AHIP Final Exam Test Questions and Answers- Latest
2025/2026 (Verified Answers)
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.
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? .✓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?
.✓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? .✓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.
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.
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? .✓✓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.
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?
✓✓Medicare .does .not .cover .massage .therapy, .or, .in .general, .glasses .or .dentures.
Mr. .Patel .is .in .good .health .and .is .preparing .a .budget .in .anticipation .of .his
.retirement .when .he .turns .66. .He .wants .to .understand .the .health .care .costs .he
.might .be .exposed .to .under .Medicare .if .he .were .to .require .hospitalization .as .a
.result .of .an .illness. .In .general .terms, .what .could .you .tell .him .about .his .costs .for
.inpatient .hospital .services
under .Original .Medicare? .✓✓Under .Original .Medicare, .there .is .a .single
.deductible .amount .due .for .the .first .60 .days .of .any .inpatient .hospital .stay, .after
which .it .converts .into .a .per-day .coinsurance .amount .through .day .90. .After .day
.90, .he .would .pay .a .daily .amount .up .to .60 .days .over .his .lifetime, .after .which .he
. would .be .responsible .for .all .costs.
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.
Mr. .Alonso .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 .MedicarePart .D .prescription .drug .plan.
.What .should .you .tell .him? .✓✓He .generally .would .pay .a .monthly .premium,
.annual .deductible, .and .per-prescription .cost-sharing.
,Ms. .Moore .plans .to .retire .when .she .turns .65 .in .a .few .months. .She .is .in
.excellent .health .and .will .have .considerable .income .when .she .retires. .She .is
.concerned .that .her .income .will .make .it .impossible .for .her .to .qualify .for
.Medicare. .What .could .you .tell .her .to .address .her .concern? .✓✓Medicare .is .a
.program .for .people .age .65 .or .older .and .those .under .age .65 .with .certain
.disabilities, .end-stage .renal .disease, .and .Lou .Gehrig's .disease .so .she .will .be
.eligible .for .Medicare.
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. .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? .✓✓Mrs. .Duarte .should .file .an .appeal .of .this .initial
.determination .within .120 .days .of .the .date .she .received .the .MSN .in .the .mail.
Mr. .Capadona .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? .✓✓It .is .illegal .for .you .to .sell .Mr. .Capadona .a
.Medigap .plan .if .he .is .enrolled .in .an .MA .plan, .and .besides, .Medigap .only .works
.with
Original .Medicare.
Mrs. .Park .is .an .elderly .retiree. .Mrs. .Park .has .a .low .fixed .income. .What .could
.you .tell .Mrs. .Park .that .might .be .of .assistance? .✓✓She .should .contact .her .state
.Medicaid .agency .to .see .if .she .qualifies .for .one .of .several .programs .that .can
.help .with .Medicare .costs .for .which .she .is .responsible.
Mr. .Rainey .is .experiencing .paranoid .delusions .and .his .physician .feels .that .he
.should .be .hospitalized. .What .should .you .tell .Mr. .Rainey .(or .his .representative)
.about .the .length .of .an .inpatient .psychiatric .hospital .stay .that .Medicare .will
.cover?
✓✓Medicare .will .cover .a .total .of .190 .days .of .inpatient .psychiatric .care .during
.Mr. .Rainey's .entire .lifetime.
Mr. .Schmidt .would .like .to .plan .for .retirement .and .has .asked .you .what .is .covered
.under .Original .Fee-for-Service .(FFS) .Medicare? .What .could .you .tell .him?
✓✓Part .A, .which .covers .hospital, .skilled .nursing .facility, .hospice, .and .home
health
, services .and .Part .B, .which .covers .professional .services .such .as .those .provided
.by .a .doctor .are .covered .under .Original .Medicare.
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.
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. .Buck .has .several .family .members .who .died .from .different .cancers. .He
.wants .to .know .if .Medicare .covers .cancer .screening.
What .should .you .tell .him? .✓✓Medicare .covers .the .periodic .performance .of .a
.range .of .screening .tests .that .are .meant .to .provide .early .detection .of .disease. .Mr.
Buck .will .need .to .check .specific .tests .before .obtaining .them .to .see .if .they .will
.be .covered.
Which .of .the .following .statement .is/are .correct .about .a .Medicare .Savings .Account
.(MSA) .Plans?
I. MSAs .may .have .either .a .partial .network, .full .network, .or .no
.network .of .providers.
II. MSA .plans .cover .Part .A .and .Part .B .benefits .but .not .Part .D
.prescription .drug .benefits.
III. An .individual .who .is .enrolled .in .an .MSA .plan .is .responsible .for .a .minimal
.deductible .of .$500 .indexed .for .inflation.
IV. Non-network .providers .must .accept .the .same .amount .that .Original
.Medicare .would .pay .them .as .payment .in .full. .✓✓I, .II, .and .IV .only
Mr. .Lombardi .is .interested .in .a .Medicare .Advantage .(MA) .PPO .plan .that .you
.represent. .It .is .one .of .three .plans .operated .by .the .same .organization .in .Mr.
Lombardi's .area. .The .MA .PPO .plan .does .not .include .drug .coverage, .but .the .other
.two .plans .do. .Mr. .Lombardi .likes .the .PPO .plan .that .does .not .include .drug
.coverage .and .intends .to .obtain .his .drug .coverage .through .a .stand-alone .Medicare
2025/2026 (Verified Answers)
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.
