AHIP 2026 MEDICARE CERTIFICATION
EXAM PREP: MODULES 1–5, FINAL EXAM
& FRAUD, WASTE, AND ABUSE (FWA)
PRACTICE QUESTIONS WITH VERIFIED
ANSWERS
What happens after Mr. Bauer has received disability payments for 24 months?
- CORRECT ANSWER : -He will be automatically enrolled in Medicare,
regardless of age.
Why did Edward become eligible for Medicare coverage? - CORRECT 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? - CORRECT 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? -
CORRECT 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? - CORRECT 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? - CORRECT 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? - CORRECT 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? - CORRECT 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? - CORRECT 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? - CORRECT
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? - CORRECT
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? - CORRECT
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? - CORRECT
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? - CORRECT 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? - CORRECT 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? - CORRECT 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? - CORRECT ANSWER : -36 months after the
month of the transplant.
What should individuals do if they are unsure about their Medicare eligibility? -
CORRECT 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? - CORRECT 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? - CORRECT ANSWER : -Medicare Advantage plans may
offer additional benefits but cannot be combined with Medigap plans.
EXAM PREP: MODULES 1–5, FINAL EXAM
& FRAUD, WASTE, AND ABUSE (FWA)
PRACTICE QUESTIONS WITH VERIFIED
ANSWERS
What happens after Mr. Bauer has received disability payments for 24 months?
- CORRECT ANSWER : -He will be automatically enrolled in Medicare,
regardless of age.
Why did Edward become eligible for Medicare coverage? - CORRECT 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? - CORRECT 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? -
CORRECT 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? - CORRECT 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? - CORRECT 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? - CORRECT 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? - CORRECT 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? - CORRECT 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? - CORRECT
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? - CORRECT
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? - CORRECT
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? - CORRECT
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? - CORRECT 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? - CORRECT 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? - CORRECT 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? - CORRECT ANSWER : -36 months after the
month of the transplant.
What should individuals do if they are unsure about their Medicare eligibility? -
CORRECT 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? - CORRECT 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? - CORRECT ANSWER : -Medicare Advantage plans may
offer additional benefits but cannot be combined with Medigap plans.
