2026 AHIP FINAL EXAM (ACTUAL TEST)
QUESTIONS AND 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 Ans - 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? Correct Ans - 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? Correct Ans -
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?
Correct Ans - 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?
Correct Ans - 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?
Correct Ans -
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? Correct Ans - 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? Correct Ans -
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? Correct Ans - 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? Correct Ans - He
generally would pay a monthly premium, annual
deductible, and per-prescription cost-sharing.
QUESTIONS AND 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 Ans - 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? Correct Ans - 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? Correct Ans -
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?
Correct Ans - 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?
Correct Ans - 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?
Correct Ans -
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? Correct Ans - 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? Correct Ans -
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? Correct Ans - 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? Correct Ans - He
generally would pay a monthly premium, annual
deductible, and per-prescription cost-sharing.
