2026 AHIP Final Exam| Actual Exam
with Verified Answers with Rationales
Question 1
Mrs. Burton is a retiree with substantial income enrolled in an MA-PD plan and is disappointed
with the service from her primary care physician because she was told she would have to wait
five weeks for an appointment when ill. She asks what she can do about the poor access to care.
What should you tell her?
a. She should switch to Original Medicare for better access
b. She could file a grievance with her plan to complain about the lack of timeliness in getting an
appointment
c. She must wait until the Annual Enrollment Period to change plans
d. She should contact her physician directly to demand an earlier appointment
Correct Answer: b. She could file a grievance with her plan to complain about the lack of
timeliness in getting an appointment
Explanation: Filing a grievance with her MA-PD plan allows Mrs. Burton to formally address
the issue of untimely access to care, prompting the plan to investigate and potentially improve
service, as per CMS guidelines.
Question 2
Edward IP, eligible for Medicare due to end-stage renal disease (ESRD), underwent successful
kidney transplant surgery 12 months ago. Now age 50, he asks if his Medicare coverage will
continue. What should you tell him?
a. His Medicare coverage will continue indefinitely
b. Individuals eligible for Medicare based on ESRD generally lose eligibility 36 months after the
month of a kidney transplant unless eligible on another basis, but he may remain enrolled in Part
B for immunosuppressive drug coverage if he has no other coverage
c. His Medicare coverage ends immediately after the transplant
d. He must reapply for Medicare annually
,Correct Answer: b. Individuals eligible for Medicare based on ESRD generally lose eligibility
36 months after the month of a kidney transplant unless eligible on another basis, but he may
remain enrolled in Part B for immunosuppressive drug coverage if he has no other coverage
Explanation: CMS rules state that ESRD-based Medicare eligibility typically ends 36 months
post-transplant unless the individual qualifies for Medicare on other grounds (e.g., age or
disability). Edward can retain Part B for immunosuppressive drugs if no other coverage exists.
Question 3
Mildred Savage, enrolled in Allcare Medicare Advantage, has inoperable cancer and wants
hospice care. Her family asks if hospice benefits are covered under her plan. What should you
tell them?
a. Hospice care is not covered by any Medicare plan
b. Mildred may remain in Allcare, with hospice benefits paid by Original Medicare under Part A,
and Allcare covering non-hospice services
c. Allcare will cover all hospice services
d. Mildred must disenroll from Allcare to receive hospice care
Correct Answer: b. Mildred may remain in Allcare, with hospice benefits paid by Original
Medicare under Part A, and Allcare covering non-hospice services
Explanation: When enrolled in a Medicare Advantage plan, hospice care is covered by Original
Medicare Part A, while the MA plan continues to cover non-hospice services, per CMS
regulations.
Question 4
Mr. Diaz, who worked until age 68 with continuous employer group coverage, asks about the
Part B premium penalty. What should you tell him?
a. He will pay a penalty based on the years he delayed Part B enrollment
b. Mr. Diaz will not pay any penalty because he had continuous coverage under his employer’s
plan
c. He will pay a one-time penalty for late enrollment
d. The penalty depends on his income level
Correct Answer: b. Mr. Diaz will not pay any penalty because he had continuous coverage under
his employer’s plan
,Explanation: Continuous creditable coverage through an employer plan exempts individuals
from the Part B late enrollment penalty, as per CMS rules, since Mr. Diaz maintained coverage
until age 68.
Question 5
Mr. Moy wants to understand what Medicare Supplemental Insurance provides, as his health
needs differ from his wife’s MA plan. What should you tell him?
a. Medicare Supplemental Insurance only covers prescription drugs
b. Medicare Supplemental Insurance would help cover his Part A and Part B deductibles or
coinsurance in Original Fee-for-Service Medicare and possibly some non-covered services
c. Medicare Supplemental Insurance is identical to Medicare Advantage
d. Medicare Supplemental Insurance cannot be used with Original Medicare
Correct Answer: b. Medicare Supplemental Insurance would help cover his Part A and Part B
deductibles or coinsurance in Original Fee-for-Service Medicare and possibly some non-covered
services
Explanation: Medigap policies supplement Original Medicare by covering out-of-pocket costs
like deductibles and coinsurance, and may include benefits like foreign travel emergency
coverage, per CMS.
