2023 AHIP QUESTIONS WITH
CORRECT ANSWERS 2025/2026
DavisAisA52AyearsAoldAandAhasArecentlyAbeenAdiagnosedAwithAend-
stageArenalAdiseaseA(ESRD)AandAwillAsoonAbeginAdialysis.AHeAisAwonderingAifAheAcanAobtainAcov
erageAunderAMedicare.AWhatAshouldAyouAtellAhim?A-AcorrectAanswersHeAmayAsign-
upAforAMedicareAatAanyAtimeAhoweverAcoverageAusuallyAbeginsAonAtheAfourthAmonthAafterAdial
ysisAtreatmentsAstart.
JuanAPerez,AwhoAisAturningAageA65AnextAmonth,AintendsAtoAworkAforAseveralAmoreAyearsAatASm
allcap,AIncorporated.ASmallcapAhasAaAworkforceAof15AemployeesAandAoffersAemployer-
sponsoredAhealthcareAcoverage.AJuanAisAaAnaturalizedAcitizenAandAhasAcontributedAtoAtheAMed
icareAsystemAforAoverA20Ayears.AJuanAasksAyouAifAheAwillAbeAentitledAtoAMedicareAandAifAheAenro
llsAhowAthatAwillAimpactAhisAemployer-
sponsoredAhealthcareAcoverage.AHowAwouldAyouArespond?A-
AcorrectAanswersJuanAisAlikelyAtoAbeAeligibleAforAMedicareAonceAheAturnsAageA65AandAifAheAenro
llsAMedicareAwouldAbecomeAtheAprimaryApayorAofAhisAhealthcareAclaimsAandASmallcapAdoesAn
otAhaveAtoAcontinueAtoAofferAhimAcoverageAcomparableAtoAthoseAunderAageA65AunderAitsAempl
oyer-sponsoredAgroupAhealthAplan.
Moy'sAwifeAhasAaAMedicareAAdvantageAplan,AbutAheAwantsAtoAunderstandAwhatAcoverageAMed
icareASupplementalAInsuranceAprovidesAsinceAhisAhealthAcareAneedsAareAdifferentAfromAhisAwif
e'sAneeds.AWhatAcouldAyouAtellAMr.AMoy?A-
AcorrectAanswersMedicareASupplementalAInsuranceAwouldAhelpAcoverAhisAPartAAAandAPartABAd
eductiblesAorAcoinsuranceAinAOriginalAFee-for-
ServiceA(FFS)AMedicareAasAwellAasApossiblyAsomeAservicesAthatAMedicareAdoesAnotAcover.
PeňaAisA66AyearsAold,AhasAcoverageAunderAanAemployerAplan,AandAwillAretireAnextAyear.ASheAhea
rdAsheAmustAenrollAinAPartABAatAtheAbeginningAofAtheAyearAtoAensureAnoAgapAinAcoverage.AWhatA
canAyouAtellAher?A-
AcorrectAanswersSheAmayAenrollAatAanyAtimeAwhileAsheAisAcoveredAunderAherAemployerAplan,Ab
utAsheAwillAhaveAaAspecialAeight-
monthAenrollmentAperiodAafterAtheAlastAmonthAonAherAemployerAplanAthatAdiffersAfromAtheAst
andardAgeneralAenrollmentAperiod,AduringAwhichAsheAmayAenrollAinAMedicareAPartAB.
ChenAwillAbeA65Asoon,AhasAbeenAaAcitizenAforAtwelveAyears,AhasAbeenAemployedAfullAtime,AandA
paidAtaxesAduringAthatAentireAperiod.ASheAisAconcernedAthatAsheAwillAnotAqualifyAforAcoverageA
underApartAAAbecauseAsheAwasAnotAbornAinAtheAUnitedAStates.AWhatAshouldAyouAtellAher?A-
AcorrectAanswersMostAindividualsAwhoAareAcitizensAandAageA65AorAoverAareAcoveredAunderAPar
tAAAbyAvirtueAofAhavingApaidAMedicareAtaxesAwhileAworking,AthoughAsomeAmayAbeAcoveredAasA
aAresultAofApayingAmonthlyApremiums.
