AHIP FINAL EXAM 2026 – Complete Practice Test Bank with 200
Questions, Verified Answers, and Detailed Rationales Covering
Medicare Advantage, Part D, FWA, and Compliance Standards
INTRODUCTION:
The AHIP (America's Health Insurance Plans) Final Exam is more than just a test—it is your
ticket to Medicare certification and a successful career in health insurance. Whether you are an
independent insurance agent, a broker, or a healthcare professional navigating the complexities
of Medicare, passing this exam is non-negotiable. It validates your understanding of Medicare
regulations, compliance standards, and ethical marketing practices—and it is required annually
to market and sell Medicare products.
1. 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? - CORRECT ANSWER-
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.
2. 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? -
CORRECT ANSWER-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.
3. 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? - CORRECT ANSWER-Mr. Diaz will not pay any penalty because he had continuous
coverage under his employer's plan.
, 4. Mr. Moy's wife has a Medicare Advantage plan, but he wants to understand what coverage
Medicare Supplemental Insurance provides since his health care needs are different from his
wife's needs. What could you tell Mr. Moy? - CORRECT ANSWER-Medicare Supplemental
Insurance would help cover his Part A and Part B deductibles or coinsurance in Original Fee-for-
Service (FFS) Medicare as well as possibly some services that Medicare does not cover.
5. Mrs. Chen will be 65 soon, has been a citizen for twelve years, has been employed full time, and
paid taxes during that entire period. She is concerned that she will not qualify for coverage
under part A because she was not born in the United States. What should you tell her? -
CORRECT ANSWER-Most individuals who are citizens and age 65 or over are covered under Part
A by virtue of having paid
Medicare taxes while working, though some may be covered as a result of paying monthly premiums.
6. 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? - CORRECT ANSWER-After
receiving such disability payments for 24 months, he will be automatically enrolled in Medicare,
regardless of age.
7. Mr. Xi will soon turn age 65 and has come to you for advice as to what services are provided
under Original Medicare. What should you tell Mr. Xi that best describes the health coverage
provided to Medicare beneficiaries? - CORRECT ANSWER-Beneficiaries under Original Medicare
have no cost-sharing for most preventive services which include immunizations such as annual
flu shots.
8. 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? - CORRECT ANSWER-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.
9. 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? - CORRECT ANSWER-He may sign-up for Medicare at any time however
coverage usually begins on the fourth month after dialysis treatments start.
, 10. 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? - CORRECT ANSWER-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.
11. Ms. Henderson believes that she will qualify for Medicare Coverage when she turns 65, without
paying any premiums, because she has been working for 40 years and paying Medicare taxes.
What should you tell her? - CORRECT ANSWER-To obtain Part B coverage, she must pay a
standard monthly premium, though it is higher for individuals with higher incomes.
12. To obtain Part B coverage, she must pay a standard monthly premium, though it is higher for
individuals with higher incomes. - CORRECT ANSWER-Mrs. Gonzalez cannot purchase a Medigap
plan that covers drugs, but she could keep her Medigap policy and enroll in a Part D prescription
drug plan.
13. 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? - CORRECT ANSWER-Tell prospect Jerry Smith that he
should consider adding a standalone Part D prescription drug coverage policy to his present
coverage.
14. Ms. Moore plans to retire when she turns 65 in a few months. She is in excellent health and will
have considerable income when she retires. She is concerned that her income will make it
impossible for her to qualify for Medicare. What could you tell her to address her concern? -
CORRECT ANSWER-Medicare is a program for people age 65 or older and those under age 65
with certain disabilities, end-stage renal disease, and Lou Gehrig's disease so she will be eligible
for Medicare.
15. 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? - CORRECT ANSWER-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.
Questions, Verified Answers, and Detailed Rationales Covering
Medicare Advantage, Part D, FWA, and Compliance Standards
INTRODUCTION:
The AHIP (America's Health Insurance Plans) Final Exam is more than just a test—it is your
ticket to Medicare certification and a successful career in health insurance. Whether you are an
independent insurance agent, a broker, or a healthcare professional navigating the complexities
of Medicare, passing this exam is non-negotiable. It validates your understanding of Medicare
regulations, compliance standards, and ethical marketing practices—and it is required annually
to market and sell Medicare products.
1. 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? - CORRECT ANSWER-
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.
2. 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? -
CORRECT ANSWER-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.
3. 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? - CORRECT ANSWER-Mr. Diaz will not pay any penalty because he had continuous
coverage under his employer's plan.
, 4. Mr. Moy's wife has a Medicare Advantage plan, but he wants to understand what coverage
Medicare Supplemental Insurance provides since his health care needs are different from his
wife's needs. What could you tell Mr. Moy? - CORRECT ANSWER-Medicare Supplemental
Insurance would help cover his Part A and Part B deductibles or coinsurance in Original Fee-for-
Service (FFS) Medicare as well as possibly some services that Medicare does not cover.
5. Mrs. Chen will be 65 soon, has been a citizen for twelve years, has been employed full time, and
paid taxes during that entire period. She is concerned that she will not qualify for coverage
under part A because she was not born in the United States. What should you tell her? -
CORRECT ANSWER-Most individuals who are citizens and age 65 or over are covered under Part
A by virtue of having paid
Medicare taxes while working, though some may be covered as a result of paying monthly premiums.
6. 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? - CORRECT ANSWER-After
receiving such disability payments for 24 months, he will be automatically enrolled in Medicare,
regardless of age.
7. Mr. Xi will soon turn age 65 and has come to you for advice as to what services are provided
under Original Medicare. What should you tell Mr. Xi that best describes the health coverage
provided to Medicare beneficiaries? - CORRECT ANSWER-Beneficiaries under Original Medicare
have no cost-sharing for most preventive services which include immunizations such as annual
flu shots.
8. 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? - CORRECT ANSWER-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.
9. 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? - CORRECT ANSWER-He may sign-up for Medicare at any time however
coverage usually begins on the fourth month after dialysis treatments start.
, 10. 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? - CORRECT ANSWER-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.
11. Ms. Henderson believes that she will qualify for Medicare Coverage when she turns 65, without
paying any premiums, because she has been working for 40 years and paying Medicare taxes.
What should you tell her? - CORRECT ANSWER-To obtain Part B coverage, she must pay a
standard monthly premium, though it is higher for individuals with higher incomes.
12. To obtain Part B coverage, she must pay a standard monthly premium, though it is higher for
individuals with higher incomes. - CORRECT ANSWER-Mrs. Gonzalez cannot purchase a Medigap
plan that covers drugs, but she could keep her Medigap policy and enroll in a Part D prescription
drug plan.
13. 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? - CORRECT ANSWER-Tell prospect Jerry Smith that he
should consider adding a standalone Part D prescription drug coverage policy to his present
coverage.
14. Ms. Moore plans to retire when she turns 65 in a few months. She is in excellent health and will
have considerable income when she retires. She is concerned that her income will make it
impossible for her to qualify for Medicare. What could you tell her to address her concern? -
CORRECT ANSWER-Medicare is a program for people age 65 or older and those under age 65
with certain disabilities, end-stage renal disease, and Lou Gehrig's disease so she will be eligible
for Medicare.
15. 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? - CORRECT ANSWER-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.
