AHIP Final Exam Study Questions and Correct
Answers (2025)
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?
She could file a grievance with her plan to complain about the lack of timeliness in getting an
appointment.
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?
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.
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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 be paid for
under the Allcare Medicare Advantage plan. What should you say?
Mildred may remain enrolled in Allcare and make a hospice election. Hospice benefits will be paid for by
Original Medicare under Part A and Allcare will continue to pay for any non-hospice services.
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?
Mr. Diaz will not pay any penalty because he had continuous coverage under his employer's 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?
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.
We have an expert-written solution to this problem!
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?
,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.
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?
After receiving such disability payments for 24 months, he will be automatically enrolled in Medicare,
regardless of age.
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?
Beneficiaries under Original Medicare have no cost-sharing for most preventive services which include
immunizations such as annual flu shots.
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 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. 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?
He may sign-up for Medicare at any time however coverage usually begins on the fourth month after
dialysis treatments start.
, 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?
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.
Ms. Henderson believes that she will qualify for Medicare Coverage when she turns 65, without paying
any premiums, because she has been working for 40 years and paying Medicare taxes. What should you
tell her?
To obtain Part B coverage, she must pay a standard monthly premium, though it is higher for individuals
with higher incomes.
We have an expert-written solution to this problem!
To obtain Part B coverage, she must pay a standard monthly premium, though it is higher for individuals
with higher incomes.
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.
Agent John Miller is meeting with Jerry Smith, a new prospect. Jerry is currently enrolled in Medicare
Parts A and B. Jerry has also purchased a Medicare Supplement (Medigap) plan which he has had for
several years. However, the plan does not provide drug benefits. How would you advise Agent John
Miller to proceed?
Tell prospect Jerry Smith that he should consider adding a standalone Part D prescription drug coverage
policy to his present coverage.
Answers (2025)
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?
She could file a grievance with her plan to complain about the lack of timeliness in getting an
appointment.
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?
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.
Previous
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Next
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0:02
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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 be paid for
under the Allcare Medicare Advantage plan. What should you say?
Mildred may remain enrolled in Allcare and make a hospice election. Hospice benefits will be paid for by
Original Medicare under Part A and Allcare will continue to pay for any non-hospice services.
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?
Mr. Diaz will not pay any penalty because he had continuous coverage under his employer's 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?
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.
We have an expert-written solution to this problem!
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?
,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.
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?
After receiving such disability payments for 24 months, he will be automatically enrolled in Medicare,
regardless of age.
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?
Beneficiaries under Original Medicare have no cost-sharing for most preventive services which include
immunizations such as annual flu shots.
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 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. 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?
He may sign-up for Medicare at any time however coverage usually begins on the fourth month after
dialysis treatments start.
, 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?
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.
Ms. Henderson believes that she will qualify for Medicare Coverage when she turns 65, without paying
any premiums, because she has been working for 40 years and paying Medicare taxes. What should you
tell her?
To obtain Part B coverage, she must pay a standard monthly premium, though it is higher for individuals
with higher incomes.
We have an expert-written solution to this problem!
To obtain Part B coverage, she must pay a standard monthly premium, though it is higher for individuals
with higher incomes.
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.
Agent John Miller is meeting with Jerry Smith, a new prospect. Jerry is currently enrolled in Medicare
Parts A and B. Jerry has also purchased a Medicare Supplement (Medigap) plan which he has had for
several years. However, the plan does not provide drug benefits. How would you advise Agent John
Miller to proceed?
Tell prospect Jerry Smith that he should consider adding a standalone Part D prescription drug coverage
policy to his present coverage.
