for disability first.
Answer: A
Rationale: Medicare eligibility for ESRD begins with dialysis treatments. Coverage typically
starts on the fourth month after dialysis treatments begin, although there is a waiting period.
MODULE 2: MEDICARE HEALTH PLANS (MA & MEDIGAP)
Question 9: 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?
A) He can enroll in both MA and Medigap plans.
B) Medigap can only be used with Original Medicare, not MA plans.
C) Medigap will cover costs not included by MA plans.
D) He does not need any plan.
Answer: B
Rationale: Federal law prohibits the sale of Medigap policies to individuals enrolled in
Medicare Advantage, since Medigap supplements only Original Medicare (Part A and Part B),
not Medicare Advantage plans.
Question 10: A Medicare Advantage plan is evaluating its network adequacy for a new PPO
product in a rural county. The plan must ensure that at least one of each provider type is
available within certain time and distance standards. Which provider type is subject to the
strictest time and distance standard under CMS regulations?
Page 4 SUCCESS!!!
