AHIP 2024 for 2025 Plan Year
Complete Study Guide for all three AHIP sections- modules/tests
Study Tips and Disclaimers:
· Medicare does not remaster a brand new test with all brand new questions every year. Most
of the questions are reused from year to year with a few new ones added in. NEW 2025
QUESTIONS HAVE BEEN ADDED TO THIS STUDY GUIDE!
· The below compilation of questions cover MOST the questions that you will find in the
module quizzes and/or test.
· This compilation is meant to be used as supplemental study aid and not to be used during
the actual test in order to “cheat”.
· A great way to use this study guide when taking your quizzes is to use the “find and
replace option” in your Word or Google Docs software and type in some keywords (ex.
Mrs. Duarte should file an appeal). In doing so, it will take you right to the question, with
the correct answer below.
Mrs. Duarte 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?
Answer : Mrs. Duarte should file an appeal of this initial determination within 120 days of the
date she received the MSN in the mail. Correct: Beneficiaries must file an appeal related to Part
A or B services within 120 days of the date they get the MSN in the mail.
Mrs. Chi is age 75 and enjoys a comfortable but not extremely high-income level. She wishes to
enroll in a MA MSA plan that she heard about from her neighbor. She also wants to have
prescription drug coverage since her doctor recently prescribed several expensive medications.
Currently, she is enrolled in Original Medicare and a standalone Part D plan. How would you
advise Mrs. Chi?
Answer : Mrs. Chi may enroll in a MA MSA plan and remain in her current standalone Part D
prescription drug plan.
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. Correct: Individuals with ESRD may sign up for
Medicare at any time. Coverage typically begins on the fourth month after dialysis treatments
start, but it could be earlier if certain conditions are met.
Juan Perez, 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. Juan is a naturalized citizen and has contributed to the
Medicare system for over 20 years. Juan 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? a. Juan is likely to be ineligible for Medicare since he was born outside the United
States and has only contributed to the Medicare system for 20 years.
Answer : b. Juan 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. Correct: Medicare is the primary payor for individuals who have
group health coverage as a result of their or their spouse’s employment with a company that is
not a large group health plan (GHP) (basically, one with fewer than 20 employees).
Furthermore, small GHPs do not have to continue to offer their age 65 and over employees and
their spouses the same benefits under the GHP as individuals under age 65.
Mr. Sanchez has just turned 65 and is entitled to Part A but has not enrolled in Part B because
he has coverage through an employer plan. If he wants to enroll in a Medicare Advantage plan,
what will he have to do?
Answer : He will have to enroll in Part B.
Ms. Thomas has worked for many years and is turning 68 in June. She is eligible for Medicare
Part A and did not enroll for Part B when first eligible because she has insurance through her
employer - Coffee Brew, Inc. She also did not enroll in Part D because she had creditable
coverage. She would like to retire in June and enroll in a Medicare Advantage plan. She has
been informed that her group coverage will end on her retirement effective date. How would you
advise Ms. Thomas?
Answer : Ms. Thomas can enroll in Part B without a late penalty at any time she is still covered
by her employer group and 8 months after her last month of employer group coverage without a
penalty. However, because she wants to enroll in a MA plan after retirement, she should make
sure her Part B coverage is effective in time to use the Medicare Advantage/Part D special
election period for individuals changing from employer group coverage to enroll in a MA plan or
,MA-PD. The SEP begins while she has employer group coverage and will last until 2 months
after the month after the month her employer coverage ends. If she wants Part D coverage she
should enroll in an MA-PD or a PDP (depending on how she decides to receive her Part A and
B benefits) during this time.
Juan Perez, who is turning age 65 next month, intends to work for several more years at
Smallcap, Incorporated. Smallcap has a workforce of15 employees and offers employer-
sponsored healthcare coverage. Juan is a naturalized citizen and has contributed to the
Medicare system for over 20 years. Juan 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?
Answer : Juan 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.
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.
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.
Mr. Liu turns 65 on june 19. he has never previously qualified for medicare so his first medicare
eligibility date will be by June 1. Mr. Liu’s icep and part d iep begin march 1 and end on
september 30. he wants prescription drug coverage with his part a and part b benefits. What
advice can you provide him?
Answer : He can enroll in a MA-PD as long as he enrolls in Part B and is entitled to Part A.
, Mr. Wingate is a newly enrolled Medicare Part D beneficiary and one of your clients. In addition
to drugs on his plan’s formulary he takes several other medications. These include a
prescription drug not on his plan’s formulary, over-the-counter medications for colds and
allergies, vitamins, and drugs from an Internet-based Canadian pharmacy to promote hair
growth and reduce joint swelling. His neighbor recently told him about a concept called TrOOP
and he asks you if any of his other medications could count toward TrOOP should he ever reach
the Part D catastrophic limit. What should you say?
Answer : None of the costs of Mr. Wingate’s other medications would currently count toward
TrOOP but he may wish to ask his plan for an exception to cover the prescription not on its
formulary.
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.
Mrs. Gonzalez 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?
Answer : Mrs. Gonzalez cannot purchase a Medigap plan that covers drugs, but she could keep
her Medigap policy and enroll in a Part D prescription drug plan. Correct: Individuals who are
enrolled in Medigap plans may only obtain Medicare drug coverage (Part D) through a stand-
alone prescription drug plan.
Mrs. West wears glasses and dentures and has enjoyed considerable pain relief from arthritis
through massage therapy. She is concerned about whether or not Medicare will cover these
items and services. What should you tell her?
Answer : Medicare does not cover massage therapy, or, in general, glasses or dentures.
Correct: Neither Medicare Part A nor Part B covers massage therapy, dentures, or routine eye
examinations to prescribe eyeglasses.
