AHIP Final Exam | Practice Questions & Answers | Complete
Medicare Certification Study Guide Graded A+
Prepare for the AHIP Medicare Certification Final Exam with this comprehensive study guide
featuring original practice questions, detailed answer explanations, and exam-focused review
material. Topics include Medicare Parts A, B, C, and D, Medicare Advantage, Prescription Drug
Plans (PDP), enrollment periods, eligibility, CMS marketing guidelines, compliance, fraud,
waste and abuse (FWA), and beneficiary protections. Designed to strengthen Medicare
knowledge and improve certification readiness, this guide is ideal for licensed insurance agents
and brokers preparing for annual AHIP certification
Category Details
Certification AHIP (America's Health Insurance Plans) Medicare Training
Certification Period 2026/2028
Modules 1–5 (Medicare Basics, Advantage, Part D, Marketing, Compliance)
Exam Format Multiple-choice, scenario-based questions
Primary References CMS Guidelines, Medicare & You Handbook, AHIP Training Modules
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 ANSWER She should contact
her state Medicaid agency to see if she qualifies forprograms that can help with
Medicare costs for which she is responsible.
QUESTION :Madeline Martinez was widowed several years ago. Her husband worked
for many years and contributed into the Medicare system. He also left a substantial
estate which provides Madeline with an annual income of approximately $130,000.
Madeline, who has only worked part-time for the last three years, will soon turn age 65
and hopes to enroll in Original Medicare. She comes to you for advice. What should you
tell her? - CORRECT ANSWER You should tell Madeline that she will be able to
enroll in Medicare Part A without paying monthly premiums due to her husband's long
work record and participation in the Medicare system. You should also tell Madeline that
,she will pay Part B premiums at more than the standard lowest rate but less than the
highest rate due her substantial income.
QUESTION :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 ANSWER After receiving such disability payments
for 24 months, he will be automatically enrolled in Medicare, regardless of age.
QUESTION :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 ANSWER 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.
QUESTION :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 ANSWER She may
enroll at any time while she is covered under her employer plan, but she will have a
special eight month enrollment period that differs from the standard general enrollment
period, during which she may enroll in Medicare Part B.
QUESTION :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 ANSWER Tell prospect Jerry Smith that he should consider adding a
standalone Part D prescription drug coverage policy to his present coverage.
QUESTION :Mr. Diaz continued working with his company and was insured under his
employer's group plan until he reached age 68. He has heard that there is a premium
penalty for those who did not sign up for Part B when first eligible and wants to know
how much he will have to pay. What should you tell him? - CORRECT ANSWER The
penalty will be a permanent 10% increase in his Part B premium for every 12-month
period that passed during which he could have enrolled and did not.
QUESTION :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 ANSWER 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.
QUESTION :Mildred Savage enrolled in Allcare Medicare Advantage plan several
years ago. Mildred recently learned that she is suffering from inoperable cancer and has
just a few months to live. She would like to spend these final months in hospice care.
,Mildred's family asks you whether hospice benefits will be paid for under the Allcare
Medicare Advantage plan. What should you say? - CORRECT ANSWER Mildred
may remain enrolled in Allcare and make a hospice election. Hospice benefits will be
paid for by Original Medicare under Part A and Allcare will continue to pay for any non-
hospice services.
QUESTION :Mr. Gomez notes that a Private Fee-for-Service (PFFS) plan available in
his area has an attractive premium. He wants to know if he must use doctors in a
network as his current HMO plan requires him to do. What should you tell him? -
CORRECT ANSWER He may receive health care services from any doctor allowed
to bill Medicare, as long as he shows the doctor the plan's identification card and the
doctor agrees to accept the PFFS plan's payment terms and conditions, which could
include balance billing.
QUESTION :Mr. Kelly wants to know whether he is eligible to sign up for a Private fee-
for-service (PFFS) plan. What questions would you need to ask to determine his
eligibility? - CORRECT ANSWER You would need to ask Mr. Kelly if he is enrolled in
Part A and Part B and if he lives in the PFFS plan's service area.
