2026 AHIP Final Exam Questions and
ANSWERS
Mrs. h,Shields h,is h,covered h,by h,Original h,Medicare. h,She h,sustained h,a h,hip h,fracture h,and h,is
h,being h,successfully h,treated h,for h,that h,condition. h,However, h,she h,and h,her h,physicians
h,feel h,that h,after h,her h,lengthy h,hospital h,stay, h,she h,will h,need h,a h,month h,or h,two h,of h,nursing
h,and h,rehabilitative h,care. h,What h,should h,you h,tell h,them h,about h,Original h,Medicare's
h,coverage h,of h,care h,in h,a h,skilled h,nursing h,facility? h,- h,ANSWER h,Medicare h,will h,cover
h,Mrs. h,Shield's h,skilled h,nursing h,services h,provided h,during h,the h,first h,20 h,days h,of h,her
h,stay, h,after h,which h,she h,would h,have h,a h,copay h,until h,she h,has h,been h,in h,the h,facility h,for
h,100 h,days.
Mrs. h,West h,wears h,glasses h,and h,dentures h,and h,has h,enjoyed h,considerable h,pain h,relief
h,from h,arthritis h,through h,massage h,therapy. h,She h,is h,concerned h,about h,whether h,or h,not
h,Medicare h,will h,cover h,these h,items h,and h,services. h,What h,should h,you h,tell h,her? h,-
h,ANSWER h,Medicare h,does h,not h,cover h,massage h,therapy, h,or, h,in h,general, h,glasses h,or
h,dentures.
Mrs. h,Park h,is h,an h,elderly h,retiree. h,Mrs. h,Park h,has h,a h,low h,fixed h,income. h,What h,could h,you
h,tell h,Mrs. h,Park h,that h,might h,be h,of h,assistance? h,- h,ANSWER h,She h,should h,contact h,her
h,state h,Medicaid h,agency h,to h,see h,if h,she h,qualifies h,for h,one h,of h,several h,programs h,that h,can
h,help h,with h,Medicare h,costs h,for h,which h,she h,is h,responsible.
Mr. h,Alonso h,receives h,some h,help h,paying h,for h,his h,two h,generic h,prescription h,drugs h,from
h,his h,employer's h,retiree h,coverage, h,but h,he h,wants h,to h,compare h,it h,to h,a h,Part h,D
h,prescription h,drug h,plan. h,He h,asks h,you h,what h,costs h,he h,would h,generally h,expect h,to
h,encounter h,when h,enrolling h,into h,a h,standard h,Medicare h,Part h,D h,prescription h,drug h,plan.
h,What h,should h,you h,tell h,him? h,- h, ANSWER h,He h,generally h,would h,pay h,a h,monthly
h,premium, h,annual h,deductible, h,and h,per- h,prescription h,cost-sharing.
Mrs. h,Gonzalez h,is h,enrolled h,in h,Original h,Medicare h,and h,has h,a h,Medigap h,policy h,as h,well,
h,but h,it h,provides h,no h,drug h,coverage. h,She h,would h,like h,to h,keep h,the h,coverage h,she h,has
h,but h,replace h,her h,existing h,Medigap h,plan h,with h,one h,that h,provides h,drug h,coverage. h,What
h,should h,you h,tell h,her? h,- h,ANSWER h,Mrs. h,Gonzalez h,cannot h,purchase h,a h,Medigap h,plan
h,that h,covers h,drugs, h,but h,she h,could h,keep h,her h,Medigap h,policy h,and h,enroll h,in h,a h,Part h,D
h,prescription h,drug h,plan.
,Mr. h,Davis h,is h,52 h,years h,old h,and h,has h,recently h,been h,diagnosed h,with h,end-stage h,renal
h,disease h,(ESRD) h,and h,will h,soon h,begin h,dialysis. h,He h,is h,wondering h,if h,he h,can h,obtain
h,coverage h,under h,Medicare. h,What h,should h,you h,tell h,him? h,- h,ANSWER h,He h, may h,sign-up
h,for h,Medicare h,at h,any h,time h,however h,coverage h,usually h,begins h,on h,the h,fourth h,month
h,after h,dialysis h,treatments h,start.
Mrs. h,Duarte h,is h,enrolled h,in h,Original h,Medicare h,Parts h,A h,and h,B. h,She h,has h,recently
h,reviewed h,her h,Medicare h,Summary h,Notice h,(MSN) h,and h,disagrees h,with h,a
h,determination h,that h,partially h,denied h,one h,of h,her h,claims h,for h,services. h,What h,advice
h,would h,you h,give h,her? h,- h,ANSWER h,Mrs. h,Duarte h,should h,file h,an h,appeal h,of h,this h,initial
h,determination h,within h,120 h,days h,of h,the h,date h,she h,received h,the h,MSN h,in h,the h,mail.
