2025 AHIP FINAL PRACTICE
EXAMINATION 2026 QUESTIONS
WITH ANSWERS GRADED A+
◍ Types of Medicare Advantage Plans.
Answer: PPO, HMO, MSA, Cost Plan, PFFS
◍ Medicare-Medicaid plans.
Answer: Serve both Medicare and Medicaid individuals. Include Part D
coverage. Individuals sometimes referred to as dual eligibles
◍ 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?.
Answer: Mr. Wu may still qualify for help in paying Part D costs through
his State Pharmaceutical Assistance Program.
◍ 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?.
Answer: 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?.
Answer: 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.
◍ 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?.
Answer: To obtain Part B coverage, she must pay a standard monthly
premium, though it is higher for individuals with higher incomes.
◍ Shirly Thomas was enrolled in Medicaid during the Public Health
Emergency (PHE). This coverage has recently been terminated due to the
end of the PH
E. 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?.
Answer: 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.
◍ Medicare Cost Plan.
Answer: Type of Medicare health plan. Have Part B to enroll. Can join
anytime plan is accepting new members. A non network provider will can
charge higher coinsurances and deuctibles. Different
enrollment/disenrollment periods apply. Can get Part D Rx coverage if
available, or apply for a separate PDP.
◍ Medicare Entitlement/Enrollment - Part A & Part B.
Answer: Individuals with ESRD may sign up at anytime. Date on which
coverage begins is the fourth month after dialysis begins.
◍ Medicare Enrollment Period.
, Answer: Individuals who do not enroll in Part B when first eligible can
enroll during a General Enrollment Period, Jan 1st to Mar 31st each year.
Coverage begins July 1st of that year.
◍ 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?.
Answer: 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.
◍ Mr. Xi will soon turn age 65 and has come to you for advice as to what
services are provided under Original Medicare. What should you tell Mr. Xi
that best describes the health coverage provided to Medicare beneficiaries?.
Answer: Beneficiaries under Original Medicare have no cost-sharing for
most preventive services which include immunizations such as annual flu
shots.
◍ 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?.
Answer: 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.
◍ Medicare Enrollment Period - Group Health Coverage.
Answer: Individuals who have group health coveage through employer may
enroll in Part A and/or Part B anytime while on group coverage during a
Special Enrollment Period. Occurs during the 8 month period following last
month of group coverage.
◍ Medicare Part A Premium.
Answer: Free if worked 40 quarters of your life and paid Medicare taxes.
Premium is $240.00 for individuals or spouses who paid Medicare taxes for
EXAMINATION 2026 QUESTIONS
WITH ANSWERS GRADED A+
◍ Types of Medicare Advantage Plans.
Answer: PPO, HMO, MSA, Cost Plan, PFFS
◍ Medicare-Medicaid plans.
Answer: Serve both Medicare and Medicaid individuals. Include Part D
coverage. Individuals sometimes referred to as dual eligibles
◍ 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?.
Answer: Mr. Wu may still qualify for help in paying Part D costs through
his State Pharmaceutical Assistance Program.
◍ 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?.
Answer: 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?.
Answer: 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.
◍ 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?.
Answer: To obtain Part B coverage, she must pay a standard monthly
premium, though it is higher for individuals with higher incomes.
◍ Shirly Thomas was enrolled in Medicaid during the Public Health
Emergency (PHE). This coverage has recently been terminated due to the
end of the PH
E. 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?.
Answer: 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.
◍ Medicare Cost Plan.
Answer: Type of Medicare health plan. Have Part B to enroll. Can join
anytime plan is accepting new members. A non network provider will can
charge higher coinsurances and deuctibles. Different
enrollment/disenrollment periods apply. Can get Part D Rx coverage if
available, or apply for a separate PDP.
◍ Medicare Entitlement/Enrollment - Part A & Part B.
Answer: Individuals with ESRD may sign up at anytime. Date on which
coverage begins is the fourth month after dialysis begins.
◍ Medicare Enrollment Period.
, Answer: Individuals who do not enroll in Part B when first eligible can
enroll during a General Enrollment Period, Jan 1st to Mar 31st each year.
Coverage begins July 1st of that year.
◍ 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?.
Answer: 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.
◍ Mr. Xi will soon turn age 65 and has come to you for advice as to what
services are provided under Original Medicare. What should you tell Mr. Xi
that best describes the health coverage provided to Medicare beneficiaries?.
Answer: Beneficiaries under Original Medicare have no cost-sharing for
most preventive services which include immunizations such as annual flu
shots.
◍ 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?.
Answer: 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.
◍ Medicare Enrollment Period - Group Health Coverage.
Answer: Individuals who have group health coveage through employer may
enroll in Part A and/or Part B anytime while on group coverage during a
Special Enrollment Period. Occurs during the 8 month period following last
month of group coverage.
◍ Medicare Part A Premium.
Answer: Free if worked 40 quarters of your life and paid Medicare taxes.
Premium is $240.00 for individuals or spouses who paid Medicare taxes for