QUESTION :Mrs. Wang wants to know generally how the benefits under Original
Medicare might compare to the benefits package of a Medicare Advantage Plan before
she starts looking at specific plans. What could you tell her? - CORRECT ANSWER
Medicare Advantage Plans may offer extra benefits that Original Medicare does not
offer such as vision, hearing, and dental services. It must include a maximum out-of-
pocket limit on Part A and Part B services.
QUESTION :Mr. Castillo, a naturalized citizen, previously enrolled in Medicare Part B
but has recently stopped paying his Part B premium. Mr. Castillo is still covered by Part
A. He would like to enroll in a Medicare Advantage (MA) plan and is still covered by Part
A. What should you tell him? - CORRECT ANSWER He is not eligible to enroll in a
Medicare Advantage plan until he re-enrolls in Medicare Part B.
QUESTION :Mr. Barker enjoys a comfortable retirement income. He recently had
surgery and expected that he would have certain services and items covered by the
plan with minimal out-of-pocket costs because his MA-PD coverage has been very
good. However, when he received the bill, he was surprised to see large charges in
excess of his maximum out-of-pocket limit that included some services and items he
thought would be fully covered. He called you to ask what he could do? What could you
tell him? - CORRECT ANSWER You can offer to review the plans appeal process to
help him ask the plan to review the coverage decision.
QUESTION :Mrs. Chi is age 75 and enjoys a comfortable but not extremely high-
income level. She wishes to enroll in a MA MSA plan that she heard about from her
neighbor. She also wants to have prescription drug coverage since her doctor recently
prescribed several expensive medications. Currently, she is enrolled in Original
Medicare and a standalone Part D plan. How would you advise Mrs. Chi? - CORRECT
, ANSWER Mrs. Chi may enroll in a MA MSA plan and remain in her current
standalone Part D prescription drug plan.
QUESTION :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 ANSWER Mrs. Ramos can obtain care from any provider who
participates in Original Medicare, but generally will have a higher cost-sharing amount if
she sees a provider who/that is not a part of the PPO network.
QUESTION :Mr. Wells is trying to understand the difference between Original Medicare
and Medicare Advantage. What would be a correct description? - CORRECT ANSWER
Medicare Advantage is a way of covering all the Original Medicare benefits through
private health insurance companies.
QUESTION :Juan Hernandez is turning 65 next month, Juan legally entered the United
States over twenty years ago but is not a citizen. Since his entry into the country, Juan
has worked at Smallcap Incorporated and contributed to the Medicare system. Juan
suffers from diabetes. He will soon retire and asks you if he can enroll in a Medicare
Advantage plan that you represent. How would you respond? - CORRECT ANSWER
Juan is eligible to enroll in a Medicare Advantage as long as he is entitled to Part A and
enrolled in Part B. Juan should go to the Social Security website to enroll in Medicare
Part A and B if he has not done so already. Once he is enrolled, he can choose a
Medicare Advantage plan.
QUESTION :Mr. Hutchinson has drug coverage through his former employer's retiree
plan. He is concerned about the Part D premium penalty if he does not enroll in a
Medicare prescription drug plan, but does not want to purchase extra coverage that he
will not need. What should you tell him? - CORRECT ANSWER He will need to enroll
in a Medicare prescription drug plan upon becoming eligible for the program in order to
avoid a premium penalty. To reduce his expenses, he should look for a plan with a zero
premium.
QUESTION :Mr. Schultz was still working when he first qualified for Medicare. At that
time, he had employer group coverage that was creditable. During his initial Part D
eligibility period, he decided not to enroll because he was satisfied with his drug
coverage. It is now a year later and Mr. Schultz has lost his employer group coverage
within the last two weeks. How would you advise him? - CORRECT ANSWER Mr.
Schultz should enroll in a Part D plan before he has a 63-day break in coverage in order
to avoid a premium penalty.
QUESTION :Mrs. Fields wants to know whether applying for the Part D low income
subsidy will be worth the time to fill out the paperwork. What could you tell her? -
CORRECT ANSWER The Part D low income subsidy could substantially lower her
overall costs. She can apply by contacting her state Medicaid office, or calling the Social
Security Administration.
