AHIP Medicare Certification Exam 2026 |
Comprehensive Study Guide with Complete Exam
Questions and Verified Correct Answers| Latest
Updated Guide!!
Question 1
Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What could you tell
Mrs. Park that might be of assistance?
Answer: She should contact her state Medicaid agency to see if she qualifies for
programs that can help with Medicare costs for which she is responsible.
Question 2
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?
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 to her substantial income.
Question 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?
Answer: After receiving such disability payments for 24 months, he will be
automatically enrolled in Medicare, regardless of age.
pg. 1
,Question 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?
Answer: Part A, which covers hospital, skilled nursing facility, hospice and home
health services and Part B, which covers professional services such as those provided by
a doctor are covered under Original Medicare.
Question 5
Mrs. Peña 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?
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 that differs from the standard
general enrollment period, during which she may enroll in Medicare Part B.
Question 6
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?
Answer: Tell prospect Jerry Smith that he should consider adding a standalone Part D
prescription drug coverage policy to his present coverage.
Question 7
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?
Answer: The penalty will be a permanent 10% increase in his Part B premium for every
12-month period that passed during which he could have enrolled and did not.
Question 8
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
pg. 2
,will make it impossible for her to qualify for Medicare. What could you tell her to
address her concern?
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.
Question 9
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?
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.
Question 10
Mr. Gomez notes that a Private Fee-for-Service (PFFS) plan available in his area has an
attractive premium. He wants to know if he must use doctors in a network as his current
HMO plan requires him to do. What should you tell him?
Answer: He may receive health care services from any doctor allowed to bill Medicare,
as long as he shows the doctor the plan's identification card and the doctor agrees to
accept the PFFS plan's payment terms and conditions, which could include balance
billing.
Question 11
Mr. Kelly wants to know whether he is eligible to sign up for a Private fee-for-service
(PFFS) plan. What questions would you need to ask to determine his eligibility?
Answer: You would need to ask Mr. Kelly if he is enrolled in Part A and Part B and if he
lives in the PFFS plan's service area.
Question 12
Mrs. Wang wants to know generally how the benefits under Original Medicare might
compare to the benefits package of a Medicare Advantage Plan before she starts looking
at specific plans. What could you tell her?
pg. 3
, Answer: Medicare Advantage Plans may offer extra benefits that Original Medicare
does not offer such as vision, hearing, and dental services. It must include a maximum
out-of-pocket limit on Part A and Part B services.
Question 13
Mr. Castillo, a naturalized citizen, previously enrolled in Medicare Part B but has
recently stopped paying his Part B premium. Mr. Castillo is still covered by Part A. He
would like to enroll in a Medicare Advantage (MA) plan and is still covered by Part A.
What should you tell him?
Answer: He is not eligible to enroll in a Medicare Advantage plan until he re-enrolls in
Medicare Part B.
Question 14
Mr. Barker enjoys a comfortable retirement income. He recently had surgery and
expected that he would have certain services and items covered by the plan with
minimal out-of-pocket costs because his MA-PD coverage has been very good. However,
when he received the bill, he was surprised to see large charges in excess of his
maximum out-of-pocket limit that included some services and items he thought would
be fully covered. He called you to ask what he could do? What could you tell him?
Answer: You can offer to review the plan's appeal process to help him ask the plan to
review the coverage decision.
Question 15
Mrs. Chi is age 75 and enjoys a comfortable but not extremely high-income level. She
wishes to enroll in a MA MSA plan that she heard about from her neighbor. She also
wants to have prescription drug coverage since her doctor recently prescribed several
expensive medications. Currently, she is enrolled in Original Medicare and a standalone
Part D plan. How would you advise Mrs. Chi?
Answer: Mrs. Chi may enroll in a MA MSA plan and remain in her current standalone
Part D prescription drug plan.
