AHIP Final Exam Test Questions 2026 | Questions &
Answers | Latest Update | Study Guide
1. What is one option available to Mr. Chen after dropping his retiree coverage
and becoming eligible for Medicare?
Apply for Medicaid
Continue with retiree coverage
Enroll in a Medicare Advantage plan
Purchase private health insurance
2. Why might Mrs. West be concerned about Medicare coverage for
acupuncture, glasses, and dentures?
These services are typically not covered by Medicare, leading to
potential out-of-pocket expenses.
These services require prior authorization from Medicare.
These services are fully covered under Medicare Part A.
These services are only available through Medicare Advantage plans.
3. If a patient is hospitalized for 10 days under Original Medicare, what costs
should they anticipate based on the standard coverage rules?
They will not incur any costs as long as they are admitted to the
hospital.
They will only pay a flat fee regardless of the length of stay.
They should anticipate paying the Part A deductible and possibly
additional daily coinsurance after the first 60 days.
They will only pay for outpatient services and not for inpatient care.
,4. If Mr. Johannsen gains the Part D low-income subsidy, how does that affect
his ability to enroll or disenroll in a Part D plan? Choose one answer.
The subsidy will become effective next year when he can enroll in a
different plan or disenroll from his current plan during the next Annual
Election Period.
He can enroll in or disenroll from a Part D plan at any time and the
subsidy will apply to the plan he chooses.
He can only enroll into or disenroll from an MA-PD plan.
He can apply the subsidy amount to his existing plan immediately, but
he cannot enroll in a different plan.
5. If Agent Armstrong violates Medicare's marketing rules while promoting ABC
Health Plan, what could be a potential consequence?
Agent Armstrong would receive a warning but no further action
would be taken.
Agent Armstrong could receive a bonus for increased enrollment
despite the violation.
Agent Armstrong could face penalties, including fines or loss of
licensure.
Agent Armstrong would be allowed to continue marketing without
any consequences.
6. If Mr. Moy decides to enroll in a Medicare Supplemental Insurance plan,
which of the following scenarios would most likely benefit him based on his
unique health care needs?
He only needs basic preventive care and rarely sees a doctor.
He prefers to manage his health care without insurance.
He is eligible for Medicaid and does not need additional coverage.
, He frequently visits specialists and requires additional coverage for
out-of-pocket expenses.
7. Ms. Lee is enrolled in an MA-PD plan but will be moving out of the plan's
service area next month. She is worried that she will not be able to enroll in
another plan available in her new residence until the Annual Election Period.
What should you tell her?
She will have to wait until the next Annual Election Period to be able
to enroll in a plan available in her new location.
She may continue to keep her existing plan, because all Medicare
health plans are required to provide coverage to anyone, no matter
where they live.
She is eligible for a Special Election Period that begins either the
month before her permanent move, if the plan is notified in
advance, or the month she provides notice of the move, and this
period typically lasts an additional two months.
She will be able to enroll in a new plan because she qualifies for a
Special Enrollment Period that begins 30 days after a plan's written
communications are returned by the United States Postal Service with
a notification that the resident has moved. So, she should be sure to
notify the Postal Service immediately.
8. 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?
Mrs. Ramos can obtain care from any provider who participates in
Original Medicare, but generally will have a higher cost-sharing
amount if she sees a provider who/that is not a part of the PPO
network.
, Mrs. Ramos should be aware that generally plan providers can decide,
on a case-by-case basis, whether they will treat her.
In general, Mrs. Ramos will need a referral to see specialists.
In general, Mrs. Ramos can obtain care from any provider who
participates in Original Medicare but will have to pay the difference
between the plan's allowed amount and the provider's usual and
customary charge.
9. If Mrs. Duarte decides to appeal the denial of her claim, what information
should she gather to support her case?
Documentation related to the services received and the reasons for
the denial.
A list of all her medications.
A letter from her doctor stating her eligibility.
Her previous Medicare Summary Notices.
10. If Mr. Barker's appeal is denied, what alternative options might he consider
to address the unexpected charges?
He could stop using his Medicare coverage altogether.
He could file a lawsuit against the Medicare program.
He could seek assistance from a Medicare advocate or explore
other coverage options.
He could change his address to avoid future charges.
11. If a beneficiary moves from a rural area to an urban area and wants to switch
their Medicare Advantage-Prescription Drug plan, what steps should they
take to ensure they utilize their special enrollment period effectively?