Medicare Certification Study Guide Graded A+
Prepare for the AHIP Medicare Certification Final Exam with this comprehensive study guide
featuring original practice questions, detailed answer explanations, and exam-focused review
material. Topics include Medicare Parts A, B, C, and D, Medicare Advantage, Prescription Drug
Plans (PDP), enrollment periods, eligibility, CMS marketing guidelines, compliance, fraud,
waste and abuse (FWA), and beneficiary protections. Designed to strengthen Medicare
knowledge and improve certification readiness, this guide is ideal for licensed insurance agents
and brokers preparing for annual AHIP certification
Category Details
Certification AHIP (America's Health Insurance Plans) Medicare Training
Certification Period 2026/2028
Modules 1–5 (Medicare Basics, Advantage, Part D, Marketing, Compliance)
Exam Format Multiple-choice, scenario-based questions
Primary References CMS Guidelines, Medicare & You Handbook, AHIP Training Modules
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 ANSWER She should contact
her state Medicaid agency to see if she qualifies forprograms that can help with
Medicare costs for which she is responsible.
QUESTION :Madeline Martinez was widowed several years ago. Her husband worked
for many years and contributed into the Medicare system. He also left a substantial
estate which provides Madeline with an annual income of approximately $130,000.
Madeline, who has only worked part-time for the last three years, will soon turn age 65
and hopes to enroll in Original Medicare. She comes to you for advice. What should you
tell her? - CORRECT ANSWER You should tell Madeline that she will be able to
enroll in Medicare Part A without paying monthly premiums due to her husband's long
work record and participation in the Medicare system. You should also tell Madeline that
,she will pay Part B premiums at more than the standard lowest rate but less than the
highest rate due her substantial income.
QUESTION :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 ANSWER After receiving such disability payments
for 24 months, he will be automatically enrolled in Medicare, regardless of age.
QUESTION :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 ANSWER 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.
QUESTION :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 ANSWER She may
enroll at any time while she is covered under her employer plan, but she will have a
special eight month enrollment period that differs from the standard general enrollment
period, during which she may enroll in Medicare Part B.
QUESTION :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 ANSWER Tell prospect Jerry Smith that he should consider adding a
standalone Part D prescription drug coverage policy to his present coverage.
QUESTION :Mr. Diaz continued working with his company and was insured under his
employer's group plan until he reached age 68. He has heard that there is a premium
penalty for those who did not sign up for Part B when first eligible and wants to know
how much he will have to pay. What should you tell him? - CORRECT ANSWER The
penalty will be a permanent 10% increase in his Part B premium for every 12-month
period that passed during which he could have enrolled and did not.
QUESTION :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 ANSWER 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.
QUESTION :Mildred Savage enrolled in Allcare Medicare Advantage plan several
years ago. Mildred recently learned that she is suffering from inoperable cancer and has
just a few months to live. She would like to spend these final months in hospice care.
,Mildred's family asks you whether hospice benefits will be paid for under the Allcare
Medicare Advantage plan. What should you say? - CORRECT ANSWER Mildred
may remain enrolled in Allcare and make a hospice election. Hospice benefits will be
paid for by Original Medicare under Part A and Allcare will continue to pay for any non-
hospice services.
QUESTION :Mr. Gomez notes that a Private Fee-for-Service (PFFS) plan available in
his area has an attractive premium. He wants to know if he must use doctors in a
network as his current HMO plan requires him to do. What should you tell him? -
CORRECT ANSWER He may receive health care services from any doctor allowed
to bill Medicare, as long as he shows the doctor the plan's identification card and the
doctor agrees to accept the PFFS plan's payment terms and conditions, which could
include balance billing.
QUESTION :Mr. Kelly wants to know whether he is eligible to sign up for a Private fee-
for-service (PFFS) plan. What questions would you need to ask to determine his
eligibility? - CORRECT ANSWER You would need to ask Mr. Kelly if he is enrolled in
Part A and Part B and if he lives in the PFFS plan's service area.
