AHIP FINAL EXAM (ACTUAL TEST)
2026 AHIP FINAL EXAM (ACTUAL
TEST) GRADED A
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 t ell
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.
,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
Ans - 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.
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 Ans - Tell 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 Ans - After 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
Ans - Medicare 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 Ans - I, 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 stand-alone Medicare
, prescription drug plan. What should you tell him about this situation? Correct Ans
- He 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 Ans - 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.
Mr. Romero is 64, retiring soon, and considering enrollment in his employer-
sponsored 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 Ans - He 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. Brennan for
treatment. How much may Dr. Brennan charge? Correct Ans - Dr. Brennan can
charge Mary Rogers no more than the cost sharing specified in the PFFS plan's terms
and condition of payment which may include balance billing up to 15% of the
Medicare rate.
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
Ans - 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.
Mr. Wells is trying to understand the difference between Original Medicare and
Medicare Advantage. What would be the correct description? Correct Ans -
Medicare Advantage is a way of covering all the Original Medicare benefits
through private health insurance companies.
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
2026 AHIP FINAL EXAM (ACTUAL
TEST) GRADED A
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 t ell
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.
,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
Ans - 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.
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 Ans - Tell 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 Ans - After 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
Ans - Medicare 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 Ans - I, 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 stand-alone Medicare
, prescription drug plan. What should you tell him about this situation? Correct Ans
- He 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 Ans - 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.
Mr. Romero is 64, retiring soon, and considering enrollment in his employer-
sponsored 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 Ans - He 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. Brennan for
treatment. How much may Dr. Brennan charge? Correct Ans - Dr. Brennan can
charge Mary Rogers no more than the cost sharing specified in the PFFS plan's terms
and condition of payment which may include balance billing up to 15% of the
Medicare rate.
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
Ans - 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.
Mr. Wells is trying to understand the difference between Original Medicare and
Medicare Advantage. What would be the correct description? Correct Ans -
Medicare Advantage is a way of covering all the Original Medicare benefits
through private health insurance companies.
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