Question 6
Mrs. Chen, a 65-year-old citizen who worked full-time and paid taxes, is concerned she won’t
qualify for Part A because she wasn’t born in the U.S. What should you tell her?
a. She does not qualify for Part A due to her non-U.S. birth
b. 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 pay premiums
c. She must pay premiums for both Part A and Part B
d. She qualifies for Part A only if she worked for 40 years
Correct Answer: b. 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 pay premiums
Explanation: U.S. citizens aged 65 or older who paid Medicare taxes for a sufficient period
(typically 40 quarters) qualify for premium-free Part A, regardless of birthplace, per CMS
eligibility rules.
, Question 7
Mr. Bauer, age 49, was declared disabled by the Social Security Administration 18 months ago
and receives disability payments. Can he obtain Medicare coverage?
a. He is not eligible due to his age
b. After receiving disability payments for 24 months, he will be automatically enrolled in
Medicare, regardless of age
c. He must wait until age 65 to enroll
d. He can only enroll if he stops receiving disability payments
Correct Answer: b. After receiving disability payments for 24 months, he will be automatically
enrolled in Medicare, regardless of age
Explanation: Individuals receiving Social Security Disability Insurance (SSDI) for 24 months
are automatically enrolled in Medicare Parts A and B, regardless of age, per CMS rules.
Question 8
Mr. Xi, turning 65, asks what services are provided under Original Medicare. What should you
tell him?
a. Original Medicare covers only hospital stays
b. Beneficiaries under Original Medicare have no cost-sharing for most preventive services,
including immunizations like annual flu shots
c. Original Medicare includes prescription drug coverage
d. Original Medicare requires no premiums
Correct Answer: b. Beneficiaries under Original Medicare have no cost-sharing for most
preventive services, including immunizations like annual flu shots
Explanation: Original Medicare (Parts A and B) covers preventive services like flu shots with
no cost-sharing when provided by participating providers, per CMS guidelines.
Question 9
Mrs. Peña, age 66, has employer coverage and will retire next year. She heard she must enroll in
Part B at the start of the year to avoid a gap. What should you tell her?
a. She must enroll in Part B at the start of the year
b. She may enroll at any time while covered under her employer plan, with a special eight-month
enrollment period after the last month of employer coverage
with Verified Answers with Rationales
Question 1
Mrs. Burton is a retiree with substantial income enrolled in an MA-PD plan and is disappointed
with the service from her primary care physician because she was told she would have to wait
five weeks for an appointment when ill. She asks what she can do about the poor access to care.
What should you tell her?
a. She should switch to Original Medicare for better access
b. She could file a grievance with her plan to complain about the lack of timeliness in getting an
appointment
c. She must wait until the Annual Enrollment Period to change plans
d. She should contact her physician directly to demand an earlier appointment
Correct Answer: b. She could file a grievance with her plan to complain about the lack of
timeliness in getting an appointment
Explanation: Filing a grievance with her MA-PD plan allows Mrs. Burton to formally address
the issue of untimely access to care, prompting the plan to investigate and potentially improve
service, as per CMS guidelines.
Question 2
Edward IP, eligible for Medicare due to end-stage renal disease (ESRD), underwent successful
kidney transplant surgery 12 months ago. Now age 50, he asks if his Medicare coverage will
continue. What should you tell him?
a. His Medicare coverage will continue indefinitely
b. Individuals eligible for Medicare based on ESRD generally lose eligibility 36 months after the
month of a kidney transplant unless eligible on another basis, but he may remain enrolled in Part
B for immunosuppressive drug coverage if he has no other coverage
c. His Medicare coverage ends immediately after the transplant
d. He must reapply for Medicare annually
,Correct Answer: b. Individuals eligible for Medicare based on ESRD generally lose eligibility
36 months after the month of a kidney transplant unless eligible on another basis, but he may
remain enrolled in Part B for immunosuppressive drug coverage if he has no other coverage
Explanation: CMS rules state that ESRD-based Medicare eligibility typically ends 36 months
post-transplant unless the individual qualifies for Medicare on other grounds (e.g., age or
disability). Edward can retain Part B for immunosuppressive drugs if no other coverage exists.