Mrs. h,Geisler's h,neighbor h,told h,her h,she h,should h,look h,at h,her h,Part h,D h,options h,during h,the
h,annual h,Medicare h,enrollment h,period h,because h,the h,features h,of h,Part h,D h,might h,have
h,changed. h,Mrs. h,Geisler h,can't h,remember h,what h,Part h,D h,is h,so h,she h,called h,you h,to h,ask
h,what h,her h,neighbor h,was h,talking h,about. h,What h,could h,you h,tell h,her? h,- h,ANSWER h,Part h,D
h,covers h,prescription h,drugs h,and h,she h,should h,look h,at h,her h,premiums, h,formulary, h,and
h,cost-sharing h,among h,other h,factors h,to h,see h,if h,they h,have h,changed.
Mr. h,Rainey h,is h,experiencing h,paranoid h,delusions h,and h,his h,physician h,feels h,that h,he
h,should h,be h,hospitalized. h,What h,should h,you h,tell h,Mr. h,Rainey h,(or h,his h,representative)
h,about h,the h,length h,of h,an h,inpatient h,psychiatric h,hospital h,stay h,that h,Medicare h,will h,cover?
h,- h,ANSWER h,Medicare h,will h,cover h,a h,total h,of h,190 h,days h,of h,inpatient h,psychiatric h,care
h,during h,Mr. h,Rainey's h,entire h,lifetime.
Mr. h,Xi h,will h,soon h,turn h,age h,65 h,and h,has h,come h,to h,you h,for h,advice h,as h,to h,what h,services
h,are h,provided h,under h,Original h,Medicare. h,W hat h,should h,you h,tell h,Mr. h,Xi h,that h,best
h,describes h,the h,health h,coverage h,provided h,to h,Medicare h,beneficiaries? h,- h,ANSWER
h,Beneficiaries h,under h,Original h,Medicare h,have h,no h,cost-sharing h,for h,most h,preventive
h,services.
Mr. h,Singh h,would h,like h,drug h,coverage h,but h,does h,not h,want h,to h,be h,enrolled h,in h,a
h,Medicare h,Advantage h,plan. h,What h,should h,you h,tell h,him? h,- h,ANSWER h,Mr. h,Singh h,can
h,enroll h,in h,a h,stand- h,alone h,prescription h,drug h,plan h,and h,continue h,to h,be h,covered h,for h,Part
h,A h,and h,Part h,B h,services h,through h,Original h,Fee-for-Service h,Medicare.
, Mrs. h,Chen h,will h,be h,65 h,soon, h,has h,been h,a h,citizen h,for h,twelve h,years, h,has h,been
h,employed h,full h,time, h,and h,paid h,taxes h,during h,that h,entire h,period. h,She h,is h,concerned h,that
h,she h,will h,not h,qualify h,for h,coverage h,under h,part h,A h,because h,she h,was h,not h,born h,in h,the
h,United h,States. h,What h,should h,you h,tell h,her? h,- h,ANSWER h,Most h,individuals h,who h,are
h,citizens h,and h,age h,65 h,or h,over h,are h,covered h,under h,Part h,A h,by h,virtue h,of h,having h,paid
h,Medicare h,taxes h,while h,working, h,though h,some h, may h,be h,covered h,as h,a h,result h,of
h,paying h,monthly h,premiums.
Mrs. h,Quinn h,recently h,turned h,66 h,and h,decided h,after h,many h,years h,of h,work h,to h,retire h,and
h,begin h,receiving h,Social h,Security h,benefits. h,Shortly h,thereafter h,Mrs. h,Quinn h,received h,a
h,letter h,informing h,her h,that h,she h,had h,been h,automatically h,enrolled h,in h,Medicare h,Part h,B.
h,She h,wants h,to h,understand h,what h,this h,means. h,What h,should h,you h,tell h,Mrs. h,Quinn? h,-
h,ANSWER h,Part h,B h,primarily h,covers h,physician h,services. h,She h,will h,be h,paying h,a
h, monthly h,premium h,and, h,except h,for h,many h,preventive h,and h,screening h,tests, h,generally
h,will h,have h,20% h,co-payments h,for h,these h,services, h,in h,addition h,to h,an h,annual h,deductible.
