AHIP – 2027 EXAM QUESTIONS &
VERIFIED CORRECT ANSWERS
PASSED 100%
Mrs. Andrews is comparing her employer's retiree insurance to Original Medicare and
would like to know which of the following services Original Medicare will cover if the
appropriate criteria are met. What could you tell her? - Correct Answer ✔✔ Original
Medicare covers ambulance services.
What impact, if any, have recent regulatory changes had on Medigap plans? - Correct
Answer ✔✔ The Part B deductible is no longer covered for individuals newly eligible for
Medicare starting January 1, 2020.
Joan and Loretta are both enrolled in Medicare. Joan pays a premium for Part A
coverage. Loretta does not. Which of the following statements best explains this
difference? - Correct Answer ✔✔ Joan worked only a short time and did not accumulate
sufficient work credits. Loretta worked for well over 10 years accumulating credit for
more than 40 quarters of contributions to the Medicare program.
Larry Miller is an Original Medicare beneficiary with Parts A and B coverage. Larry is
admitted to Good Care Hospital in January with pneumonia and stays for three days
before being discharged. Six months later in July, Larry takes a bad fall and is admitted
to Good Care Hospital with a broken leg. After emergency surgery to repair his broken
leg, Larry is hospitalized for a week before being discharged home. In December, Larry
is admitted to Mount Wellness Hospital once again with a serious case of the flu. For
how many Part A deductibles will Larry be responsible for? - Correct Answer ✔✔ Larry
will be responsible for three Part A deductibles.
Kevin Birch enrolled in Original Medicare (Parts A and B). Mr. Birch has been receiving
rehabilitation services in a skilled nursing facility. He calls you to say that he has just
received a notice that Medicare will no longer cover his stay and he still cannot walk
properly. He thinks they are ending his services too soon. What do you tell him? -
Correct Answer ✔✔ He should follow the directions on the notice to file a fast appeal.
Mr. Birch should file it by noon of the calendar day following receipt of the provider's
notice of termination of services.
Mr. Ray would like drug coverage but does not want to be enrolled in a Medicare
Advantage plan. What should you tell him? - Correct Answer ✔✔ Mr. Ray can enroll in a
stand-alone prescription drug plan and continue to be covered for Part A and Part B
services through Original Fee-for-Service Medicare.
Mrs. Sanders will be 65 soon, has been a citizen for twelve years, has been employed
full-time, and paid taxes during that entire period. She is concerned that she will not
,qualify for coverage under Part A because she was not born in the United States. What
should you tell her? - Correct Answer ✔✔ Most individuals who are citizens and age 65
or over are covered under Part A by virtue of having paid Medicare taxes while working,
though some may be covered as a result of paying monthly premiums.
Mrs. Carpenter is enrolled in Original Medicare Parts A and B. She has recently
reviewed her Medicare Summary Notice (MSN) and disagrees with a determination that
partially denied one of her claims for services. What advice would you give her? -
Correct Answer ✔✔ Mrs. Carpenter should file an appeal of this initial determination
within 120 days of the date she received the MSN in the mail.
Mr. Hoffman receives some help paying for his two generic prescription drugs from his
employer's retiree coverage, but he wants to compare it to a Part D prescription drug
plan. He asks you what costs he would generally expect to encounter when enrolling
into a standard Medicare Part D prescription drug plan. What should you tell him? -
Correct Answer ✔✔ He generally would pay a monthly premium, annual deductible, and
per-prescription cost-sharing.
Mrs. Larson is enrolled in Original Medicare and has a Medigap policy as well, but it
provides no drug coverage. She would like to keep the coverage she has but replace
her existing Medigap plan with one that provides drug coverage. What should you tell
her? - Correct Answer ✔✔ Mrs. Larson cannot purchase a Medigap plan that covers
drugs, but she could keep her Medigap policy and enroll in a Part D prescription drug
plan.
Mary Alice is covered by Original Medicare Parts A and B. During her initial enrollment
period she purchased a standard Medigap Plan A policy from you because of its
relatively low cost. After speaking to her friend Stan, she asks whether any of the
following are "core benefits" covered in her plan? - Correct Answer ✔✔ I. Coverage for
Part A hospital coinsurance amount
II. Coverage for 365 additional days during an insured's lifetime after Medicare benefits
end
III. Coverage for 3 pints of blood
Mr. Ellis continued working with his company and was insured under his employer's
group plan until he reached age 68 when he retired. Five months later Mr. Ellis enrolled
in Part B. 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? - Correct Answer ✔✔ Mr. Ellis will not pay any penalty because he had
continuous coverage under his employer's plan and he enrolled in Part B within the 8-
month period immediately following the last month he had group coverage.
Mrs. Georgia is concerned about the deductibles and co-payments associated with
Original Medicare. What can you tell her about Medigap as an option to address this
concern? - Correct Answer ✔✔ Medigap plans do not cover Original Medicare benefits,
but they coordinate with Original Medicare coverage.
