[STUDY GUIDE] • HIGH-YIELD PRACTICE & REVIEW EDITION
AHIP Final Test 2026/2027 Verified
Exam Questions with Solutions and
Correct Answer Keys
Comprehensive Examination Question Bank • Concept Mapping
TOTAL QUESTIONS EXAM TOPICS ANSWERS
255 Questions 11 Modules 100% Verified
DOCUMENT OVERVIEW
This document contains 255 verified questions with correct answers and explanations related to Medicare
Advantage, Medicare prescription drug plans, and other related topics. Each question is designed to support
study and review for individuals preparing for certification in Medicare health plans, ensuring comprehension of
key policies and regulations.
EXAM BLUEPRINT & TOPIC DISTRIBUTION
Systematic breakdown of subject domains and exam coverage.
Topic Module Scope & Core Focus
Medicare Advantage Plans Covers the structure, benefits, and eligibility requirements of Medicare Advantage plans.
Explains the enrollment timelines and processes for beneficiaries during the Annual Election
Annual Election Period (AEP) Period.
Part A and Part B Coverage Details the coverage options and enrollment criteria for Medicare Parts A and B.
Medicare Prescription Drug Coverage Focuses on the specifics of Medicare Part D and the associated prescription drug plans.
Outlines the circumstances under which beneficiaries can enroll in Medicare plans outside
Special Enrollment Periods (SEPs) the standard enrollment periods.
Discusses the supplemental insurance options available to Medicare beneficiaries to cover
Medigap Plans out-of-pocket costs.
Eligibility Requirements Examines the eligibility criteria for various Medicare programs and plans.
Highlights the compliance requirements and regulatory considerations for Medicare agents
Compliance and Regulations and organizations.
Confidential • Student Study Edition • Practice & Review Guide Page 1 of 71
,STUDENT STUDY & MASTERY EDITION PRACTICE & REVIEW GUIDE
Describes acceptable marketing practices and guidelines for Medicare Advantage and Part D
Marketing Medicare Plans plans.
Explains the processes through which beneficiaries can file complaints or appeals regarding
Grievances and Appeals Medicare plans.
Low-Income Subsidy Programs Details programs available to assist low-income beneficiaries with Medicare costs.
Total Exam Coverage 11 Integrated Topic Modules • 255 Examination Questions
QUESTION 1
Mrs. Burton is a retiree with substantial income. She is enrolled in an MA-PD plan and
was disappointed with the service she received from her primary care physician
because she was told she would have to wait five weeks to get an appointment when
she was feeling ill. She called you to ask what she could do so she would not have to
put up with such poor access to care. What could you tell her?
Answer: She could file a grievance with her plan to complain about the lack of timeliness in getting an
appointment.
QUESTION 2
Edward IP suffered from serious kidney disease. As a result. Edward became eligible
for Medicare coverage due to end-stage renal disease (ESRD). A close relative donated
their kidney and Edward successfully underwent transplant surgery 12 months ago.
Edward is now age 50 and asks you if his Medicare coverage will continue, what should
you say?
Answer: Individuals eligible for Medicare based on ESRD generally lose eligibility 36 months after the month
in which the individual receives a kidney transplant unless they are eligible for Medicare on another basis
such as age or disability. Edward may, however, remain enrolled in Part B but solely for coverage of
immunosuppressive drugs if he has no other health care coverage that would cover the drugs.
QUESTION 3
Mildred Savage enrolled in Allcare Medicare Advantage plan several years ago. Mildred
recently learned that she is suffering from inoperable cancer and has just a few months
to live. She would like to spend these final months in hospice care. Mildred's family
asks you whether hospice benefits will bepaid for under the Allcare Medicare
Advantage plan. What should you say?
Answer: Mildred may remain enrolled in Allcare and make a hospice election. Hospice benefits will bepaid
for by Original Medicare under Part A and Allcare will continue to pay for any nonhospice services.
Confidential • Student Study Edition • Practice & Review Guide Page 2 of 71
,STUDENT STUDY & MASTERY EDITION PRACTICE & REVIEW GUIDE
QUESTION 4
Mr. Diaz continued working with his company and was insured under his employer's
group plan until he reached age 68. 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?
Answer: Mr. Diaz will not pay any penalty because he had continuous coverage under his employer's plan.
