AHIP HEALTH INSURANCE CONCEPTS EXAM 2026.
Section 1: Medicare Basics and Eligibility (Questions 1-25)
1. Mrs. Shields is covered by Original Medicare. She sustained a hip fracture and is
being successfully treated for that condition. However, she and her physicians feel
that after her lengthy hospital stay, she will need a month or two of nursing and
rehabilitative care. What should you tell them about Original Medicare's coverage
of care in a skilled nursing facility?
A. Medicare will cover all skilled nursing services for up to 100 days with no out-
of-pocket costs
B. Medicare will cover Mrs. Shield's skilled nursing services provided during the
first 20 days of her stay, after which she would have a copay until she has been in
the facility for 100 days
C. Medicare does not cover skilled nursing facility care under any circumstances
D. Medicare will cover skilled nursing services only if she has a Medigap policy
Answer: B
Rationale: Medicare Part A covers skilled nursing facility care for up to 100 days
per benefit period. The first 20 days are fully covered, days 21-100 require a daily
coinsurance payment, and after 100 days the beneficiary is responsible for all
costs. This is a fundamental Medicare benefit that agents must understand .
,2. Mrs. West wears glasses and dentures and has enjoyed considerable pain relief
from arthritis through massage therapy. She is concerned about whether
Medicare will cover these items and services. What should you tell her?
A. Medicare covers massage therapy, glasses, and dentures for all beneficiaries
B. Medicare covers only glasses and dentures, but not massage therapy
C. Medicare does not cover massage therapy, or in general, glasses or dentures
D. Medicare covers all these services if prescribed by a physician
Answer: C
Rationale: Original Medicare generally does not cover routine dental services
(including dentures), routine vision services (including eyeglasses), or massage
therapy. These are common exclusions that beneficiaries should be aware of
when considering their coverage options .
3. 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?
,A. He must wait until age 65 to qualify for Medicare
B. He may sign-up for Medicare at any time; however, coverage usually begins on
the fourth month after dialysis treatments start
C. He is not eligible for Medicare because he is under age 65
D. He can enroll immediately and coverage begins the same day
Answer: B
Rationale: Individuals with ESRD can qualify for Medicare regardless of age.
Coverage generally begins the first day of the fourth month of dialysis treatments,
though there are exceptions for certain cases .
4. 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?
A. She will not qualify for Part A because she was not born in the US
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
C. She must purchase Part A with monthly premiums
, D. She must have lived in the US for at least 20 years to qualify
Answer: B
Rationale: Medicare Part A eligibility is primarily based on work history and
payment of Medicare taxes. US citizenship and age 65 or older generally qualify
an individual for premium-free Part A if they or their spouse have paid Medicare
taxes for at least 40 quarters .
5. Mrs. Quinn recently turned 66 and decided after many years of work to retire
and begin receiving Social Security benefits. Shortly thereafter Mrs. Quinn
received a letter informing her that she had been automatically enrolled in
Medicare Part B. She wants to understand what this means. What should you tell
Mrs. Quinn?
A. Part B primarily covers hospital and skilled nursing facility care
B. Part B covers physician services, outpatient care, and some preventive services
C. Part B covers prescription drugs
D. Part B covers long-term care services
Answer: B
Section 1: Medicare Basics and Eligibility (Questions 1-25)
1. Mrs. Shields is covered by Original Medicare. She sustained a hip fracture and is
being successfully treated for that condition. However, she and her physicians feel
that after her lengthy hospital stay, she will need a month or two of nursing and
rehabilitative care. What should you tell them about Original Medicare's coverage
of care in a skilled nursing facility?
A. Medicare will cover all skilled nursing services for up to 100 days with no out-
of-pocket costs
B. Medicare will cover Mrs. Shield's skilled nursing services provided during the
first 20 days of her stay, after which she would have a copay until she has been in
the facility for 100 days
C. Medicare does not cover skilled nursing facility care under any circumstances
D. Medicare will cover skilled nursing services only if she has a Medigap policy
Answer: B
Rationale: Medicare Part A covers skilled nursing facility care for up to 100 days
per benefit period. The first 20 days are fully covered, days 21-100 require a daily
coinsurance payment, and after 100 days the beneficiary is responsible for all
costs. This is a fundamental Medicare benefit that agents must understand .
,2. Mrs. West wears glasses and dentures and has enjoyed considerable pain relief
from arthritis through massage therapy. She is concerned about whether
Medicare will cover these items and services. What should you tell her?
A. Medicare covers massage therapy, glasses, and dentures for all beneficiaries
B. Medicare covers only glasses and dentures, but not massage therapy
C. Medicare does not cover massage therapy, or in general, glasses or dentures
D. Medicare covers all these services if prescribed by a physician
Answer: C
Rationale: Original Medicare generally does not cover routine dental services
(including dentures), routine vision services (including eyeglasses), or massage
therapy. These are common exclusions that beneficiaries should be aware of
when considering their coverage options .
3. 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?
,A. He must wait until age 65 to qualify for Medicare
B. He may sign-up for Medicare at any time; however, coverage usually begins on
the fourth month after dialysis treatments start
C. He is not eligible for Medicare because he is under age 65
D. He can enroll immediately and coverage begins the same day
Answer: B
Rationale: Individuals with ESRD can qualify for Medicare regardless of age.
Coverage generally begins the first day of the fourth month of dialysis treatments,
though there are exceptions for certain cases .
4. 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?
A. She will not qualify for Part A because she was not born in the US
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
C. She must purchase Part A with monthly premiums
, D. She must have lived in the US for at least 20 years to qualify
Answer: B
Rationale: Medicare Part A eligibility is primarily based on work history and
payment of Medicare taxes. US citizenship and age 65 or older generally qualify
an individual for premium-free Part A if they or their spouse have paid Medicare
taxes for at least 40 quarters .
5. Mrs. Quinn recently turned 66 and decided after many years of work to retire
and begin receiving Social Security benefits. Shortly thereafter Mrs. Quinn
received a letter informing her that she had been automatically enrolled in
Medicare Part B. She wants to understand what this means. What should you tell
Mrs. Quinn?
A. Part B primarily covers hospital and skilled nursing facility care
B. Part B covers physician services, outpatient care, and some preventive services
C. Part B covers prescription drugs
D. Part B covers long-term care services
Answer: B