,GonzalezAisAenrolledAinAOriginalAMedicareAandAhasAaAMedigapApolicyAasAwell,AbutAitAprovidesAn
oAdrugAcoverage.ASheAwouldAlikeAtoAkeepAtheAcoverageAsheAhasAbutAreplaceAherAexistingAMedig
apAplanAwithAoneAthatAprovidesAdrugAcoverage.AWhatAshouldAyouAtellAher?A-
AcorrectAanswersMrs.AGonzalezAcannotApurchaseAaAMedigapAplanAthatAcoversAdrugs,AbutAsheAc
ouldAkeepAherAMedigapApolicyAandAenrollAinAaAPartADAprescriptionAdrugAplan.
WestAwearsAglassesAandAdenturesAandAhasAenjoyedAconsiderableApainAreliefAfromAarthritisAthr
oughAmassageAtherapy.ASheAisAconcernedAaboutAwhetherAorAnotAMedicareAwillAcoverAtheseAite
msAandAservices.AWhatAshouldAyouAtellAher?A-
AcorrectAanswersMedicareAdoesAnotAcoverAmassageAtherapy,Aor,AinAgeneral,AglassesAorAdenture
s.
PatelAisAinAgoodAhealthAandAisApreparingAaAbudgetAinAanticipationAofAhisAretirementAwhenAheAt
urnsA66.AHeAwantsAtoAunderstandAtheAhealthAcareAcostsAheAmightAbeAexposedAtoAunderAMedic
areAifAheAwereAtoArequireAhospitalizationAasAaAresultAofAanAillness.AInAgeneralAterms,AwhatAcoul
dAyouAtellAhimAaboutAhisAcostsAforAinpatientAhospitalAservices
underAOriginalAMedicare?A-
AcorrectAanswersUnderAOriginalAMedicare,AthereAisAaAsingleAdeductibleAamountAdueAforAtheAfir
stA60AdaysAofAanyAinpatientAhospitalAstay,AafterAwhichAitAconvertsAintoAaAper-
dayAcoinsuranceAamountAthroughAdayA90.AAfterAdayA90,AheAwouldApayAaAdailyAamountAupAtoA6
0AdaysAoverAhisAlifetime,AafterAwhichAheAwouldAbeAresponsibleAforAallAcosts.
HendersonAbelievesAthatAsheAwillAqualifyAforAMedicareACoverageAwhenAsheAturnsA65,AwithoutA
payingAanyApremiums,AbecauseAsheAhasAbeenAworkingAforA40AyearsAandApayingAMedicareAtaxe
s.AWhatAshouldAyouAtellAher?A-
AcorrectAanswersToAobtainAPartABAcoverage,AsheAmustApayAaAstandardAmonthlyApremium,Athou
ghAitAisAhigherAforAindividualsAwithAhigherAincomes.
AlonsoAreceivesAsomeAhelpApayingAforAhisAtwoAgenericAprescriptionAdrugsAfromAhisAemployer's
AretireeAcoverage,AbutAheAwantsAtoAcompareAitAtoAaAPartADAprescriptionAdrugAplan.AHeAasksAyou
AwhatAcostsAheAwouldAgenerallyAexpectAtoAencounterAwhenAenrollingAintoAaAstandardAMedicar
ePartADAprescriptionAdrugAplan.AWhatAshouldAyouAtellAhim?A-
AcorrectAanswersHeAgenerallyAwouldApayAaAmonthlyApremium,AannualAdeductible,AandAper-
prescriptionAcost-sharing.
MooreAplansAtoAretireAwhenAsheAturnsA65AinAaAfewAmonths.ASheAisAinAexcellentAhealthAandAwillA
haveAconsiderableAincomeAwhenAsheAretires.ASheAisAconcernedAthatAherAincomeAwillAmakeAitAi
mpossibleAforAherAtoAqualifyAforAMedicare.AWhatAcouldAyouAtellAherAtoAaddressAherAconcern?A-
AcorrectAanswersMedicareAisAaAprogramAforApeopleAageA65AorAolderAandAthoseAunderAageA65Aw
ithAcertainAdisabilities,Aend-
stageArenalAdisease,AandALouAGehrig'sAdiseaseAsoAsheAwillAbeAeligibleAforAMedicare.
