AHIP 2025–2026 Final Exam Study Guide | Comprehensive Questions & Verified Correct Answers – Graded A+ (Latest Edition)

AHIP 2025–2026 Final Exam Study Guide: Comprehensive Questions & Verified Answers –
Graded A+ | Latest Edition



1. Mrs. Burton is a retiree with substantial income. She is enrolled in an MA-PD
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plan and was disappointed with the service she received from her primary care
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physician because she was told she would have to wait five weeks to get an app
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o
intment when she was feeling ill. She called you to ask what she could do so she
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w
ould not have to put up with such poor access to care. What could you tell her?:
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he could file a grievance with her plan to complain about the lack of timeliness in getting
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an appointment.
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2. Edward IP suffered from serious kidney disease. As a result. Edward be-
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came eligible for Medicare coverage due to end-
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stage renal disease (ESRD). A close relative donated their kidney and Edward s
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uccessfully underwent transplant surgery 12 months ago. Edward is now age 5 g g g g g g g g g g g




0 and asks you if his Medicare coverage will continue, what should you say?: In
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dividuals eligible for Medicare based on ESRD generally lose eligibility 36 months afte
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r the month in which the individual receives a kidney transplant unless they are eligible for
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Medicare on another basis such as age or disability. Edward may, however, remain enr
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olled in Part B but solely for coverage of immunosuppressive drugs if he has no other he
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alth care coverage that would cover the drugs.
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3. Mildred Savage enrolled in Allcare Medicare Advantage plan several years ag
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o. Mildred recently learned that she is suffering from inoperable cancer and has
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ust a few months to live. She would like to spend these final months in hospice c
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,are. Mildred's family asks you whether hospice benefits will be paid for under th
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e Allcare Medicare Advantage plan. What should you say?: Mildred may remain en
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rolled in Allcare and make a hospice election. Hospice benefits will be paid for by Origi
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nal Medicare under Part A and Allcare will continue to pay for any non-
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hospice services. g




4. Mr. Diaz continued working with his company and was insured under his emp
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loyer's group plan until he reached age 68. He has heard that there is a premium
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penalty for those who did not sign up for Part B when first eligible and
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wants to kno g g




w how much he will have to pay. What should you tell him?: Mr. Diaz will not pay an
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y penalty because he had continuous coverage under his employer's plan.
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5. Mr. Moy's wife has a Medicare Advantage plan, but he wants to under-
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stand what coverage Medicare Supplemental Insurance provides since his he
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alth care needs are different from his wife's needs. What could you tell Mr. Moy?
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: Medicare Supplemental Insurance would help cover his Part A and Part B deductible
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s or coinsurance in Original Fee-for-
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Service (FFS) Medicare as well as possibly some services that Medicare does not co ver.
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6. Mrs. Chen will be 65 soon, has been a citizen for twelve years, has been emplo
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yed full time, and paid taxes during that entire period. She is concerned
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,that she will not qualify for coverage under part A because she was not born in
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the United States. What should you tell her?: Most individuals who are citizens and
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age 65 or over are covered under Part A by virtue of having paid Medicare taxes while
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working, though some may be covered as a result of paying monthly premiums.
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7. Mr. Bauer is 49 years old, but eighteen months ago he was declared dis-
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g abled by the Social Security Administration and has been receiving disability p
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ayments. He is wondering whether he can obtain coverage under Medicare. Wh
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at should you tell him?: After receiving such disability payments for 24 months, he will
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be automatically enrolled in Medicare, regardless of age.
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8.
Mr. Xi will soon turn age 65 and has come to you for advice as to what services
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g are provided under Original Medicare. What should you tell Mr. Xi that
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best descri bes the health coverage provided to Medicare beneficiaries?: Ben-
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eficiaries under Original Medicare have no cost-
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sharing for most preventive services which include immunizations such as annual flu s hots.
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9.
Mrs. PeaHis 66 years old, has coverage under an employer plan, and will retire n
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e
xt year. She heard she must enroll in Part B at the beginning of the year to ensur
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e no gap in coverage. What can you tell her?: She may enroll at any time while she is
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covered under her employer plan, but she will have a special eight-
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month enrollment period after the last month on her employer plan that differs from the
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standard general enrollment period, during which she may enroll in Medicare Part B.
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10. Mr. Davis is 52 years old and has recently been diagnosed with end-
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stage renal disease (ESRD) and will soon begin dialysis. He is wondering if he c
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, an obtain coverage under Medicare. What should you tell him?: He may sign-
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up for Medicare at any time however coverage usually begins on the fourth month after
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