Mr. h,Patel h,is h,in h,good h,health h,and h,is h,preparing h,a h,budget h,in h,anticipation h,of h,his
h,retirement h, when h,he h,turns h,66. h,He h,wants h,to h,understand h,the h,health h,care h,costs h,he
h,might h,be h,exposed h,to h,under h,Medicare h,if h,he h,were h,to h,require h,hospitalization h,because
h,of h,an h,illness. h,In h,general h,terms, h, what h,could h,you h,tell h,him h,about h,his h,costs h,for
h,inpatient h,hospital h,services h,under h,Original h,Medicare? h,- h,ANSWER h,Under h,Original
h,Medicare, h,there h,is h,a h,single h,deductible h,amount h,due h,for h,the h,first h,60 h,days h,of h,any
h,inpatient h,hospital h,stay, h,after h,which h,it h,converts h , into h,a h,per-day h,coinsurance h,amount
h,through h,day h,90. h,After h,day h,90, h,he h,would h,pay h,a h,daily h,amount h,up h,to h,60 h,days h,over
h,his h,lifetime, h,after h,which h,he h,would h,be h,responsible h,for h,all h,costs.
What h,impact, h,if h,any, h,have h,recent h,regulatory h,changes h,had h,on h,Medigap h,plans? h,-
h,ANSWER h,The h,Part h,B h,deductible h,is h,no h,longer h,covered h,for h,individuals h,newly h,eligible
h,for h,Medicare h,starting h,January h,1, h,2020.
Mrs. h,Paterson h,is h,concerned h,about h,the h,deductibles h,and h,co-payments h,associated
h,with h,Original h,Medicare. h,What h,can h,you h,tell h,her h,about h,Medigap h,as h,an h,option h,to
h,address h,this h,concern? h,- h,ANSWER h,Medigap h,plans h,do h,not h,cover h,Original h,Medicare
h,benefits, h,but h,they h,coordinate h,with h,Original h,Medicare h,coverage.
Mrs. h,Turner h,is h,comparing h,her h,employer's h,retiree h,insurance h,to h,Original h,Medicare
h,and h,would h,like h,to h,know h,which h,of h,the h,following h,services h,Original h,Medicare h,will
h,cover h,if h,the h,appropriate h,criteria h,are h,met. h,What h,could h,you h,tell h,her? h,- h,ANSWER
h,Original h,Medicare h,covers h,ambulance h,services.
ANSWERS
Mrs. h,Shields h,is h,covered h,by h,Original h,Medicare. h,She h,sustained h,a h,hip h,fracture h,and h,is
h,being h,successfully h,treated h,for h,that h,condition. h,However, h,she h,and h,her h,physicians
h,feel h,that h,after h,her h,lengthy h,hospital h,stay, h,she h,will h,need h,a h,month h,or h,two h,of h,nursing
h,and h,rehabilitative h,care. h,What h,should h,you h,tell h,them h,about h,Original h,Medicare's
h,coverage h,of h,care h,in h,a h,skilled h,nursing h,facility? h,- h,ANSWER h,Medicare h,will h,cover
h,Mrs. h,Shield's h,skilled h,nursing h,services h,provided h,during h,the h,first h,20 h,days h,of h,her
h,stay, h,after h,which h,she h,would h,have h,a h,copay h,until h,she h,has h,been h,in h,the h,facility h,for
h,100 h,days.
Mrs. h,West h,wears h,glasses h,and h,dentures h,and h,has h,enjoyed h,considerable h,pain h,relief
h,from h,arthritis h,through h,massage h,therapy. h,She h,is h,concerned h,about h,whether h,or h,not
h,Medicare h,will h,cover h,these h,items h,and h,services. h,What h,should h,you h,tell h,her? h,-
h,ANSWER h,Medicare h,does h,not h,cover h,massage h,therapy, h,or, h,in h,general, h,glasses h,or
h,dentures.
Mrs. h,Park h,is h,an h,elderly h,retiree. h,Mrs. h,Park h,has h,a h,low h,fixed h,income. h,What h,could h,you
h,tell h,Mrs. h,Park h,that h,might h,be h,of h,assistance? h,- h,ANSWER h,She h,should h,contact h,her
h,state h,Medicaid h,agency h,to h,see h,if h,she h,qualifies h,for h,one h,of h,several h,programs h,that h,can
h,help h,with h,Medicare h,costs h,for h,which h,she h,is h,responsible.