QUESTION 5
Mr. Moy's wife has a Medicare Advantage plan, but he wants to understand what
coverage Medicare Supplemental Insurance provides since his health care needs are
different from his wife's
needs. What could you tell Mr. Moy?
Answer: Medicare Supplemental Insurance would help cover his Part A and Part B deductibles or
coinsurance in Original Fee-for-Service (FFS) Medicare as well as possibly some services that Medicare does
not cover.
QUESTION 6
Mrs. Chen 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?
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.
QUESTION 7
Mr. Bauer is 49 years old, but eighteen months ago he was declared disabled by the
Social Security Administration and has been receiving disability payments. He is
wondering whether he can obtain coverage under Medicare. What should you tell him?
Answer: After receiving such disability payments for 24 months, he will be automatically enrolled in
Medicare, regardless of age.
Confidential • Student Study Edition • Practice & Review Guide Page 3 of 71
, STUDENT STUDY & MASTERY EDITION PRACTICE & REVIEW GUIDE
QUESTION 8
Mr. Xi 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. Xi that best describes the
health coverage provided to Medicare beneficiaries?
Answer: Beneficiaries under Original Medicare have no cost-sharing for most preventive services which
include immunizations such as annual flu shots.
QUESTION 9
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?
Answer: 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.
QUESTION 10
Mr. Davis 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?
Answer: He may sign-up for Medicare at any time however coverage usually begins on the fourth month after
dialysis treatments start.
QUESTION 11
Madeline Martinez was widowed several years ago. Her husband worked for many
years and contributed into the Medicare system. He also left a substantial estate which
provides Madeline with an annual income of approximately $130,000. Madeline, who
has only worked part-time for the last three years, will soon turn age 65 and hopes to
enroll in Original Medicare. She comes to you for advice. What should you tell her?
Answer: You should tell Madeline that she will be able to enroll in Medicare Part A without paying monthly
premiums due to her husband's long work record and participation in the Medicare
system. You should also tell Madeline that she will pay Part B premiums at more than the standard lowest
rate but less than the highest rate due her substantial income.
Confidential • Student Study Edition • Practice & Review Guide Page 4 of 71
AHIP Final Test 2026/2027 Verified
Exam Questions with Solutions and
Correct Answer Keys
Comprehensive Examination Question Bank • Concept Mapping
TOTAL QUESTIONS EXAM TOPICS ANSWERS
255 Questions 11 Modules 100% Verified
DOCUMENT OVERVIEW
This document contains 255 verified questions with correct answers and explanations related to Medicare
Advantage, Medicare prescription drug plans, and other related topics. Each question is designed to support
study and review for individuals preparing for certification in Medicare health plans, ensuring comprehension of
key policies and regulations.
EXAM BLUEPRINT & TOPIC DISTRIBUTION
Systematic breakdown of subject domains and exam coverage.
Topic Module Scope & Core Focus
Medicare Advantage Plans Covers the structure, benefits, and eligibility requirements of Medicare Advantage plans.
Explains the enrollment timelines and processes for beneficiaries during the Annual Election
Annual Election Period (AEP) Period.
Part A and Part B Coverage Details the coverage options and enrollment criteria for Medicare Parts A and B.
Medicare Prescription Drug Coverage Focuses on the specifics of Medicare Part D and the associated prescription drug plans.
Outlines the circumstances under which beneficiaries can enroll in Medicare plans outside
Special Enrollment Periods (SEPs) the standard enrollment periods.
Discusses the supplemental insurance options available to Medicare beneficiaries to cover
Medigap Plans out-of-pocket costs.
Eligibility Requirements Examines the eligibility criteria for various Medicare programs and plans.
Highlights the compliance requirements and regulatory considerations for Medicare agents
Compliance and Regulations and organizations.
Confidential • Student Study Edition • Practice & Review Guide Page 1 of 71
,STUDENT STUDY & MASTERY EDITION PRACTICE & REVIEW GUIDE
Describes acceptable marketing practices and guidelines for Medicare Advantage and Part D
Marketing Medicare Plans plans.
Explains the processes through which beneficiaries can file complaints or appeals regarding
Grievances and Appeals Medicare plans.
Low-Income Subsidy Programs Details programs available to assist low-income beneficiaries with Medicare costs.