, Mr. Turner will soon turn age 65 and has come to you for advice as to what services are
provided under Original Medicare. What should you tell Mr. Turner that best describes
the health coverage provided to Medicare beneficiaries? - Correct Answer ✔✔
Beneficiaries under Original Medicare have no cost-sharing for most preventive
services.
Mr. Harvey would like to purchase a Medicare Advantage (MA) plan and a Medigap
plan to pick up costs not covered by that plan. What should you tell him? - Correct
Answer ✔✔ It is illegal for you to sell Mr. Harvey a Medigap plan if he is enrolled in an
MA plan, and besides, Medigap only works with Original Medicare.
Annie Mills will turn age 65 in August 2026. Annie intends to enroll in Original Medicare
Part A and Part B. She would also like to enroll in a Medicare Supplement (Medigap)
plan. Annie's older neighbor John, has told her about the Medigap Plan F in which he is
enrolled. It not only provides foreign travel emergency benefits but also covers his
Medicare Part B deductible. Annie comes to you for advice. What should you tell her? -
Correct Answer ✔✔ You are sorry to disappoint Annie, but a Medigap F plan is no
longer available to those who turn 65 after January 1, 2020. Annie might instead
consider other Medigap plans that offer foreign travel benefits but do not cover the Part
B deductible.
Mr. Bell is 52 years old and has recently been diagnosed with end-stage renal disease
(ESRD) and will soon begin dialysis. He is wondering if he can obtain coverage under
Medicare. What should you tell him? - Correct Answer ✔✔ He may sign up for Medicare
at any time; however, coverage usually begins on the fourth month after dialysis
treatments start.
Jason is experiencing paranoid delusions and his physician feels that he should be
hospitalized. What should you tell Jason (or his representative) about the length of an
inpatient psychiatric hospital stay that Medicare will cover? - Correct Answer ✔✔
Medicare will cover a total of 190 days of inpatient psychiatric care during Jason's entire
lifetime.
Lucas Fields, who is turning age 65 next month, intends to work for several more years
at Smallcap, Incorporated. Smallcap has a workforce of 15 employees and offers
employer-sponsored healthcare coverage. Lucas is a naturalized citizen and has
contributed to the Medicare system for over 20 years. Lucas asks you if he will be
entitled to Medicare and if he enrolls how that will impact his employer-sponsored
healthcare coverage. How would you respond? - Correct Answer ✔✔ Lucas is likely to
be eligible for Medicare once he turns age 65 and if he enrolls, Medicare would become
the primary payor of his healthcare claims and Smallcap does not have to continue to
offer him coverage comparable to those under age 65 under its employer-sponsored
group health plan and would become a secondary payor.
VERIFIED CORRECT ANSWERS
PASSED 100%
Mrs. Andrews is comparing her employer's retiree insurance to Original Medicare and
would like to know which of the following services Original Medicare will cover if the
appropriate criteria are met. What could you tell her? - Correct Answer ✔✔ Original
Medicare covers ambulance services.
What impact, if any, have recent regulatory changes had on Medigap plans? - Correct
Answer ✔✔ The Part B deductible is no longer covered for individuals newly eligible for
Medicare starting January 1, 2020.
Joan and Loretta are both enrolled in Medicare. Joan pays a premium for Part A
coverage. Loretta does not. Which of the following statements best explains this
difference? - Correct Answer ✔✔ Joan worked only a short time and did not accumulate
sufficient work credits. Loretta worked for well over 10 years accumulating credit for
more than 40 quarters of contributions to the Medicare program.
Larry Miller is an Original Medicare beneficiary with Parts A and B coverage. Larry is
admitted to Good Care Hospital in January with pneumonia and stays for three days
before being discharged. Six months later in July, Larry takes a bad fall and is admitted
to Good Care Hospital with a broken leg. After emergency surgery to repair his broken
leg, Larry is hospitalized for a week before being discharged home. In December, Larry
is admitted to Mount Wellness Hospital once again with a serious case of the flu. For
how many Part A deductibles will Larry be responsible for? - Correct Answer ✔✔ Larry
will be responsible for three Part A deductibles.
Kevin Birch enrolled in Original Medicare (Parts A and B). Mr. Birch has been receiving
rehabilitation services in a skilled nursing facility. He calls you to say that he has just
received a notice that Medicare will no longer cover his stay and he still cannot walk
properly. He thinks they are ending his services too soon. What do you tell him? -
Correct Answer ✔✔ He should follow the directions on the notice to file a fast appeal.
Mr. Birch should file it by noon of the calendar day following receipt of the provider's
notice of termination of services.
Mr. Ray would like drug coverage but does not want to be enrolled in a Medicare
Advantage plan. What should you tell him? - Correct Answer ✔✔ Mr. Ray can enroll in a
stand-alone prescription drug plan and continue to be covered for Part A and Part B
services through Original Fee-for-Service Medicare.
Mrs. Sanders will be 65 soon, has been a citizen for twelve years, has been employed
full-time, and paid taxes during that entire period. She is concerned that she will not
,qualify for coverage under Part A because she was not born in the United States. What
should you tell her? - Correct Answer ✔✔ Most individuals who are citizens and age 65
or over are covered under Part A by virtue of having paid Medicare taxes while working,
though some may be covered as a result of paying monthly premiums.
