1
AHIP Final Exam Test Questions & Answers (Late
2025/2026)
—Version 2.0 Advanced
Comprehensive Practice Exam
—150 Questions
with Detailed Rationales
.
EXAM OVERVIEW
The AHIP (America's Health Insurance Plans) Medicare certification is mandatory for agents
marketing Medicare Advantage and Part D plans. The exam requires a 90% passing score with
a 2-hour time limit, and candidates are allowed 3 attempts per registration. Certification opens
annually on June 23 for the upcoming plan year. The final exam consists of 50 questions from
Modules 1–5, and the test is open-book for those not seeking CE credits. This comprehensive
practice exam features 150 advanced, scenario-based questions with detailed rationales
covering Medicare eligibility, Medicare Advantage (Part C), Part D prescription drug coverage,
Medigap, enrollment periods, marketing guidelines, fraud/waste/abuse prevention, and CMS
compliance standards.
SECTION 1: MEDICARE ELIGIBILITY, PARTS A & B — ADVANCED CONCEPTS (Questions 1–30)
Question 1
Mr. Yamamoto is a 67-year-old U.S. citizen who has worked and paid Medicare taxes for 32
quarters (8 years). He is currently covered under his spouse's employer-sponsored plan. He
wants to enroll in Medicare Part A but is concerned about costs. Which of the following
statements accurately describes his situation?
,2
A) He qualifies for premium-free Part A because he is a U.S. citizen over age 65
B) He does not qualify for premium-free Part A and must pay a monthly premium of up to $506
in 2025, though he may be eligible for a reduced premium based on his 30–39 quarters of
coverage
C) He can enroll in Part A at any time without penalty but must pay the full premium regardless
of work history
D) He is ineligible for Part A until he accumulates 40 quarters of Medicare taxes
- detailed 100% correctanswer :- B
Rationale: Premium-free Part A requires 40 quarters (10 years) of Medicare-covered
employment. Individuals with 30–39 quarters may purchase Part A at a reduced monthly
premium; those with fewer than 30 quarters pay the full premium.
Question 2
Mrs. Okafor is 64 and will turn 65 in four months. She is a lawful permanent resident who has
lived in the U.S. continuously for 6 years but has only worked and paid Medicare taxes for 3
years. She is concerned about her Medicare eligibility. What should you tell her?
A) She is not eligible for Medicare because she has not been a citizen for at least 5 years
B) She may be eligible for Medicare as a lawful permanent resident with 5+ years of continuous
residence, but she will need to purchase Part A since she does not have sufficient work history
C) She automatically qualifies for premium-free Part A because she is a permanent resident
D) She must wait until she has 40 quarters of work history before enrolling in any part of
Medicare
- detailed 100% correctanswer :- B
Rationale: Lawful permanent residents are eligible for Medicare if they have resided in the U.S.
continuously for at least 5 years. However, premium-free Part A requires 40 quarters of
Medicare taxes; with only 3 years (12 quarters), she would need to purchase Part A.
Question 3
Mr. Kowalski is 68 and has been enrolled in Medicare Part A since age 65. He delayed Part B
enrollment because he had creditable employer coverage through his job at a large corporation
with 400 employees. He retired last week and his employer coverage ended effective
immediately. When can he enroll in Part B, and what are the consequences?
A) He must wait until the next General Enrollment Period (January 1–March 31) and will pay a
10% late enrollment penalty for each year he delayed
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B) He has a Special Enrollment Period of 8 months beginning when his employer coverage
ended, during which he can enroll without penalty
C) He can enroll within 63 days of losing coverage without penalty, after which he must wait for
the General Enrollment Period
D) He permanently lost the opportunity to enroll in Part B and must rely on Part A only
- detailed 100% correctanswer :- B
Rationale: Individuals with creditable employer coverage have an 8-month Special Enrollment
Period (SEP) following the termination of that coverage to enroll in Part B without penalty.
Question 4
Ms. Donovan is 52 and was diagnosed with ALS (amyotrophic lateral sclerosis) 3 months ago.
She has been approved for Social Security disability benefits. When will her Medicare coverage
begin?
A) After receiving disability payments for 24 months from the date of diagnosis
B) Immediately upon approval of disability benefits, with no 24-month waiting period for ALS
C) When she turns 65, regardless of disability status
D) After 12 months of receiving disability payments
- detailed 100% correctanswer :- B
Rationale: Individuals diagnosed with ALS are eligible for Medicare immediately upon receiving
Social Security disability benefits, with no 24-month waiting period.
Question 5
Mr. Patterson is 70 and enrolled in Medicare Part A and Part B. He is hospitalized for a heart
attack and stays for 55 days. What are his out-of-pocket costs for this hospital stay under
Original Medicare?