, XiAwillAsoonAturnAageA65AandAhasAcomeAtoAyouAforAadviceAasAtoAwhatAservicesAareAprovidedAun
derAOriginalAMedicare.AWhatAshouldAyouAtellAMr.AXiAthatAbestAdescribesAtheAhealthAcoverageAp
rovidedAtoAMedicareAbeneficiaries?A-
AcorrectAanswersBeneficiariesAunderAOriginalAMedicareAhaveAnoAcost-
sharingAforAmostApreventiveAservicesAwhichAincludeAimmunizationsAsuchAasAannualAfluAshots.
DuarteAisAenrolledAinAOriginalAMedicareAPartsAAAandAB.ASheAhasArecentlyAreviewedAherAMedica
reASummaryANoticeA(MSN)AandAdisagreesAwithAaAdeterminationAthatApartiallyAdeniedAoneAofAh
erAclaimsAforAservices.AWhatAadviceAwouldAyouAgiveAher?A-
AcorrectAanswersMrs.ADuarteAshouldAfileAanAappealAofAthisAinitialAdetermination AwithinA120Ada
ysAofAtheAdateAsheAreceivedAtheAMSNAinAtheAmail.
CapadonaAwouldAlikeAtoApurchaseAaAMedicareAAdvantageA(MA)AplanAandAaAMedigapAplanAtoApi
ckAupAcostsAnotAcoveredAbyAthatAplan.
WhatAshouldAyouAtellAhim?A-
AcorrectAanswersItAisAillegalAforAyouAtoAsellAMr.ACapadonaAaAMedigapAplanAifAheAisAenrolledAinAa
nAMAAplan,AandAbesides,AMedigapAonlyAworksAwithAOriginalAMedicare.
ParkAisAanAelderlyAretiree.AMrs.AParkAhasAaAlowAfixedAincome.AWhatAcouldAyouAtellAMrs.AParkAth
atAmightAbeAofAassistance?A-
AcorrectAanswersSheAshouldAcontactAherAstateAMedicaidAagencyAtoAseeAifAsheAqualifiesAforAoneA
ofAseveralAprogramsAthatAcanAhelpAwithAMedicareAcostsAforAwhichAsheAisAresponsible.
RaineyAisAexperiencingAparanoidAdelusionsAandAhisAphysicianAfeelsAthatAheAshouldAbeAhospitali
zed.AWhatAshouldAyouAtellAMr.ARaineyA(orAhisArepresentative)AaboutAtheAlengthAofAanAinpatient
ApsychiatricAhospitalAstayAthatAMedicareAwillAcover?A-
AcorrectAanswersMedicareAwillAcoverAaAtotalAofA190AdaysAofAinpatientApsychiatricAcareAduringA
Mr.ARainey'sAentireAlifetime.
SchmidtAwouldAlikeAtoAplanAforAretirementAandAhasAaskedAyouAwhatAisAcoveredAunderAOriginalA
Fee-for-ServiceA(FFS)AMedicare?AWhatAcouldAyouAtellAhim?A-
AcorrectAanswersPartAA,AwhichAcoversAhospital,AskilledAnursingAfacility,Ahospice,AandAhomeAhea
lthAservicesAandAPartAB,AwhichAcoversAprofessionalAservicesAsuchAasAthoseAprovidedAbyAaAdocto
rAareAcoveredAunderAOriginalAMedicare.
AgentAJohnAMillerAisAmeetingAwithAJerryASmith,AaAnewAprospect.AJerryAisAcurrentlyAenrolledAinA
MedicareAPartsAAAandAB.AJerryAhasAalsoApurchasedAaAMedicareASupplementA(Medigap)AplanAw
hichAheAhasAhadAforAseveralAyears.AHowever,AtheAplanAdoesAnotAprovideAdrugAbenefits.AHowAw
ouldAyouAadviseAAgentAJohnAMillerAtoAproceed?A-
AcorrectAanswersTellAprospectAJerryASmithAthatAheAshouldAconsiderAaddingAaAstandaloneAPartA
DAprescriptionAdrugAcoverageApolicyAtoAhisApresentAcoverage.