Mr. h,Alonso h,receives h,some h,help h,paying h,for h,his h,two h,generic h,prescription h,drugs h,from
h,his h,employer's h,retiree h,coverage, h,but h,he h,wants h,to h,compare h,it h,to h,a h,Part h,D
h,prescription h,drug h,plan. h,He h,asks h,you h,what h,costs h,he h,would h,generally h,expect h,to
h,encounter h,when h,enrolling h,into h,a h,standard h,Medicare h,Part h,D h,prescription h,drug h,plan.
h,What h,should h,you h,tell h,him? h,- h, ANSWER h,He h,generally h,would h,pay h,a h,monthly
h,premium, h,annual h,deductible, h,and h,per- h,prescription h,cost-sharing.
Mrs. h,Gonzalez h,is h,enrolled h,in h,Original h,Medicare h,and h,has h,a h,Medigap h,policy h,as h,well,
h,but h,it h,provides h,no h,drug h,coverage. h,She h,would h,like h,to h,keep h,the h,coverage h,she h,has
h,but h,replace h,her h,existing h,Medigap h,plan h,with h,one h,that h,provides h,drug h,coverage. h,What
h,should h,you h,tell h,her? h,- h,ANSWER h,Mrs. h,Gonzalez h,cannot h,purchase h,a h,Medigap h,plan
h,that h,covers h,drugs, h,but h,she h,could h,keep h,her h,Medigap h,policy h,and h,enroll h,in h,a h,Part h,D
h,prescription h,drug h,plan.
,Mr. h,Davis h,is h,52 h,years h,old h,and h,has h,recently h,been h,diagnosed h,with h,end-stage h,renal
h,disease h,(ESRD) h,and h,will h,soon h,begin h,dialysis. h,He h,is h,wondering h,if h,he h,can h,obtain
h,coverage h,under h,Medicare. h,What h,should h,you h,tell h,him? h,- h,ANSWER h,He h, may h,sign-up
h,for h,Medicare h,at h,any h,time h,however h,coverage h,usually h,begins h,on h,the h,fourth h,month
h,after h,dialysis h,treatments h,start.
Mrs. h,Duarte h,is h,enrolled h,in h,Original h,Medicare h,Parts h,A h,and h,B. h,She h,has h,recently
h,reviewed h,her h,Medicare h,Summary h,Notice h,(MSN) h,and h,disagrees h,with h,a
h,determination h,that h,partially h,denied h,one h,of h,her h,claims h,for h,services. h,What h,advice
h,would h,you h,give h,her? h,- h,ANSWER h,Mrs. h,Duarte h,should h,file h,an h,appeal h,of h,this h,initial
h,determination h,within h,120 h,days h,of h,the h,date h,she h,received h,the h,MSN h,in h,the h,mail.
Mrs. h,Geisler's h,neighbor h,told h,her h,she h,should h,look h,at h,her h,Part h,D h,options h,during h,the
h,annual h,Medicare h,enrollment h,period h,because h,the h,features h,of h,Part h,D h,might h,have
h,changed. h,Mrs. h,Geisler h,can't h,remember h,what h,Part h,D h,is h,so h,she h,called h,you h,to h,ask
h,what h,her h,neighbor h,was h,talking h,about. h,What h,could h,you h,tell h,her? h,- h,ANSWER h,Part h,D
h,covers h,prescription h,drugs h,and h,she h,should h,look h,at h,her h,premiums, h,formulary, h,and
h,cost-sharing h,among h,other h,factors h,to h,see h,if h,they h,have h,changed.
Mr. h,Rainey h,is h,experiencing h,paranoid h,delusions h,and h,his h,physician h,feels h,that h,he
h,should h,be h,hospitalized. h,What h,should h,you h,tell h,Mr. h,Rainey h,(or h,his h,representative)
h,about h,the h,length h,of h,an h,inpatient h,psychiatric h,hospital h,stay h,that h,Medicare h,will h,cover?
h,- h,ANSWER h,Medicare h,will h,cover h,a h,total h,of h,190 h,days h,of h,inpatient h,psychiatric h,care
h,during h,Mr. h,Rainey's h,entire h,lifetime.
Mr. h,Xi h,will h,soon h,turn h,age h,65 h,and h,has h,come h,to h,you h,for h,advice h,as h,to h,what h,services
h,are h,provided h,under h,Original h,Medicare. h,W hat h,should h,you h,tell h,Mr. h,Xi h,that h,best
h,describes h,the h,health h,coverage h,provided h,to h,Medicare h,beneficiaries? h,- h,ANSWER
h,Beneficiaries h,under h,Original h,Medicare h,have h,no h,cost-sharing h,for h,most h,preventive
h,services.
