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AHIP Final Exam Test Questions and Answers
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AHIP Final Exam Test Questions And
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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?Correct Answershe 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?Correct Answersjuan 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? Correct Answersmedicare 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?Correct Answersshe 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?Correct Answersmost Individuals Who Are Citizens And Age 65 Or Over Are Covered Under
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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?
Correct Answersmrs. 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? 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?Correct Answersunder 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?Correct Answersto 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 Answershe 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?Correct Answersmedicare 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.
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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? Correct Answersbeneficiaries 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?Correct Answersmrs. 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?Correct Answersit 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?Correct Answersshe 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?Correct Answersmedicare 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?Correct Answerspart 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?Correct Answerstell 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?Correct Answersafter
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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?Correct Answersmedicare 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.Correct Answersi, 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 Standalone Medicare Prescription Drug Plan. What Should You Tell Him About This
Situation?Correct Answershe Could Enroll Either In One Of The MA Plans That Include
Prescription Drug Coverage Or Original Medicare With A Medigap Plan And Standalone Part D
Prescription Drug Coverage, But He Cannot Enroll In The MA-Only PPO Plan And A Stand-Alone
Prescription Drug Plan.
Mrs. Ramos Is Considering A Medicare Advantage PPO And Has Questions About Which
Providers She Can Go To For Her Health Care. What Should You Tell Her?Correct Answersmrs.
Ramos Can Obtain Care From Any Provider Who Participates In Original Medicare, But
Generally Will Have A Higher Costsharing Amount If She Sees A Provider Who/That Is Not A
Part Of The PPO Network.
Mr. Romero Is 64, Retiring Soon, And Considering Enrollment In His Employersponsored Retiree
Group Health Plan That Includes Drug Coverage With Nominal Copays. He Heard About A
Neighbor's MA-PD Plan That You Represent And Because He Takes Numerous Prescription
Drugs, He Is Considering Signing Up For It. What Should You Tell Him?Correct Answershe
Should Compare The Benefits In His Employer-Sponsored Retiree Group Health Plan With The
Benefits In His Neighbor's MA-PD Plan To Determine Which One Will Provide Sufficient
Coverage For His Prescription Needs.
Dr. Elizabeth Brennan Does Not Contract With The ABC PFFS Plan But Accepts The Plan's Terms
And Conditions For Payment. Mary Rodgers Sees Dr.
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AHIP Final Exam Test Questions And
Answers (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?Correct Answershe 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?Correct Answersjuan 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? Correct Answersmedicare 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?Correct Answersshe 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?Correct Answersmost Individuals Who Are Citizens And Age 65 Or Over Are Covered Under
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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?
Correct Answersmrs. 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? 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?Correct Answersunder 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?Correct Answersto 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 Answershe 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?Correct Answersmedicare 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.
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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? Correct Answersbeneficiaries 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?Correct Answersmrs. 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?Correct Answersit 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?Correct Answersshe 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?Correct Answersmedicare 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?Correct Answerspart 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?Correct Answerstell 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?Correct Answersafter
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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?Correct Answersmedicare 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.Correct Answersi, 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 Standalone Medicare Prescription Drug Plan. What Should You Tell Him About This
Situation?Correct Answershe Could Enroll Either In One Of The MA Plans That Include
Prescription Drug Coverage Or Original Medicare With A Medigap Plan And Standalone Part D
Prescription Drug Coverage, But He Cannot Enroll In The MA-Only PPO Plan And A Stand-Alone
Prescription Drug Plan.
Mrs. Ramos Is Considering A Medicare Advantage PPO And Has Questions About Which
Providers She Can Go To For Her Health Care. What Should You Tell Her?Correct Answersmrs.
Ramos Can Obtain Care From Any Provider Who Participates In Original Medicare, But
Generally Will Have A Higher Costsharing Amount If She Sees A Provider Who/That Is Not A
Part Of The PPO Network.
Mr. Romero Is 64, Retiring Soon, And Considering Enrollment In His Employersponsored Retiree
Group Health Plan That Includes Drug Coverage With Nominal Copays. He Heard About A
Neighbor's MA-PD Plan That You Represent And Because He Takes Numerous Prescription
Drugs, He Is Considering Signing Up For It. What Should You Tell Him?Correct Answershe
Should Compare The Benefits In His Employer-Sponsored Retiree Group Health Plan With The
Benefits In His Neighbor's MA-PD Plan To Determine Which One Will Provide Sufficient
Coverage For His Prescription Needs.
Dr. Elizabeth Brennan Does Not Contract With The ABC PFFS Plan But Accepts The Plan's Terms
And Conditions For Payment. Mary Rodgers Sees Dr.
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