AHIP 2027 Final Exam Actual Questions
Answers – Medicare Certification Pass
Guarantee (Updated PDF)
QUESTION 1
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) You can sell him a Medigap plan to help with costs not
covered under Medicare Advantage.
B) 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.
C) Medigap plans are designed to work alongside
Medicare Advantage plans.
D) He must disenroll from his MA plan before buying a
Medigap plan.
Correct Answer: B
Rationale: Federal law prohibits the sale of a Medigap
policy to any individual enrolled in a Medicare Advantage
,plan. Medigap policies are designed exclusively to
supplement Original Medicare (Parts A and B) cost-
sharing and cannot be used to cover MA plan
deductibles, copays, or coinsurance.
QUESTION 2
Edward 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?
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.
,Correct Answer: C
Rationale: For beneficiaries who qualify for Medicare
solely due to ESRD, Medicare coverage terminates 36
months after a successful kidney transplant. Coverage
continues for those 36 post-transplant months unless the
individual becomes eligible for Medicare due to age (65+)
or another qualifying disability before that period ends.
QUESTION 3
Mr. Wu is eligible for Medicare. He has limited financial
resources but failed to qualify for the Part D low-income
subsidy (Extra Help). Where might he turn for help with
his prescription drug costs?
A) Apply for Medicaid to cover prescription costs.
B) Seek assistance from pharmaceutical company
discount programs.
C) Mr. Wu may still qualify for help in paying Part D costs
through his State Pharmaceutical Assistance Program
(SPAP).
D) Try to enroll in a Medigap plan with drug coverage.
, Correct Answer: C
Rationale: Many states operate State Pharmaceutical
Assistance Programs (SPAPs) that provide additional
financial help with Part D premiums and cost-sharing to
residents who do not qualify for the federal Low-Income
Subsidy. SPAP eligibility, benefits, and income limits vary
by state. Medigap policies with drug coverage are no
longer sold to new Medicare beneficiaries.
QUESTION 4
Mrs. Ramos is considering a Medicare Advantage
Prescription Drug (MA-PD) plan. She is currently taking a
brand-name medication that is not on the plan's
formulary. Under CMS guidelines, what option does she
have?
A) She may request a formulary exception to cover the
medication.
B) She must switch to a different medication that is on
the formulary.
C) She may pay full price for the drug out-of-pocket and
Answers – Medicare Certification Pass
Guarantee (Updated PDF)
QUESTION 1
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) You can sell him a Medigap plan to help with costs not
covered under Medicare Advantage.
B) 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.
C) Medigap plans are designed to work alongside
Medicare Advantage plans.
D) He must disenroll from his MA plan before buying a
Medigap plan.
Correct Answer: B
Rationale: Federal law prohibits the sale of a Medigap
policy to any individual enrolled in a Medicare Advantage
,plan. Medigap policies are designed exclusively to
supplement Original Medicare (Parts A and B) cost-
sharing and cannot be used to cover MA plan
deductibles, copays, or coinsurance.
QUESTION 2
Edward 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?
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.
,Correct Answer: C
Rationale: For beneficiaries who qualify for Medicare
solely due to ESRD, Medicare coverage terminates 36
months after a successful kidney transplant. Coverage
continues for those 36 post-transplant months unless the
individual becomes eligible for Medicare due to age (65+)
or another qualifying disability before that period ends.
QUESTION 3
Mr. Wu is eligible for Medicare. He has limited financial
resources but failed to qualify for the Part D low-income
subsidy (Extra Help). Where might he turn for help with
his prescription drug costs?
A) Apply for Medicaid to cover prescription costs.
B) Seek assistance from pharmaceutical company
discount programs.
C) Mr. Wu may still qualify for help in paying Part D costs
through his State Pharmaceutical Assistance Program
(SPAP).
D) Try to enroll in a Medigap plan with drug coverage.
, Correct Answer: C
Rationale: Many states operate State Pharmaceutical
Assistance Programs (SPAPs) that provide additional
financial help with Part D premiums and cost-sharing to
residents who do not qualify for the federal Low-Income
Subsidy. SPAP eligibility, benefits, and income limits vary
by state. Medigap policies with drug coverage are no
longer sold to new Medicare beneficiaries.
QUESTION 4
Mrs. Ramos is considering a Medicare Advantage
Prescription Drug (MA-PD) plan. She is currently taking a
brand-name medication that is not on the plan's
formulary. Under CMS guidelines, what option does she
have?
A) She may request a formulary exception to cover the
medication.
B) She must switch to a different medication that is on
the formulary.
C) She may pay full price for the drug out-of-pocket and