Mr. h,Singh h,would h,like h,drug h,coverage h,but h,does h,not h,want h,to h,be h,enrolled h,in h,a
h,Medicare h,Advantage h,plan. h,What h,should h,you h,tell h,him? h,- h,ANSWER h,Mr. h,Singh h,can
h,enroll h,in h,a h,stand- h,alone h,prescription h,drug h,plan h,and h,continue h,to h,be h,covered h,for h,Part
h,A h,and h,Part h,B h,services h,through h,Original h,Fee-for-Service h,Medicare.
, Mrs. h,Chen h,will h,be h,65 h,soon, h,has h,been h,a h,citizen h,for h,twelve h,years, h,has h,been
h,employed h,full h,time, h,and h,paid h,taxes h,during h,that h,entire h,period. h,She h,is h,concerned h,that
h,she h,will h,not h,qualify h,for h,coverage h,under h,part h,A h,because h,she h,was h,not h,born h,in h,the
h,United h,States. h,What h,should h,you h,tell h,her? h,- h,ANSWER h,Most h,individuals h,who h,are
h,citizens h,and h,age h,65 h,or h,over h,are h,covered h,under h,Part h,A h,by h,virtue h,of h,having h,paid
h,Medicare h,taxes h,while h,working, h,though h,some h, may h,be h,covered h,as h,a h,result h,of
h,paying h,monthly h,premiums.
Mrs. h,Quinn h,recently h,turned h,66 h,and h,decided h,after h,many h,years h,of h,work h,to h,retire h,and
h,begin h,receiving h,Social h,Security h,benefits. h,Shortly h,thereafter h,Mrs. h,Quinn h,received h,a
h,letter h,informing h,her h,that h,she h,had h,been h,automatically h,enrolled h,in h,Medicare h,Part h,B.
h,She h,wants h,to h,understand h,what h,this h,means. h,What h,should h,you h,tell h,Mrs. h,Quinn? h,-
h,ANSWER h,Part h,B h,primarily h,covers h,physician h,services. h,She h,will h,be h,paying h,a
h, monthly h,premium h,and, h,except h,for h,many h,preventive h,and h,screening h,tests, h,generally
h,will h,have h,20% h,co-payments h,for h,these h,services, h,in h,addition h,to h,an h,annual h,deductible.
Mr. h,Patel h,is h,in h,good h,health h,and h,is h,preparing h,a h,budget h,in h,anticipation h,of h,his
h,retirement h, when h,he h,turns h,66. h,He h,wants h,to h,understand h,the h,health h,care h,costs h,he
h,might h,be h,exposed h,to h,under h,Medicare h,if h,he h,were h,to h,require h,hospitalization h,because
h,of h,an h,illness. h,In h,general h,terms, h, what h,could h,you h,tell h,him h,about h,his h,costs h,for
h,inpatient h,hospital h,services h,under h,Original h,Medicare? h,- h,ANSWER h,Under h,Original
h,Medicare, h,there h,is h,a h,single h,deductible h,amount h,due h,for h,the h,first h,60 h,days h,of h,any
h,inpatient h,hospital h,stay, h,after h,which h,it h,converts h , into h,a h,per-day h,coinsurance h,amount
h,through h,day h,90. h,After h,day h,90, h,he h,would h,pay h,a h,daily h,amount h,up h,to h,60 h,days h,over
h,his h,lifetime, h,after h,which h,he h,would h,be h,responsible h,for h,all h,costs.
What h,impact, h,if h,any, h,have h,recent h,regulatory h,changes h,had h,on h,Medigap h,plans? h,-
h,ANSWER h,The h,Part h,B h,deductible h,is h,no h,longer h,covered h,for h,individuals h,newly h,eligible
h,for h,Medicare h,starting h,January h,1, h,2020.
Mrs. h,Paterson h,is h,concerned h,about h,the h,deductibles h,and h,co-payments h,associated
h,with h,Original h,Medicare. h,What h,can h,you h,tell h,her h,about h,Medigap h,as h,an h,option h,to
h,address h,this h,concern? h,- h,ANSWER h,Medigap h,plans h,do h,not h,cover h,Original h,Medicare
h,benefits, h,but h,they h,coordinate h,with h,Original h,Medicare h,coverage.
Mrs. h,Turner h,is h,comparing h,her h,employer's h,retiree h,insurance h,to h,Original h,Medicare
h,and h,would h,like h,to h,know h,which h,of h,the h,following h,services h,Original h,Medicare h,will
h,cover h,if h,the h,appropriate h,criteria h,are h,met. h,What h,could h,you h,tell h,her? h,- h,ANSWER
h,Original h,Medicare h,covers h,ambulance h,services.