BauerAisA49AyearsAold,AbutAeighteenAmonthsAagoAheAwasAdeclaredAdisabledAbyAtheASocialASecur
ityAAdministrationAandAhasAbeenAreceivingAdisabilityApayments.AHeAisAwonderingAwhetherAheA
CORRECT ANSWERS 2025/2026
DavisAisA52AyearsAoldAandAhasArecentlyAbeenAdiagnosedAwithAend-
stageArenalAdiseaseA(ESRD)AandAwillAsoonAbeginAdialysis.AHeAisAwonderingAifAheAcanAobtainAcov
erageAunderAMedicare.AWhatAshouldAyouAtellAhim?A-AcorrectAanswersHeAmayAsign-
upAforAMedicareAatAanyAtimeAhoweverAcoverageAusuallyAbeginsAonAtheAfourthAmonthAafterAdial
ysisAtreatmentsAstart.
JuanAPerez,AwhoAisAturningAageA65AnextAmonth,AintendsAtoAworkAforAseveralAmoreAyearsAatASm
allcap,AIncorporated.ASmallcapAhasAaAworkforceAof15AemployeesAandAoffersAemployer-
sponsoredAhealthcareAcoverage.AJuanAisAaAnaturalizedAcitizenAandAhasAcontributedAtoAtheAMed
icareAsystemAforAoverA20Ayears.AJuanAasksAyouAifAheAwillAbeAentitledAtoAMedicareAandAifAheAenro
llsAhowAthatAwillAimpactAhisAemployer-
sponsoredAhealthcareAcoverage.AHowAwouldAyouArespond?A-
AcorrectAanswersJuanAisAlikelyAtoAbeAeligibleAforAMedicareAonceAheAturnsAageA65AandAifAheAenro
llsAMedicareAwouldAbecomeAtheAprimaryApayorAofAhisAhealthcareAclaimsAandASmallcapAdoesAn
otAhaveAtoAcontinueAtoAofferAhimAcoverageAcomparableAtoAthoseAunderAageA65AunderAitsAempl
oyer-sponsoredAgroupAhealthAplan.
Moy'sAwifeAhasAaAMedicareAAdvantageAplan,AbutAheAwantsAtoAunderstandAwhatAcoverageAMed
icareASupplementalAInsuranceAprovidesAsinceAhisAhealthAcareAneedsAareAdifferentAfromAhisAwif
e'sAneeds.AWhatAcouldAyouAtellAMr.AMoy?A-
AcorrectAanswersMedicareASupplementalAInsuranceAwouldAhelpAcoverAhisAPartAAAandAPartABAd
eductiblesAorAcoinsuranceAinAOriginalAFee-for-
ServiceA(FFS)AMedicareAasAwellAasApossiblyAsomeAservicesAthatAMedicareAdoesAnotAcover.
PeňaAisA66AyearsAold,AhasAcoverageAunderAanAemployerAplan,AandAwillAretireAnextAyear.ASheAhea
rdAsheAmustAenrollAinAPartABAatAtheAbeginningAofAtheAyearAtoAensureAnoAgapAinAcoverage.AWhatA
canAyouAtellAher?A-
AcorrectAanswersSheAmayAenrollAatAanyAtimeAwhileAsheAisAcoveredAunderAherAemployerAplan,Ab
utAsheAwillAhaveAaAspecialAeight-
monthAenrollmentAperiodAafterAtheAlastAmonthAonAherAemployerAplanAthatAdiffersAfromAtheAst
andardAgeneralAenrollmentAperiod,AduringAwhichAsheAmayAenrollAinAMedicareAPartAB.
ChenAwillAbeA65Asoon,AhasAbeenAaAcitizenAforAtwelveAyears,AhasAbeenAemployedAfullAtime,AandA
paidAtaxesAduringAthatAentireAperiod.ASheAisAconcernedAthatAsheAwillAnotAqualifyAforAcoverageA
underApartAAAbecauseAsheAwasAnotAbornAinAtheAUnitedAStates.AWhatAshouldAyouAtellAher?A-
AcorrectAanswersMostAindividualsAwhoAareAcitizensAandAageA65AorAoverAareAcoveredAunderAPar
tAAAbyAvirtueAofAhavingApaidAMedicareAtaxesAwhileAworking,AthoughAsomeAmayAbeAcoveredAasA
aAresultAofApayingAmonthlyApremiums.