Mrs. Carpenter is enrolled in Original Medicare Parts A and B. She has recently
reviewed her Medicare Summary Notice (MSN) and disagrees with a determination that
partially denied one of her claims for services. What advice would you give her? -
Correct Answer ✔✔ Mrs. Carpenter should file an appeal of this initial determination
within 120 days of the date she received the MSN in the mail.
Mr. Hoffman receives some help paying for his two generic prescription drugs from his
employer's retiree coverage, but he wants to compare it to a Part D prescription drug
plan. He asks you what costs he would generally expect to encounter when enrolling
into a standard Medicare Part D prescription drug plan. What should you tell him? -
Correct Answer ✔✔ He generally would pay a monthly premium, annual deductible, and
per-prescription cost-sharing.
Mrs. Larson is enrolled in Original Medicare and has a Medigap policy as well, but it
provides no drug coverage. She would like to keep the coverage she has but replace
her existing Medigap plan with one that provides drug coverage. What should you tell
her? - Correct Answer ✔✔ Mrs. Larson cannot purchase a Medigap plan that covers
drugs, but she could keep her Medigap policy and enroll in a Part D prescription drug
plan.
Mary Alice is covered by Original Medicare Parts A and B. During her initial enrollment
period she purchased a standard Medigap Plan A policy from you because of its
relatively low cost. After speaking to her friend Stan, she asks whether any of the
following are "core benefits" covered in her plan? - Correct Answer ✔✔ I. Coverage for
Part A hospital coinsurance amount
II. Coverage for 365 additional days during an insured's lifetime after Medicare benefits
end
III. Coverage for 3 pints of blood
Mr. Ellis continued working with his company and was insured under his employer's
group plan until he reached age 68 when he retired. Five months later Mr. Ellis enrolled
in Part B. 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? - Correct Answer ✔✔ Mr. Ellis will not pay any penalty because he had
continuous coverage under his employer's plan and he enrolled in Part B within the 8-
month period immediately following the last month he had group coverage.
Mrs. Georgia is concerned about the deductibles and co-payments associated with
Original Medicare. What can you tell her about Medigap as an option to address this
concern? - Correct Answer ✔✔ Medigap plans do not cover Original Medicare benefits,
but they coordinate with Original Medicare coverage.
, Mr. Turner will soon turn age 65 and has come to you for advice as to what services are
provided under Original Medicare. What should you tell Mr. Turner that best describes
the health coverage provided to Medicare beneficiaries? - Correct Answer ✔✔
Beneficiaries under Original Medicare have no cost-sharing for most preventive
services.
Mr. Harvey would like to purchase a Medicare Advantage (MA) plan and a Medigap
plan to pick up costs not covered by that plan. What should you tell him? - Correct
Answer ✔✔ It is illegal for you to sell Mr. Harvey a Medigap plan if he is enrolled in an
MA plan, and besides, Medigap only works with Original Medicare.
Annie Mills will turn age 65 in August 2026. Annie intends to enroll in Original Medicare
Part A and Part B. She would also like to enroll in a Medicare Supplement (Medigap)
plan. Annie's older neighbor John, has told her about the Medigap Plan F in which he is
enrolled. It not only provides foreign travel emergency benefits but also covers his
Medicare Part B deductible. Annie comes to you for advice. What should you tell her? -
Correct Answer ✔✔ You are sorry to disappoint Annie, but a Medigap F plan is no
longer available to those who turn 65 after January 1, 2020. Annie might instead
consider other Medigap plans that offer foreign travel benefits but do not cover the Part
B deductible.
Mr. Bell is 52 years old and has recently been diagnosed with end-stage renal disease
(ESRD) and will soon begin dialysis. He is wondering if he can obtain coverage under
Medicare. What should you tell him? - Correct Answer ✔✔ He may sign up for Medicare
at any time; however, coverage usually begins on the fourth month after dialysis
treatments start.
Jason is experiencing paranoid delusions and his physician feels that he should be
hospitalized. What should you tell Jason (or his representative) about the length of an
inpatient psychiatric hospital stay that Medicare will cover? - Correct Answer ✔✔
Medicare will cover a total of 190 days of inpatient psychiatric care during Jason's entire
lifetime.
Lucas Fields, who is turning age 65 next month, intends to work for several more years
at Smallcap, Incorporated. Smallcap has a workforce of 15 employees and offers
employer-sponsored healthcare coverage. Lucas is a naturalized citizen and has
contributed to the Medicare system for over 20 years. Lucas asks you if he will be
entitled to Medicare and if he enrolls how that will impact his employer-sponsored
healthcare coverage. How would you respond? - Correct Answer ✔✔ Lucas is likely to
be eligible for Medicare once he turns age 65 and if he enrolls, Medicare would become
the primary payor of his healthcare claims and Smallcap does not have to continue to
offer him coverage comparable to those under age 65 under its employer-sponsored
group health plan and would become a secondary payor.
