AHIP Medicare Final Exam 2026 | Questions & Answers |
Certification Study Guide
1. If Mrs. Chen does not enroll in Medicare Part B during her initial enrollment
period, what consequence might she face?
She will lose her eligibility for Medicare altogether.
She will automatically be enrolled in a Medicare Advantage plan.
She will receive coverage under Medicaid instead.
She may incur a late enrollment penalty.
2. Mrs. Peňa 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?
She may not enroll in Part B while covered under an employer group
health plan and must wait until the standard general enrollment
period after she retires.
She must wait at least 30 days after her employment terminates before
she may enroll in Medicare Part B.
She may enroll at any time while she is covered under her employer
plan, but she will have a special eight-month enrollment period
after the last month on her employer plan that differs from the
standard general enrollment period, during which she may enroll in
Medicare Part B.
She may only enroll in Part B during the general enrollment period
whether she is retired or not.
3. Mrs. Willard 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?
, All Medicare Advantage Plans offer cost-sharing that is lower than
Original Medicare for all Part A and Part B covered services, but the
maximum out-of-pocket limit is higher than in Original Medicare.
Medicare Advantage Plans may offer extra benefits that Original
Medicare does not offer such as vision, hearing, and dental services
and must include a maximum out-of-pocket limit on Part A and Part
B services.
Medicare Advantage Plans are not permitted to offer any benefits
beyond those available under the Original Medicare program and
must have the same maximum out-of-pocket limit on Part A and Part B
services as FFS Medicare.
Medicare Advantage Plans do not necessarily have to cover all of the
Original Medicare Part A and Part B services but must include a
maximum out-of-pocket limit.
4. If Mrs. Fields decides not to apply for the Part D low-income subsidy, what
might be a consequence regarding her prescription drug costs?
She may face higher out-of-pocket expenses for her medications.
She will not be able to access any prescription drugs.
She will be automatically enrolled in a better plan.
She will receive free medications regardless of her income.
5. Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What could
you tell Mrs. Park that might be of assistance?
She should contact her state Medicaid agency to see if she qualifies
for one of several programs that can help with Medicare costs for
which she is responsible.
She can apply to the Medicare agency for lower premiums and cost-
sharing.
, She should only seek help from private organizations to cover her
Medicare costs.
She should not sign up for a Medicare Advantage plan.
6. Which statement best describes Medicare Advantage (MA)?
MA is a supplement to original Medicare
MA is an alternative to original Medicare
MA is an alternative to Medicare Part B
MA is an alternative to Medicare Part A
7. What condition allows individuals like Mr. Davis to qualify for Medicare
coverage regardless of age?
Cancer
Heart disease
Diabetes
End-stage renal disease (ESRD)
8. What type of programs are available to assist low-income Medicare
beneficiaries?
Life insurance policies
Assistance programs
Retirement accounts
Investment plans
, 9. If Mr. Capadona is considering both a Medicare Advantage plan and a
Medigap plan, what factors should he evaluate to make an informed
decision?
He should only consider the monthly premium of each plan without
regard to coverage.
He should evaluate his healthcare needs, preferred providers, costs,
and whether he wants additional benefits.
He should choose the plan with the most advertising without
considering his personal needs.
He should rely solely on recommendations from friends without
evaluating his own situation.
10. What is the primary eligibility criterion for Medicare Part A?
Age or disability
Citizenship status
Employment status
Income level
11. Describe how Medicare Advantage Special Needs Plans (SNPs) cater to
individuals with specific health conditions.
Medicare Advantage Special Needs Plans (SNPs) offer the same
benefits as Original Medicare without any specialization.
Medicare Advantage Special Needs Plans (SNPs) are only available to
individuals over the age of 65.
Medicare Advantage Special Needs Plans (SNPs) do not cover
prescription drugs.
Certification Study Guide
1. If Mrs. Chen does not enroll in Medicare Part B during her initial enrollment
period, what consequence might she face?
She will lose her eligibility for Medicare altogether.
She will automatically be enrolled in a Medicare Advantage plan.
She will receive coverage under Medicaid instead.
She may incur a late enrollment penalty.
2. Mrs. Peňa 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?
She may not enroll in Part B while covered under an employer group
health plan and must wait until the standard general enrollment
period after she retires.
She must wait at least 30 days after her employment terminates before
she may enroll in Medicare Part B.
She may enroll at any time while she is covered under her employer
plan, but she will have a special eight-month enrollment period
after the last month on her employer plan that differs from the
standard general enrollment period, during which she may enroll in
Medicare Part B.
She may only enroll in Part B during the general enrollment period
whether she is retired or not.
3. Mrs. Willard 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?
, All Medicare Advantage Plans offer cost-sharing that is lower than
Original Medicare for all Part A and Part B covered services, but the
maximum out-of-pocket limit is higher than in Original Medicare.
Medicare Advantage Plans may offer extra benefits that Original
Medicare does not offer such as vision, hearing, and dental services
and must include a maximum out-of-pocket limit on Part A and Part
B services.
Medicare Advantage Plans are not permitted to offer any benefits
beyond those available under the Original Medicare program and
must have the same maximum out-of-pocket limit on Part A and Part B
services as FFS Medicare.
Medicare Advantage Plans do not necessarily have to cover all of the
Original Medicare Part A and Part B services but must include a
maximum out-of-pocket limit.
4. If Mrs. Fields decides not to apply for the Part D low-income subsidy, what
might be a consequence regarding her prescription drug costs?
She may face higher out-of-pocket expenses for her medications.
She will not be able to access any prescription drugs.
She will be automatically enrolled in a better plan.
She will receive free medications regardless of her income.
5. Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What could
you tell Mrs. Park that might be of assistance?
She should contact her state Medicaid agency to see if she qualifies
for one of several programs that can help with Medicare costs for
which she is responsible.
She can apply to the Medicare agency for lower premiums and cost-
sharing.
, She should only seek help from private organizations to cover her
Medicare costs.
She should not sign up for a Medicare Advantage plan.
6. Which statement best describes Medicare Advantage (MA)?
MA is a supplement to original Medicare
MA is an alternative to original Medicare
MA is an alternative to Medicare Part B
MA is an alternative to Medicare Part A
7. What condition allows individuals like Mr. Davis to qualify for Medicare
coverage regardless of age?
Cancer
Heart disease
Diabetes
End-stage renal disease (ESRD)
8. What type of programs are available to assist low-income Medicare
beneficiaries?
Life insurance policies
Assistance programs
Retirement accounts
Investment plans
, 9. If Mr. Capadona is considering both a Medicare Advantage plan and a
Medigap plan, what factors should he evaluate to make an informed
decision?
He should only consider the monthly premium of each plan without
regard to coverage.
He should evaluate his healthcare needs, preferred providers, costs,
and whether he wants additional benefits.
He should choose the plan with the most advertising without
considering his personal needs.
He should rely solely on recommendations from friends without
evaluating his own situation.
10. What is the primary eligibility criterion for Medicare Part A?
Age or disability
Citizenship status
Employment status
Income level
11. Describe how Medicare Advantage Special Needs Plans (SNPs) cater to
individuals with specific health conditions.
Medicare Advantage Special Needs Plans (SNPs) offer the same
benefits as Original Medicare without any specialization.
Medicare Advantage Special Needs Plans (SNPs) are only available to
individuals over the age of 65.
Medicare Advantage Special Needs Plans (SNPs) do not cover
prescription drugs.