Answers | Latest Update | Study Guide
1. What is one option available to Mr. Chen after dropping his retiree coverage
and becoming eligible for Medicare?
Apply for Medicaid
Continue with retiree coverage
Enroll in a Medicare Advantage plan
Purchase private health insurance
2. Why might Mrs. West be concerned about Medicare coverage for
acupuncture, glasses, and dentures?
These services are typically not covered by Medicare, leading to
potential out-of-pocket expenses.
These services require prior authorization from Medicare.
These services are fully covered under Medicare Part A.
These services are only available through Medicare Advantage plans.
3. If a patient is hospitalized for 10 days under Original Medicare, what costs
should they anticipate based on the standard coverage rules?
They will not incur any costs as long as they are admitted to the
hospital.
They will only pay a flat fee regardless of the length of stay.
They should anticipate paying the Part A deductible and possibly
additional daily coinsurance after the first 60 days.
They will only pay for outpatient services and not for inpatient care.
,4. If Mr. Johannsen gains the Part D low-income subsidy, how does that affect
his ability to enroll or disenroll in a Part D plan? Choose one answer.
The subsidy will become effective next year when he can enroll in a
different plan or disenroll from his current plan during the next Annual
Election Period.
He can enroll in or disenroll from a Part D plan at any time and the
subsidy will apply to the plan he chooses.
He can only enroll into or disenroll from an MA-PD plan.
He can apply the subsidy amount to his existing plan immediately, but
he cannot enroll in a different plan.
5. If Agent Armstrong violates Medicare's marketing rules while promoting ABC
Health Plan, what could be a potential consequence?
Agent Armstrong would receive a warning but no further action
would be taken.
Agent Armstrong could receive a bonus for increased enrollment
despite the violation.
Agent Armstrong could face penalties, including fines or loss of
licensure.
Agent Armstrong would be allowed to continue marketing without
any consequences.
6. If Mr. Moy decides to enroll in a Medicare Supplemental Insurance plan,
which of the following scenarios would most likely benefit him based on his
unique health care needs?
He only needs basic preventive care and rarely sees a doctor.
He prefers to manage his health care without insurance.
He is eligible for Medicaid and does not need additional coverage.
, He frequently visits specialists and requires additional coverage for
out-of-pocket expenses.
7. Ms. Lee is enrolled in an MA-PD plan but will be moving out of the plan's
service area next month. She is worried that she will not be able to enroll in
another plan available in her new residence until the Annual Election Period.
What should you tell her?
She will have to wait until the next Annual Election Period to be able
to enroll in a plan available in her new location.
She may continue to keep her existing plan, because all Medicare
health plans are required to provide coverage to anyone, no matter
where they live.
She is eligible for a Special Election Period that begins either the
month before her permanent move, if the plan is notified in
advance, or the month she provides notice of the move, and this
period typically lasts an additional two months.
She will be able to enroll in a new plan because she qualifies for a
Special Enrollment Period that begins 30 days after a plan's written
communications are returned by the United States Postal Service with
a notification that the resident has moved. So, she should be sure to
notify the Postal Service immediately.
8. 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?
Mrs. Ramos can obtain care from any provider who participates in
Original Medicare, but generally will have a higher cost-sharing
amount if she sees a provider who/that is not a part of the PPO
network.
, Mrs. Ramos should be aware that generally plan providers can decide,
on a case-by-case basis, whether they will treat her.
In general, Mrs. Ramos will need a referral to see specialists.
In general, Mrs. Ramos can obtain care from any provider who
participates in Original Medicare but will have to pay the difference
between the plan's allowed amount and the provider's usual and
customary charge.
9. If Mrs. Duarte decides to appeal the denial of her claim, what information
should she gather to support her case?
Documentation related to the services received and the reasons for
the denial.
A list of all her medications.
A letter from her doctor stating her eligibility.
Her previous Medicare Summary Notices.
10. If Mr. Barker's appeal is denied, what alternative options might he consider
to address the unexpected charges?
He could stop using his Medicare coverage altogether.
He could file a lawsuit against the Medicare program.
He could seek assistance from a Medicare advocate or explore
other coverage options.
He could change his address to avoid future charges.
11. If a beneficiary moves from a rural area to an urban area and wants to switch
their Medicare Advantage-Prescription Drug plan, what steps should they
take to ensure they utilize their special enrollment period effectively?
