2026 AHIP
ACTUAL FINAL EXAM
VERIFIED QUESTIONS & ANSWERS
WHAT’S INSIDE?
❖2026 ACTUAL AHIP FINAL EXAM QUESTIONS &
VERIFIED ANSWERS
❖FULLY ALIGNED WITH 3 LATEST VERSIONS
❖EACH QUESTION INCLUDES CORRECT ANSWERS &
RATIONALES TO REINFORCE UNDERSTANDING
,1. 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?
*** correct answers **
Part B primarily covers physician services. She will be paying a monthly premium and, except
for many preventive and screening tests, generally will have 20% co-payments for these services, in addition to an
annual deductible.
2. Mr. Patel is in good health and is preparing a budget in anticipation of his
retirement when he turns 66. He wants to understand the health care costs he
might be exposed to under Medicare if he were to require hospitalization
because of an illness. In general terms, what could you tell him about his costs
for inpatient hospital services under Original Medicare?
*** correct answers ** Under Original Medicare, there is a single deductible amount due for the first 60
days of any inpatient hospital stay, after which it converts into a per-day coinsurance amount through day 90. After day
90, he would pay a daily amount up to 60 days over his lifetime, after which he would be responsible for all costs.
3. What impact, if any, have recent regulatory changes had on Medigap plans?
-
*** correct answers ** The Part B deductible is no longer covered for individuals newly eligible for Medicare starting Januar
1, 2020.
4. Mrs. Paterson is concerned about the deductibles and co-payments associ-
ated with Original Medicare. What can you tell her about Medigap as an
,option to address this concern? *** correct answers ** Medigap plans do not cover Original Medicare
benefits, but they coordinate with Original Medicare coverage.
5. 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? *** correct answers ** 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.
6. Mrs. West wears glasses and dentures and has enjoyed considerable pain
relief from arthritis through massage therapy. She is concerned about whether
or not Medicare will cover these items and services. What should you tell her?
*** correct answers ** Medicare does not cover massage therapy, or, in general, glasses or dentures.
7. 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 answers ** 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.
8. Mr. Alonso receives some help paying for his two generic prescription drugs
from his employer's retiree coverage, but he wants to compare it to a Part D
prescription drug plan. He asks you what costs he would generally expect to
encounter when enrolling into a standard Medicare Part D prescription drug
plan. What should you tell him?
*** correct answers ** He generally would pay a monthly premium, annual deductible, and per-
prescription cost-sharing.
9. 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?
*** correct answers ** Mrs. Gonzalez cannot purchase a Medigap plan that covers drugs, but she
could keep her Medigap policy and enroll in a Part D prescription drug plan.
10. 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 answers ** He may sign-up for Medicare at any time however coverage usually
begins on the fourth month after dialysis treatments start.
11. Mrs. Duarte is enrolled in Original Medicare Parts A and B. She has recently
reviewed her Medicare Summary Notice (MSN) and disagrees with a determi-
nation that partially denied one of her claims for services. What advice would
ACTUAL FINAL EXAM
VERIFIED QUESTIONS & ANSWERS
WHAT’S INSIDE?
❖2026 ACTUAL AHIP FINAL EXAM QUESTIONS &
VERIFIED ANSWERS
❖FULLY ALIGNED WITH 3 LATEST VERSIONS
❖EACH QUESTION INCLUDES CORRECT ANSWERS &
RATIONALES TO REINFORCE UNDERSTANDING
,1. 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?
*** correct answers **
Part B primarily covers physician services. She will be paying a monthly premium and, except
for many preventive and screening tests, generally will have 20% co-payments for these services, in addition to an
annual deductible.
2. Mr. Patel is in good health and is preparing a budget in anticipation of his
retirement when he turns 66. He wants to understand the health care costs he
might be exposed to under Medicare if he were to require hospitalization
because of an illness. In general terms, what could you tell him about his costs
for inpatient hospital services under Original Medicare?
*** correct answers ** Under Original Medicare, there is a single deductible amount due for the first 60
days of any inpatient hospital stay, after which it converts into a per-day coinsurance amount through day 90. After day
90, he would pay a daily amount up to 60 days over his lifetime, after which he would be responsible for all costs.
3. What impact, if any, have recent regulatory changes had on Medigap plans?
-
*** correct answers ** The Part B deductible is no longer covered for individuals newly eligible for Medicare starting Januar
1, 2020.
4. Mrs. Paterson is concerned about the deductibles and co-payments associ-
ated with Original Medicare. What can you tell her about Medigap as an
,option to address this concern? *** correct answers ** Medigap plans do not cover Original Medicare
benefits, but they coordinate with Original Medicare coverage.
5. 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? *** correct answers ** 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.
6. Mrs. West wears glasses and dentures and has enjoyed considerable pain
relief from arthritis through massage therapy. She is concerned about whether
or not Medicare will cover these items and services. What should you tell her?
*** correct answers ** Medicare does not cover massage therapy, or, in general, glasses or dentures.
7. 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 answers ** 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.
8. Mr. Alonso receives some help paying for his two generic prescription drugs
from his employer's retiree coverage, but he wants to compare it to a Part D
prescription drug plan. He asks you what costs he would generally expect to
encounter when enrolling into a standard Medicare Part D prescription drug
plan. What should you tell him?
*** correct answers ** He generally would pay a monthly premium, annual deductible, and per-
prescription cost-sharing.
9. 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?
*** correct answers ** Mrs. Gonzalez cannot purchase a Medigap plan that covers drugs, but she
could keep her Medigap policy and enroll in a Part D prescription drug plan.
10. 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 answers ** He may sign-up for Medicare at any time however coverage usually
begins on the fourth month after dialysis treatments start.
11. Mrs. Duarte is enrolled in Original Medicare Parts A and B. She has recently
reviewed her Medicare Summary Notice (MSN) and disagrees with a determi-
nation that partially denied one of her claims for services. What advice would