Question 16
Mrs. Ramos is considering a Medicare Advantage PPO and has questions about which
providers she can go to for her health care. What should you tell her?
pg. 4
Comprehensive Study Guide with Complete Exam
Questions and Verified Correct Answers| Latest
Updated Guide!!
Question 1
Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What could you tell
Mrs. Park that might be of assistance?
Answer: She should contact her state Medicaid agency to see if she qualifies for
programs that can help with Medicare costs for which she is responsible.
Question 2
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?
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 to her substantial income.
Question 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?
Answer: After receiving such disability payments for 24 months, he will be
automatically enrolled in Medicare, regardless of age.
pg. 1
,Question 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?
Answer: Part A, which covers hospital, skilled nursing facility, hospice and home
health services and Part B, which covers professional services such as those provided by
a doctor are covered under Original Medicare.
Question 5
Mrs. Peña 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?
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 that differs from the standard
general enrollment period, during which she may enroll in Medicare Part B.
Question 6
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?
Answer: Tell prospect Jerry Smith that he should consider adding a standalone Part D
prescription drug coverage policy to his present coverage.
Question 7
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?
Answer: The penalty will be a permanent 10% increase in his Part B premium for every
12-month period that passed during which he could have enrolled and did not.
Question 8
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
pg. 2
,will make it impossible for her to qualify for Medicare. What could you tell her to
address her concern?
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.
Question 9
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?
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.
Question 10
Mr. Gomez notes that a Private Fee-for-Service (PFFS) plan available in his area has an
attractive premium. He wants to know if he must use doctors in a network as his current
HMO plan requires him to do. What should you tell him?
Answer: He may receive health care services from any doctor allowed to bill Medicare,
as long as he shows the doctor the plan's identification card and the doctor agrees to
accept the PFFS plan's payment terms and conditions, which could include balance
billing.
Question 11
Mr. Kelly wants to know whether he is eligible to sign up for a Private fee-for-service
(PFFS) plan. What questions would you need to ask to determine his eligibility?
Answer: You would need to ask Mr. Kelly if he is enrolled in Part A and Part B and if he
lives in the PFFS plan's service area.
Question 12
Mrs. Wang wants to know generally how the benefits under Original Medicare might
compare to the benefits package of a Medicare Advantage Plan before she starts looking
at specific plans. What could you tell her?
pg. 3
, Answer: Medicare Advantage Plans may offer extra benefits that Original Medicare
does not offer such as vision, hearing, and dental services. It must include a maximum
out-of-pocket limit on Part A and Part B services.
Question 13
Mr. Castillo, a naturalized citizen, previously enrolled in Medicare Part B but has
recently stopped paying his Part B premium. Mr. Castillo is still covered by Part A. He
would like to enroll in a Medicare Advantage (MA) plan and is still covered by Part A.
What should you tell him?
Answer: He is not eligible to enroll in a Medicare Advantage plan until he re-enrolls in
Medicare Part B.
Question 14
Mr. Barker enjoys a comfortable retirement income. He recently had surgery and
expected that he would have certain services and items covered by the plan with
minimal out-of-pocket costs because his MA-PD coverage has been very good. However,
when he received the bill, he was surprised to see large charges in excess of his
maximum out-of-pocket limit that included some services and items he thought would
be fully covered. He called you to ask what he could do? What could you tell him?
Answer: You can offer to review the plan's appeal process to help him ask the plan to
review the coverage decision.
Question 15
Mrs. Chi is age 75 and enjoys a comfortable but not extremely high-income level. She
wishes to enroll in a MA MSA plan that she heard about from her neighbor. She also
wants to have prescription drug coverage since her doctor recently prescribed several
expensive medications. Currently, she is enrolled in Original Medicare and a standalone
Part D plan. How would you advise Mrs. Chi?
Answer: Mrs. Chi may enroll in a MA MSA plan and remain in her current standalone
Part D prescription drug plan.
Question 16
Mrs. Ramos is considering a Medicare Advantage PPO and has questions about which
providers she can go to for her health care. What should you tell her?
pg. 4