QUESTION :Mrs. Wang wants to know generally how the benefits under Original
Medicare might compare to the benefits package of a Medicare Advantage Plan before
she starts looking at specific plans. What could you tell her? - CORRECT ANSWER
Medicare Advantage Plans may offer extra benefits that Original Medicare does not
offer such as vision, hearing, and dental services. It must include a maximum out-of-
pocket limit on Part A and Part B services.
QUESTION :Mr. Castillo, a naturalized citizen, previously enrolled in Medicare Part B
but has recently stopped paying his Part B premium. Mr. Castillo is still covered by Part
A. He would like to enroll in a Medicare Advantage (MA) plan and is still covered by Part
A. What should you tell him? - CORRECT ANSWER He is not eligible to enroll in a
Medicare Advantage plan until he re-enrolls in Medicare Part B.
QUESTION :Mr. Barker enjoys a comfortable retirement income. He recently had
surgery and expected that he would have certain services and items covered by the
plan with minimal out-of-pocket costs because his MA-PD coverage has been very
good. However, when he received the bill, he was surprised to see large charges in
excess of his maximum out-of-pocket limit that included some services and items he
thought would be fully covered. He called you to ask what he could do? What could you
tell him? - CORRECT ANSWER You can offer to review the plans appeal process to
help him ask the plan to review the coverage decision.
QUESTION :Mrs. Chi is age 75 and enjoys a comfortable but not extremely high-
income level. She wishes to enroll in a MA MSA plan that she heard about from her
neighbor. She also wants to have prescription drug coverage since her doctor recently
prescribed several expensive medications. Currently, she is enrolled in Original
Medicare and a standalone Part D plan. How would you advise Mrs. Chi? - CORRECT
, ANSWER Mrs. Chi may enroll in a MA MSA plan and remain in her current
standalone Part D prescription drug plan.
QUESTION :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 ANSWER Mrs. Ramos can obtain care from any provider who
participates in Original Medicare, but generally will have a higher cost-sharing amount if
she sees a provider who/that is not a part of the PPO network.
QUESTION :Mr. Wells is trying to understand the difference between Original Medicare
and Medicare Advantage. What would be a correct description? - CORRECT ANSWER
Medicare Advantage is a way of covering all the Original Medicare benefits through
private health insurance companies.
QUESTION :Juan Hernandez is turning 65 next month, Juan legally entered the United
States over twenty years ago but is not a citizen. Since his entry into the country, Juan
has worked at Smallcap Incorporated and contributed to the Medicare system. Juan
suffers from diabetes. He will soon retire and asks you if he can enroll in a Medicare
Advantage plan that you represent. How would you respond? - CORRECT ANSWER
Juan is eligible to enroll in a Medicare Advantage as long as he is entitled to Part A and
enrolled in Part B. Juan should go to the Social Security website to enroll in Medicare
Part A and B if he has not done so already. Once he is enrolled, he can choose a
Medicare Advantage plan.
QUESTION :Mr. Hutchinson has drug coverage through his former employer's retiree
plan. He is concerned about the Part D premium penalty if he does not enroll in a
Medicare prescription drug plan, but does not want to purchase extra coverage that he
will not need. What should you tell him? - CORRECT ANSWER He will need to enroll
in a Medicare prescription drug plan upon becoming eligible for the program in order to
avoid a premium penalty. To reduce his expenses, he should look for a plan with a zero
premium.
QUESTION :Mr. Schultz was still working when he first qualified for Medicare. At that
time, he had employer group coverage that was creditable. During his initial Part D
eligibility period, he decided not to enroll because he was satisfied with his drug
coverage. It is now a year later and Mr. Schultz has lost his employer group coverage
within the last two weeks. How would you advise him? - CORRECT ANSWER Mr.
Schultz should enroll in a Part D plan before he has a 63-day break in coverage in order
to avoid a premium penalty.
QUESTION :Mrs. Fields wants to know whether applying for the Part D low income
subsidy will be worth the time to fill out the paperwork. What could you tell her? -
CORRECT ANSWER The Part D low income subsidy could substantially lower her
overall costs. She can apply by contacting her state Medicaid office, or calling the Social
Security Administration.