Total Exam Coverage 11 Integrated Topic Modules • 255 Examination Questions
QUESTION 1
Mrs. Burton is a retiree with substantial income. She is enrolled in an MA-PD plan and
was disappointed with the service she received from her primary care physician
because she was told she would have to wait five weeks to get an appointment when
she was feeling ill. She called you to ask what she could do so she would not have to
put up with such poor access to care. What could you tell her?
Answer: She could file a grievance with her plan to complain about the lack of timeliness in getting an
appointment.
QUESTION 2
Edward IP suffered from serious kidney disease. As a result. Edward became eligible
for Medicare coverage due to end-stage renal disease (ESRD). A close relative donated
their kidney and Edward successfully underwent transplant surgery 12 months ago.
Edward is now age 50 and asks you if his Medicare coverage will continue, what should
you say?
Answer: Individuals eligible for Medicare based on ESRD generally lose eligibility 36 months after the month
in which the individual receives a kidney transplant unless they are eligible for Medicare on another basis
such as age or disability. Edward may, however, remain enrolled in Part B but solely for coverage of
immunosuppressive drugs if he has no other health care coverage that would cover the drugs.
QUESTION 3
Mildred Savage enrolled in Allcare Medicare Advantage plan several years ago. Mildred
recently learned that she is suffering from inoperable cancer and has just a few months
to live. She would like to spend these final months in hospice care. Mildred's family
asks you whether hospice benefits will bepaid for under the Allcare Medicare
Advantage plan. What should you say?
Answer: Mildred may remain enrolled in Allcare and make a hospice election. Hospice benefits will bepaid
for by Original Medicare under Part A and Allcare will continue to pay for any nonhospice services.
Confidential • Student Study Edition • Practice & Review Guide Page 2 of 71
,STUDENT STUDY & MASTERY EDITION PRACTICE & REVIEW GUIDE
QUESTION 4
Mr. Diaz continued working with his company and was insured under his employer's
group plan until he reached age 68. 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?
Answer: Mr. Diaz will not pay any penalty because he had continuous coverage under his employer's plan.
QUESTION 5
Mr. Moy's wife has a Medicare Advantage plan, but he wants to understand what
coverage Medicare Supplemental Insurance provides since his health care needs are
different from his wife's
needs. What could you tell Mr. Moy?
Answer: Medicare Supplemental Insurance would help cover his Part A and Part B deductibles or
coinsurance in Original Fee-for-Service (FFS) Medicare as well as possibly some services that Medicare does
not cover.
QUESTION 6
Mrs. Chen 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?
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.
QUESTION 7
Mr. Bauer is 49 years old, but eighteen months ago he was declared disabled by the
Social Security Administration and has been receiving disability payments. He is
wondering whether he can obtain coverage under Medicare. What should you tell him?
Answer: After receiving such disability payments for 24 months, he will be automatically enrolled in
Medicare, regardless of age.
Confidential • Student Study Edition • Practice & Review Guide Page 3 of 71
, STUDENT STUDY & MASTERY EDITION PRACTICE & REVIEW GUIDE
QUESTION 8
Mr. Xi 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. Xi that best describes the
health coverage provided to Medicare beneficiaries?
Answer: Beneficiaries under Original Medicare have no cost-sharing for most preventive services which
include immunizations such as annual flu shots.
QUESTION 9
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?
Answer: 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.
QUESTION 10
Mr. Davis 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?
Answer: He may sign-up for Medicare at any time however coverage usually begins on the fourth month after
dialysis treatments start.
QUESTION 11
Madeline Martinez was widowed several years ago. Her husband worked for many
years and contributed into the Medicare system. He also left a substantial estate which
provides Madeline with an annual income of approximately $130,000. Madeline, who
has only worked part-time for the last three years, will soon turn age 65 and hopes to
enroll in Original Medicare. She comes to you for advice. What should you tell her?
Answer: You should tell Madeline that she will be able to enroll in Medicare Part A without paying monthly
premiums due to her husband's long work record and participation in the Medicare
system. You should also tell Madeline that she will pay Part B premiums at more than the standard lowest
rate but less than the highest rate due her substantial income.
Confidential • Student Study Edition • Practice & Review Guide Page 4 of 71