Question 3
Mildred Savage, enrolled in Allcare Medicare Advantage, has inoperable cancer and wants
hospice care. Her family asks if hospice benefits are covered under her plan. What should you
tell them?
a. Hospice care is not covered by any Medicare plan
b. Mildred may remain in Allcare, with hospice benefits paid by Original Medicare under Part A,
and Allcare covering non-hospice services
c. Allcare will cover all hospice services
d. Mildred must disenroll from Allcare to receive hospice care
Correct Answer: b. Mildred may remain in Allcare, with hospice benefits paid by Original
Medicare under Part A, and Allcare covering non-hospice services
Explanation: When enrolled in a Medicare Advantage plan, hospice care is covered by Original
Medicare Part A, while the MA plan continues to cover non-hospice services, per CMS
regulations.
Question 4
Mr. Diaz, who worked until age 68 with continuous employer group coverage, asks about the
Part B premium penalty. What should you tell him?
a. He will pay a penalty based on the years he delayed Part B enrollment
b. Mr. Diaz will not pay any penalty because he had continuous coverage under his employer’s
plan
c. He will pay a one-time penalty for late enrollment
d. The penalty depends on his income level
Correct Answer: b. Mr. Diaz will not pay any penalty because he had continuous coverage under
his employer’s plan
,Explanation: Continuous creditable coverage through an employer plan exempts individuals
from the Part B late enrollment penalty, as per CMS rules, since Mr. Diaz maintained coverage
until age 68.
Question 5
Mr. Moy wants to understand what Medicare Supplemental Insurance provides, as his health
needs differ from his wife’s MA plan. What should you tell him?
a. Medicare Supplemental Insurance only covers prescription drugs
b. Medicare Supplemental Insurance would help cover his Part A and Part B deductibles or
coinsurance in Original Fee-for-Service Medicare and possibly some non-covered services
c. Medicare Supplemental Insurance is identical to Medicare Advantage
d. Medicare Supplemental Insurance cannot be used with Original Medicare
Correct Answer: b. Medicare Supplemental Insurance would help cover his Part A and Part B
deductibles or coinsurance in Original Fee-for-Service Medicare and possibly some non-covered
services
Explanation: Medigap policies supplement Original Medicare by covering out-of-pocket costs
like deductibles and coinsurance, and may include benefits like foreign travel emergency
coverage, per CMS.
Question 6
Mrs. Chen, a 65-year-old citizen who worked full-time and paid taxes, is concerned she won’t
qualify for Part A because she wasn’t born in the U.S. What should you tell her?
a. She does not qualify for Part A due to her non-U.S. birth
b. 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 pay premiums
c. She must pay premiums for both Part A and Part B
d. She qualifies for Part A only if she worked for 40 years
Correct Answer: b. 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 pay premiums
Explanation: U.S. citizens aged 65 or older who paid Medicare taxes for a sufficient period
(typically 40 quarters) qualify for premium-free Part A, regardless of birthplace, per CMS
eligibility rules.
, Question 7
Mr. Bauer, age 49, was declared disabled by the Social Security Administration 18 months ago
and receives disability payments. Can he obtain Medicare coverage?
a. He is not eligible due to his age
b. After receiving disability payments for 24 months, he will be automatically enrolled in
Medicare, regardless of age
c. He must wait until age 65 to enroll
d. He can only enroll if he stops receiving disability payments
Correct Answer: b. After receiving disability payments for 24 months, he will be automatically
enrolled in Medicare, regardless of age
Explanation: Individuals receiving Social Security Disability Insurance (SSDI) for 24 months
are automatically enrolled in Medicare Parts A and B, regardless of age, per CMS rules.
Question 8
Mr. Xi, turning 65, asks what services are provided under Original Medicare. What should you
tell him?
a. Original Medicare covers only hospital stays
b. Beneficiaries under Original Medicare have no cost-sharing for most preventive services,
including immunizations like annual flu shots
c. Original Medicare includes prescription drug coverage
d. Original Medicare requires no premiums
Correct Answer: b. Beneficiaries under Original Medicare have no cost-sharing for most
preventive services, including immunizations like annual flu shots
Explanation: Original Medicare (Parts A and B) covers preventive services like flu shots with
no cost-sharing when provided by participating providers, per CMS guidelines.
Question 9
Mrs. Peña, age 66, has employer coverage and will retire next year. She heard she must enroll in
Part B at the start of the year to avoid a gap. What should you tell her?
a. She must enroll in Part B at the start of the year
b. She may enroll at any time while covered under her employer plan, with a special eight-month
enrollment period after the last month of employer coverage