A) He pays nothing for the first 60 days of hospitalization
B) He pays the Part A deductible for days 1–60, with no additional daily coinsurance until day 61
C) He pays 20% of all hospital charges for the entire stay
D) He pays a flat fee of $500 per day for all hospital days
- detailed 100% correctanswer :- B
Rationale: Under Original Medicare Part A, there is a single deductible for the first 60 days of
inpatient hospital care. Daily coinsurance begins on day 61 and continues through day 90.
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Question 6
Mrs. Higgins has Original Medicare and requires skilled nursing facility care following a knee
replacement. She has been in the SNF for 35 days. What are her costs?
A) Days 1–20: $0; Days 21–35: daily coinsurance payment
B) Days 1–35: $0 (fully covered)
C) Days 1–35: 20% coinsurance of all charges
D) Days 1–100: $0 (fully covered with no cost-sharing)
- detailed 100% correctanswer :- A
Rationale: Medicare Part A covers the first 20 days of SNF care at no cost to the beneficiary.
Days 21–100 require a daily coinsurance payment.
Question 7
Mr. Nguyen is 67 and has Medicare Part A and Part B. He receives a bill for outpatient physical
therapy services. Which part of Medicare covers this service, and what is his cost-sharing
obligation?
A) Part A covers outpatient physical therapy with no cost-sharing
B) Part B covers outpatient physical therapy; he pays 20% coinsurance after meeting the Part B
deductible
C) Part D covers physical therapy services with a copayment
D) Medicare does not cover outpatient physical therapy
- detailed 100% correctanswer :- B
Rationale: Outpatient physical therapy is covered under Medicare Part B. Beneficiaries pay 20%
coinsurance after meeting the Part B deductible.
Question 8
Ms. Friedman is 66 and enrolled in Original Medicare. She wants to understand what Medigap
(Medicare Supplement Insurance) covers. Which of the following statements is accurate?
A) Medigap policies cover prescription drugs, dental, and vision services
B) Medigap policies help cover out-of-pocket costs such as Part A and Part B deductibles,
coinsurance, and copayments under Original Medicare
C) Medigap policies replace Original Medicare entirely
D) Medigap policies are only available to Medicare Advantage enrollees
AHIP Final Exam Test Questions & Answers (Late
2025/2026)
—Version 2.0 Advanced
Comprehensive Practice Exam
—150 Questions
with Detailed Rationales
.
EXAM OVERVIEW
The AHIP (America's Health Insurance Plans) Medicare certification is mandatory for agents
marketing Medicare Advantage and Part D plans. The exam requires a 90% passing score with
a 2-hour time limit, and candidates are allowed 3 attempts per registration. Certification opens
annually on June 23 for the upcoming plan year. The final exam consists of 50 questions from
Modules 1–5, and the test is open-book for those not seeking CE credits. This comprehensive
practice exam features 150 advanced, scenario-based questions with detailed rationales
covering Medicare eligibility, Medicare Advantage (Part C), Part D prescription drug coverage,
Medigap, enrollment periods, marketing guidelines, fraud/waste/abuse prevention, and CMS
compliance standards.
SECTION 1: MEDICARE ELIGIBILITY, PARTS A & B — ADVANCED CONCEPTS (Questions 1–30)
Question 1
Mr. Yamamoto is a 67-year-old U.S. citizen who has worked and paid Medicare taxes for 32
quarters (8 years). He is currently covered under his spouse's employer-sponsored plan. He
wants to enroll in Medicare Part A but is concerned about costs. Which of the following
statements accurately describes his situation?
,2
A) He qualifies for premium-free Part A because he is a U.S. citizen over age 65
B) He does not qualify for premium-free Part A and must pay a monthly premium of up to $506
in 2025, though he may be eligible for a reduced premium based on his 30–39 quarters of
coverage
C) He can enroll in Part A at any time without penalty but must pay the full premium regardless
of work history
D) He is ineligible for Part A until he accumulates 40 quarters of Medicare taxes
- detailed 100% correctanswer :- B
Rationale: Premium-free Part A requires 40 quarters (10 years) of Medicare-covered
employment. Individuals with 30–39 quarters may purchase Part A at a reduced monthly
premium; those with fewer than 30 quarters pay the full premium.
Question 2
Mrs. Okafor is 64 and will turn 65 in four months. She is a lawful permanent resident who has
lived in the U.S. continuously for 6 years but has only worked and paid Medicare taxes for 3
years. She is concerned about her Medicare eligibility. What should you tell her?