,GonzalezAisAenrolledAinAOriginalAMedicareAandAhasAaAMedigapApolicyAasAwell,AbutAitAprovidesAn
oAdrugAcoverage.ASheAwouldAlikeAtoAkeepAtheAcoverageAsheAhasAbutAreplaceAherAexistingAMedig
apAplanAwithAoneAthatAprovidesAdrugAcoverage.AWhatAshouldAyouAtellAher?A-
AcorrectAanswersMrs.AGonzalezAcannotApurchaseAaAMedigapAplanAthatAcoversAdrugs,AbutAsheAc
ouldAkeepAherAMedigapApolicyAandAenrollAinAaAPartADAprescriptionAdrugAplan.
WestAwearsAglassesAandAdenturesAandAhasAenjoyedAconsiderableApainAreliefAfromAarthritisAthr
oughAmassageAtherapy.ASheAisAconcernedAaboutAwhetherAorAnotAMedicareAwillAcoverAtheseAite
msAandAservices.AWhatAshouldAyouAtellAher?A-
AcorrectAanswersMedicareAdoesAnotAcoverAmassageAtherapy,Aor,AinAgeneral,AglassesAorAdenture
s.
PatelAisAinAgoodAhealthAandAisApreparingAaAbudgetAinAanticipationAofAhisAretirementAwhenAheAt
urnsA66.AHeAwantsAtoAunderstandAtheAhealthAcareAcostsAheAmightAbeAexposedAtoAunderAMedic
areAifAheAwereAtoArequireAhospitalizationAasAaAresultAofAanAillness.AInAgeneralAterms,AwhatAcoul
dAyouAtellAhimAaboutAhisAcostsAforAinpatientAhospitalAservices
underAOriginalAMedicare?A-
AcorrectAanswersUnderAOriginalAMedicare,AthereAisAaAsingleAdeductibleAamountAdueAforAtheAfir
stA60AdaysAofAanyAinpatientAhospitalAstay,AafterAwhichAitAconvertsAintoAaAper-
dayAcoinsuranceAamountAthroughAdayA90.AAfterAdayA90,AheAwouldApayAaAdailyAamountAupAtoA6
0AdaysAoverAhisAlifetime,AafterAwhichAheAwouldAbeAresponsibleAforAallAcosts.
HendersonAbelievesAthatAsheAwillAqualifyAforAMedicareACoverageAwhenAsheAturnsA65,AwithoutA
payingAanyApremiums,AbecauseAsheAhasAbeenAworkingAforA40AyearsAandApayingAMedicareAtaxe
s.AWhatAshouldAyouAtellAher?A-
AcorrectAanswersToAobtainAPartABAcoverage,AsheAmustApayAaAstandardAmonthlyApremium,Athou
ghAitAisAhigherAforAindividualsAwithAhigherAincomes.
AlonsoAreceivesAsomeAhelpApayingAforAhisAtwoAgenericAprescriptionAdrugsAfromAhisAemployer's
AretireeAcoverage,AbutAheAwantsAtoAcompareAitAtoAaAPartADAprescriptionAdrugAplan.AHeAasksAyou
AwhatAcostsAheAwouldAgenerallyAexpectAtoAencounterAwhenAenrollingAintoAaAstandardAMedicar
ePartADAprescriptionAdrugAplan.AWhatAshouldAyouAtellAhim?A-
AcorrectAanswersHeAgenerallyAwouldApayAaAmonthlyApremium,AannualAdeductible,AandAper-
prescriptionAcost-sharing.
MooreAplansAtoAretireAwhenAsheAturnsA65AinAaAfewAmonths.ASheAisAinAexcellentAhealthAandAwillA
haveAconsiderableAincomeAwhenAsheAretires.ASheAisAconcernedAthatAherAincomeAwillAmakeAitAi
mpossibleAforAherAtoAqualifyAforAMedicare.AWhatAcouldAyouAtellAherAtoAaddressAherAconcern?A-
AcorrectAanswersMedicareAisAaAprogramAforApeopleAageA65AorAolderAandAthoseAunderAageA65Aw
ithAcertainAdisabilities,Aend-
stageArenalAdisease,AandALouAGehrig'sAdiseaseAsoAsheAwillAbeAeligibleAforAMedicare.