Complete Study Guide for all three AHIP sections- modules/tests
Study Tips and Disclaimers:
· Medicare does not remaster a brand new test with all brand new questions every year. Most
of the questions are reused from year to year with a few new ones added in. NEW 2025
QUESTIONS HAVE BEEN ADDED TO THIS STUDY GUIDE!
· The below compilation of questions cover MOST the questions that you will find in the
module quizzes and/or test.
· This compilation is meant to be used as supplemental study aid and not to be used during
the actual test in order to “cheat”.
· A great way to use this study guide when taking your quizzes is to use the “find and
replace option” in your Word or Google Docs software and type in some keywords (ex.
Mrs. Duarte should file an appeal). In doing so, it will take you right to the question, with
the correct answer below.
Mrs. Duarte 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?
Answer : Mrs. Duarte should file an appeal of this initial determination within 120 days of the
date she received the MSN in the mail. Correct: Beneficiaries must file an appeal related to Part
A or B services within 120 days of the date they get the MSN in the mail.
Mrs. Chi is age 75 and enjoys a comfortable but not extremely high-income level. She wishes to
enroll in a MA MSA plan that she heard about from her neighbor. She also wants to have
prescription drug coverage since her doctor recently prescribed several expensive medications.
Currently, she is enrolled in Original Medicare and a standalone Part D plan. How would you
advise Mrs. Chi?
Answer : Mrs. Chi may enroll in a MA MSA plan and remain in her current standalone Part D
prescription drug plan.
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. Correct: Individuals with ESRD may sign up for
Medicare at any time. Coverage typically begins on the fourth month after dialysis treatments
start, but it could be earlier if certain conditions are met.
Juan Perez, 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. Juan is a naturalized citizen and has contributed to the
Medicare system for over 20 years. Juan 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? a. Juan is likely to be ineligible for Medicare since he was born outside the United
States and has only contributed to the Medicare system for 20 years.
Answer : b. Juan 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. Correct: Medicare is the primary payor for individuals who have
group health coverage as a result of their or their spouse’s employment with a company that is
not a large group health plan (GHP) (basically, one with fewer than 20 employees).
Furthermore, small GHPs do not have to continue to offer their age 65 and over employees and
their spouses the same benefits under the GHP as individuals under age 65.
Mr. Sanchez has just turned 65 and is entitled to Part A but has not enrolled in Part B because
he has coverage through an employer plan. If he wants to enroll in a Medicare Advantage plan,
what will he have to do?
Answer : He will have to enroll in Part B.
Ms. Thomas has worked for many years and is turning 68 in June. She is eligible for Medicare
Part A and did not enroll for Part B when first eligible because she has insurance through her
employer - Coffee Brew, Inc. She also did not enroll in Part D because she had creditable
coverage. She would like to retire in June and enroll in a Medicare Advantage plan. She has
been informed that her group coverage will end on her retirement effective date. How would you
advise Ms. Thomas?
Answer : Ms. Thomas can enroll in Part B without a late penalty at any time she is still covered
by her employer group and 8 months after her last month of employer group coverage without a
penalty. However, because she wants to enroll in a MA plan after retirement, she should make
sure her Part B coverage is effective in time to use the Medicare Advantage/Part D special
election period for individuals changing from employer group coverage to enroll in a MA plan or
,MA-PD. The SEP begins while she has employer group coverage and will last until 2 months
after the month after the month her employer coverage ends. If she wants Part D coverage she
should enroll in an MA-PD or a PDP (depending on how she decides to receive her Part A and
B benefits) during this time.
Juan Perez, who is turning age 65 next month, intends to work for several more years at
Smallcap, Incorporated. Smallcap has a workforce of15 employees and offers employer-
sponsored healthcare coverage. Juan is a naturalized citizen and has contributed to the
Medicare system for over 20 years. Juan 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?
Answer : Juan 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.
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.
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.
Mr. Liu turns 65 on june 19. he has never previously qualified for medicare so his first medicare
eligibility date will be by June 1. Mr. Liu’s icep and part d iep begin march 1 and end on
september 30. he wants prescription drug coverage with his part a and part b benefits. What
advice can you provide him?
Answer : He can enroll in a MA-PD as long as he enrolls in Part B and is entitled to Part A.
, Mr. Wingate is a newly enrolled Medicare Part D beneficiary and one of your clients. In addition
to drugs on his plan’s formulary he takes several other medications. These include a
prescription drug not on his plan’s formulary, over-the-counter medications for colds and
allergies, vitamins, and drugs from an Internet-based Canadian pharmacy to promote hair
growth and reduce joint swelling. His neighbor recently told him about a concept called TrOOP
and he asks you if any of his other medications could count toward TrOOP should he ever reach
the Part D catastrophic limit. What should you say?
Answer : None of the costs of Mr. Wingate’s other medications would currently count toward
TrOOP but he may wish to ask his plan for an exception to cover the prescription not on its
formulary.
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.
Mrs. Gonzalez 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?
Answer : Mrs. Gonzalez cannot purchase a Medigap plan that covers drugs, but she could keep
her Medigap policy and enroll in a Part D prescription drug plan. Correct: Individuals who are
enrolled in Medigap plans may only obtain Medicare drug coverage (Part D) through a stand-
alone prescription drug plan.
Mrs. West wears glasses and dentures and has enjoyed considerable pain relief from arthritis
through massage therapy. She is concerned about whether or not Medicare will cover these
items and services. What should you tell her?
Answer : Medicare does not cover massage therapy, or, in general, glasses or dentures.
Correct: Neither Medicare Part A nor Part B covers massage therapy, dentures, or routine eye
examinations to prescribe eyeglasses.