A) She is not eligible for Medicare because she has not been a citizen for at least 5 years
B) She may be eligible for Medicare as a lawful permanent resident with 5+ years of continuous
residence, but she will need to purchase Part A since she does not have sufficient work history
C) She automatically qualifies for premium-free Part A because she is a permanent resident
D) She must wait until she has 40 quarters of work history before enrolling in any part of
Medicare
- detailed 100% correctanswer :- B
Rationale: Lawful permanent residents are eligible for Medicare if they have resided in the U.S.
continuously for at least 5 years. However, premium-free Part A requires 40 quarters of
Medicare taxes; with only 3 years (12 quarters), she would need to purchase Part A.
Question 3
Mr. Kowalski is 68 and has been enrolled in Medicare Part A since age 65. He delayed Part B
enrollment because he had creditable employer coverage through his job at a large corporation
with 400 employees. He retired last week and his employer coverage ended effective
immediately. When can he enroll in Part B, and what are the consequences?
A) He must wait until the next General Enrollment Period (January 1–March 31) and will pay a
10% late enrollment penalty for each year he delayed
,3
B) He has a Special Enrollment Period of 8 months beginning when his employer coverage
ended, during which he can enroll without penalty
C) He can enroll within 63 days of losing coverage without penalty, after which he must wait for
the General Enrollment Period
D) He permanently lost the opportunity to enroll in Part B and must rely on Part A only
- detailed 100% correctanswer :- B
Rationale: Individuals with creditable employer coverage have an 8-month Special Enrollment
Period (SEP) following the termination of that coverage to enroll in Part B without penalty.
Question 4
Ms. Donovan is 52 and was diagnosed with ALS (amyotrophic lateral sclerosis) 3 months ago.
She has been approved for Social Security disability benefits. When will her Medicare coverage
begin?
A) After receiving disability payments for 24 months from the date of diagnosis
B) Immediately upon approval of disability benefits, with no 24-month waiting period for ALS
C) When she turns 65, regardless of disability status
D) After 12 months of receiving disability payments
- detailed 100% correctanswer :- B
Rationale: Individuals diagnosed with ALS are eligible for Medicare immediately upon receiving
Social Security disability benefits, with no 24-month waiting period.
Question 5
Mr. Patterson is 70 and enrolled in Medicare Part A and Part B. He is hospitalized for a heart
attack and stays for 55 days. What are his out-of-pocket costs for this hospital stay under
Original Medicare?
A) He pays nothing for the first 60 days of hospitalization
B) He pays the Part A deductible for days 1–60, with no additional daily coinsurance until day 61
C) He pays 20% of all hospital charges for the entire stay
D) He pays a flat fee of $500 per day for all hospital days
- detailed 100% correctanswer :- B
Rationale: Under Original Medicare Part A, there is a single deductible for the first 60 days of
inpatient hospital care. Daily coinsurance begins on day 61 and continues through day 90.
, 4
Question 6
Mrs. Higgins has Original Medicare and requires skilled nursing facility care following a knee
replacement. She has been in the SNF for 35 days. What are her costs?
A) Days 1–20: $0; Days 21–35: daily coinsurance payment
B) Days 1–35: $0 (fully covered)
C) Days 1–35: 20% coinsurance of all charges
D) Days 1–100: $0 (fully covered with no cost-sharing)
- detailed 100% correctanswer :- A
Rationale: Medicare Part A covers the first 20 days of SNF care at no cost to the beneficiary.
Days 21–100 require a daily coinsurance payment.
Question 7
Mr. Nguyen is 67 and has Medicare Part A and Part B. He receives a bill for outpatient physical
therapy services. Which part of Medicare covers this service, and what is his cost-sharing
obligation?
A) Part A covers outpatient physical therapy with no cost-sharing
B) Part B covers outpatient physical therapy; he pays 20% coinsurance after meeting the Part B
deductible
C) Part D covers physical therapy services with a copayment
D) Medicare does not cover outpatient physical therapy
- detailed 100% correctanswer :- B
Rationale: Outpatient physical therapy is covered under Medicare Part B. Beneficiaries pay 20%
coinsurance after meeting the Part B deductible.
Question 8
Ms. Friedman is 66 and enrolled in Original Medicare. She wants to understand what Medigap
(Medicare Supplement Insurance) covers. Which of the following statements is accurate?
A) Medigap policies cover prescription drugs, dental, and vision services
B) Medigap policies help cover out-of-pocket costs such as Part A and Part B deductibles,
coinsurance, and copayments under Original Medicare
C) Medigap policies replace Original Medicare entirely
D) Medigap policies are only available to Medicare Advantage enrollees