, XiAwillAsoonAturnAageA65AandAhasAcomeAtoAyouAforAadviceAasAtoAwhatAservicesAareAprovidedAun
derAOriginalAMedicare.AWhatAshouldAyouAtellAMr.AXiAthatAbestAdescribesAtheAhealthAcoverageAp
rovidedAtoAMedicareAbeneficiaries?A-
AcorrectAanswersBeneficiariesAunderAOriginalAMedicareAhaveAnoAcost-
sharingAforAmostApreventiveAservicesAwhichAincludeAimmunizationsAsuchAasAannualAfluAshots.
DuarteAisAenrolledAinAOriginalAMedicareAPartsAAAandAB.ASheAhasArecentlyAreviewedAherAMedica
reASummaryANoticeA(MSN)AandAdisagreesAwithAaAdeterminationAthatApartiallyAdeniedAoneAofAh
erAclaimsAforAservices.AWhatAadviceAwouldAyouAgiveAher?A-
AcorrectAanswersMrs.ADuarteAshouldAfileAanAappealAofAthisAinitialAdetermination AwithinA120Ada
ysAofAtheAdateAsheAreceivedAtheAMSNAinAtheAmail.
CapadonaAwouldAlikeAtoApurchaseAaAMedicareAAdvantageA(MA)AplanAandAaAMedigapAplanAtoApi
ckAupAcostsAnotAcoveredAbyAthatAplan.
WhatAshouldAyouAtellAhim?A-
AcorrectAanswersItAisAillegalAforAyouAtoAsellAMr.ACapadonaAaAMedigapAplanAifAheAisAenrolledAinAa
nAMAAplan,AandAbesides,AMedigapAonlyAworksAwithAOriginalAMedicare.
ParkAisAanAelderlyAretiree.AMrs.AParkAhasAaAlowAfixedAincome.AWhatAcouldAyouAtellAMrs.AParkAth
atAmightAbeAofAassistance?A-
AcorrectAanswersSheAshouldAcontactAherAstateAMedicaidAagencyAtoAseeAifAsheAqualifiesAforAoneA
ofAseveralAprogramsAthatAcanAhelpAwithAMedicareAcostsAforAwhichAsheAisAresponsible.
RaineyAisAexperiencingAparanoidAdelusionsAandAhisAphysicianAfeelsAthatAheAshouldAbeAhospitali
zed.AWhatAshouldAyouAtellAMr.ARaineyA(orAhisArepresentative)AaboutAtheAlengthAofAanAinpatient
ApsychiatricAhospitalAstayAthatAMedicareAwillAcover?A-
AcorrectAanswersMedicareAwillAcoverAaAtotalAofA190AdaysAofAinpatientApsychiatricAcareAduringA
Mr.ARainey'sAentireAlifetime.
SchmidtAwouldAlikeAtoAplanAforAretirementAandAhasAaskedAyouAwhatAisAcoveredAunderAOriginalA
Fee-for-ServiceA(FFS)AMedicare?AWhatAcouldAyouAtellAhim?A-
AcorrectAanswersPartAA,AwhichAcoversAhospital,AskilledAnursingAfacility,Ahospice,AandAhomeAhea
lthAservicesAandAPartAB,AwhichAcoversAprofessionalAservicesAsuchAasAthoseAprovidedAbyAaAdocto
rAareAcoveredAunderAOriginalAMedicare.
AgentAJohnAMillerAisAmeetingAwithAJerryASmith,AaAnewAprospect.AJerryAisAcurrentlyAenrolledAinA
MedicareAPartsAAAandAB.AJerryAhasAalsoApurchasedAaAMedicareASupplementA(Medigap)AplanAw
hichAheAhasAhadAforAseveralAyears.AHowever,AtheAplanAdoesAnotAprovideAdrugAbenefits.AHowAw
ouldAyouAadviseAAgentAJohnAMillerAtoAproceed?A-
AcorrectAanswersTellAprospectAJerryASmithAthatAheAshouldAconsiderAaddingAaAstandaloneAPartA
DAprescriptionAdrugAcoverageApolicyAtoAhisApresentAcoverage.
BauerAisA49AyearsAold,AbutAeighteenAmonthsAagoAheAwasAdeclaredAdisabledAbyAtheASocialASecur
ityAAdministrationAandAhasAbeenAreceivingAdisabilityApayments.AHeAisAwonderingAwhetherAheA