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? .✓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?
.✓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? .✓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.
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.
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? .✓✓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.
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?
✓✓Medicare .does .not .cover .massage .therapy, .or, .in .general, .glasses .or .dentures.
Mr. .Patel .is .in .good .health .and .is .preparing .a .budget .in .anticipation .of .his
.retirement .when .he .turns .66. .He .wants .to .understand .the .health .care .costs .he
.might .be .exposed .to .under .Medicare .if .he .were .to .require .hospitalization .as .a
.result .of .an .illness. .In .general .terms, .what .could .you .tell .him .about .his .costs .for
.inpatient .hospital .services
under .Original .Medicare? .✓✓Under .Original .Medicare, .there .is .a .single
.deductible .amount .due .for .the .first .60 .days .of .any .inpatient .hospital .stay, .after
which .it .converts .into .a .per-day .coinsurance .amount .through .day .90. .After .day
.90, .he .would .pay .a .daily .amount .up .to .60 .days .over .his .lifetime, .after .which .he
. would .be .responsible .for .all .costs.
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.
Mr. .Alonso .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 .MedicarePart .D .prescription .drug .plan.
.What .should .you .tell .him? .✓✓He .generally .would .pay .a .monthly .premium,
.annual .deductible, .and .per-prescription .cost-sharing.
,Ms. .Moore .plans .to .retire .when .she .turns .65 .in .a .few .months. .She .is .in
.excellent .health .and .will .have .considerable .income .when .she .retires. .She .is
.concerned .that .her .income .will .make .it .impossible .for .her .to .qualify .for
.Medicare. .What .could .you .tell .her .to .address .her .concern? .✓✓Medicare .is .a
.program .for .people .age .65 .or .older .and .those .under .age .65 .with .certain
.disabilities, .end-stage .renal .disease, .and .Lou .Gehrig's .disease .so .she .will .be
.eligible .for .Medicare.
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. .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? .✓✓Mrs. .Duarte .should .file .an .appeal .of .this .initial
.determination .within .120 .days .of .the .date .she .received .the .MSN .in .the .mail.
Mr. .Capadona .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? .✓✓It .is .illegal .for .you .to .sell .Mr. .Capadona .a
.Medigap .plan .if .he .is .enrolled .in .an .MA .plan, .and .besides, .Medigap .only .works
.with
Original .Medicare.
Mrs. .Park .is .an .elderly .retiree. .Mrs. .Park .has .a .low .fixed .income. .What .could
.you .tell .Mrs. .Park .that .might .be .of .assistance? .✓✓She .should .contact .her .state
.Medicaid .agency .to .see .if .she .qualifies .for .one .of .several .programs .that .can
.help .with .Medicare .costs .for .which .she .is .responsible.
Mr. .Rainey .is .experiencing .paranoid .delusions .and .his .physician .feels .that .he
.should .be .hospitalized. .What .should .you .tell .Mr. .Rainey .(or .his .representative)
.about .the .length .of .an .inpatient .psychiatric .hospital .stay .that .Medicare .will
.cover?
✓✓Medicare .will .cover .a .total .of .190 .days .of .inpatient .psychiatric .care .during
.Mr. .Rainey's .entire .lifetime.
Mr. .Schmidt .would .like .to .plan .for .retirement .and .has .asked .you .what .is .covered
.under .Original .Fee-for-Service .(FFS) .Medicare? .What .could .you .tell .him?
✓✓Part .A, .which .covers .hospital, .skilled .nursing .facility, .hospice, .and .home
health
, services .and .Part .B, .which .covers .professional .services .such .as .those .provided
.by .a .doctor .are .covered .under .Original .Medicare.
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.
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. .Buck .has .several .family .members .who .died .from .different .cancers. .He
.wants .to .know .if .Medicare .covers .cancer .screening.
What .should .you .tell .him? .✓✓Medicare .covers .the .periodic .performance .of .a
.range .of .screening .tests .that .are .meant .to .provide .early .detection .of .disease. .Mr.
Buck .will .need .to .check .specific .tests .before .obtaining .them .to .see .if .they .will
.be .covered.
Which .of .the .following .statement .is/are .correct .about .a .Medicare .Savings .Account
.(MSA) .Plans?
I. MSAs .may .have .either .a .partial .network, .full .network, .or .no
.network .of .providers.
II. MSA .plans .cover .Part .A .and .Part .B .benefits .but .not .Part .D
.prescription .drug .benefits.
III. An .individual .who .is .enrolled .in .an .MSA .plan .is .responsible .for .a .minimal
.deductible .of .$500 .indexed .for .inflation.
IV. Non-network .providers .must .accept .the .same .amount .that .Original
.Medicare .would .pay .them .as .payment .in .full. .✓✓I, .II, .and .IV .only
Mr. .Lombardi .is .interested .in .a .Medicare .Advantage .(MA) .PPO .plan .that .you
.represent. .It .is .one .of .three .plans .operated .by .the .same .organization .in .Mr.
Lombardi's .area. .The .MA .PPO .plan .does .not .include .drug .coverage, .but .the .other
.two .plans .do. .Mr. .Lombardi .likes .the .PPO .plan .that .does .not .include .drug
.coverage .and .intends .to .obtain .his .drug .coverage .through .a .stand-alone .Medicare
