AHIP FINAL EXAM NEWEST 2025-2026
VERSION QUESTIONS WITH GOLDEN TIPS
SOLUTIONS
Mr. Wu is eligible for Medicare. He has limited financial resources but failed to qualify for the Part D
low-income subsidy. Where might he turn for help with his prescription drug costs? - ANS>> Mr. Wu
may still qualify for help in paying Part D costs through his State Pharmaceutical Assistance Program.
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? - ANS>> After receiving such disability payments
for 24 months, he will be automatically enrolled in Medicare, regardless of age.
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? - ANS>> 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.
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? - 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? - ANS>> Tell prospect Jerry Smith that he should consider adding a standalone Part D
prescription drug coverage policy to his present coverage.
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? - ANS>> He may sign-up for Medicare at any time however coverage usually begins on the fourth
month after dialysis treatments start.
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? - ANS>>
Mr. Diaz will not pay any penalty because he had continuous coverage under his employer's plan.
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? - ANS>> 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.
Edward IP suffered from serious kidney disease. As a result. Edward became eligible for Medicare
coverage due to end-stage renal disease (ESRD). A close relative donated their kidney and Edward
successfully underwent transplant surgery 12 months ago. Edward is now age 50 and asks you if his
Medicare coverage will continue, what should you say? - ANS>> Individuals eligible for Medicare based
on ESRD generally lose eligibility 36 months after the month in which the individual receives a kidney
transplant unless they are eligible for Medicare on another basis such as age or disability. Edward may,
however, remain enrolled in Part B but solely for coverage of immunosuppressive drugs if he has no
other health care coverage that would cover the drugs.
, 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? -
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.
Mr. Capadona would like to purchase a Medicare Advantage (MA) plan and a Medigap plan to pick up
costs not covered by that plan. What should you tell him? - ANS>> It is illegal for you to sell Mr.
Capadona a Medigap plan if he is enrolled in an MA plan, and besides, Medigap only works with Original
Medicare.
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? - ANS>> To obtain Part B coverage, she must pay a standard monthly premium, though it is
higher for individuals with higher incomes.
Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What could you tell Mrs. Park that
might be of assistance? - ANS>> She should contact her state Medicaid agency to see if she qualifies for
one of several programs that can help with Medicare costs for which she is responsible.
Shirly Thomas was enrolled in Medicaid during the Public Health Emergency (PHE). This coverage has
recently been terminated due to the end of the PHE. While Shirley was enrolled in Medicaid, she missed
an opportunity to enroll in Medicare and now wants Part B. Which of the following statements best
describes Shirley's ability to now enroll in Medicare Part B? - ANS>> Shirley is eligible for a Special
Enrollment Period (SEP) for up to six months after the termination of her Medicaid coverage. Under this
SEP, Shirley can choose retroactive coverage back to the date of termination from Medicaid or coverage
beginning the month after the month of enrollment.
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? - ANS>> 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.
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? - ANS>> Mrs. Gonzalez cannot purchase a
VERSION QUESTIONS WITH GOLDEN TIPS
SOLUTIONS
Mr. Wu is eligible for Medicare. He has limited financial resources but failed to qualify for the Part D
low-income subsidy. Where might he turn for help with his prescription drug costs? - ANS>> Mr. Wu
may still qualify for help in paying Part D costs through his State Pharmaceutical Assistance Program.
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? - ANS>> After receiving such disability payments
for 24 months, he will be automatically enrolled in Medicare, regardless of age.
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? - ANS>> 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.
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? - 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? - ANS>> Tell prospect Jerry Smith that he should consider adding a standalone Part D
prescription drug coverage policy to his present coverage.
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? - ANS>> He may sign-up for Medicare at any time however coverage usually begins on the fourth
month after dialysis treatments start.
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? - ANS>>
Mr. Diaz will not pay any penalty because he had continuous coverage under his employer's plan.
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? - ANS>> 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.
Edward IP suffered from serious kidney disease. As a result. Edward became eligible for Medicare
coverage due to end-stage renal disease (ESRD). A close relative donated their kidney and Edward
successfully underwent transplant surgery 12 months ago. Edward is now age 50 and asks you if his
Medicare coverage will continue, what should you say? - ANS>> Individuals eligible for Medicare based
on ESRD generally lose eligibility 36 months after the month in which the individual receives a kidney
transplant unless they are eligible for Medicare on another basis such as age or disability. Edward may,
however, remain enrolled in Part B but solely for coverage of immunosuppressive drugs if he has no
other health care coverage that would cover the drugs.
, 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? -
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.
Mr. Capadona would like to purchase a Medicare Advantage (MA) plan and a Medigap plan to pick up
costs not covered by that plan. What should you tell him? - ANS>> It is illegal for you to sell Mr.
Capadona a Medigap plan if he is enrolled in an MA plan, and besides, Medigap only works with Original
Medicare.
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? - ANS>> To obtain Part B coverage, she must pay a standard monthly premium, though it is
higher for individuals with higher incomes.
Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What could you tell Mrs. Park that
might be of assistance? - ANS>> She should contact her state Medicaid agency to see if she qualifies for
one of several programs that can help with Medicare costs for which she is responsible.
Shirly Thomas was enrolled in Medicaid during the Public Health Emergency (PHE). This coverage has
recently been terminated due to the end of the PHE. While Shirley was enrolled in Medicaid, she missed
an opportunity to enroll in Medicare and now wants Part B. Which of the following statements best
describes Shirley's ability to now enroll in Medicare Part B? - ANS>> Shirley is eligible for a Special
Enrollment Period (SEP) for up to six months after the termination of her Medicaid coverage. Under this
SEP, Shirley can choose retroactive coverage back to the date of termination from Medicaid or coverage
beginning the month after the month of enrollment.
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? - ANS>> 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.
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? - ANS>> Mrs. Gonzalez cannot purchase a
