AHIP Exam 2026
Study Guide |
Medicare
Training, Plans,
Compliance, and
Enrollment
Strategies
Reference: AHIP (America's Health Insurance Plans). (2026). Medicare +
Fraud, Waste, and Abuse Training. AHIP.
This study guide contains original questions and rationales created from official
AHIP Medicare training materials and CMS regulations for the 2026
certification cycle.
,Exam Overview
Feature Detail
Exam Format Open-book, open-note
Number of Questions 50
Time Limit 2 hours
Passing Score 90% (45 correct out of 50)
Attempts Allowed 3 (carriers may limit after 1 failure)
Validity Annual – must renew each year
Source:
Domain 1: Medicare Fundamentals (Parts A and B)
Question 1
Edward 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?
A) His Medicare coverage will end 12 months after transplant surgery,
regardless of his age.
B) His Medicare coverage will continue as long as he receives follow-up care
for the transplant.
,C) His Medicare coverage will end 36 months after the transplant unless he
otherwise qualifies.
D) His Medicare coverage ends immediately after transplant surgery.
Correct Answer: C
Rationale:
Correct (C): For individuals eligible for Medicare due to ESRD, coverage
ends 36 months after a successful kidney transplant unless they qualify for
Medicare due to age (65+) or disability. Edward's coverage will continue for 3
years post-transplant unless he turns 65 or qualifies for disability before then.
Incorrect (A): The post-transplant coverage period is 36 months, not 12
months.
Incorrect (B): Follow-up care alone does not extend coverage; the 36-
month rule applies regardless.
Incorrect (D): Coverage does not end immediately; there is a 36-month
continuation period.
Study Tip: "ESRD transplant = 36 months of continued coverage. 'Three years
post-kidney.'"
Source:
Question 2
Mr. Wu is eligible for Medicare. He has limited financial resources but failed to
qualify for the Part D low-income subsidy (Extra Help due to assets slightly
exceeding the limit), where might he turn for help with his prescription drug
costs?
A) He is ineligible for any further assistance.
B) State Pharmaceutical Assistance Program (SPAP) may help.
C) Only Medicaid can cover his drug costs.
D) He must pay full cost for medications.
, Correct Answer: B
Rationale:
Correct (B): Many states offer State Pharmaceutical Assistance Programs
(SPAPs) to help residents with prescription drug costs, particularly for those
who do not qualify for the federal Extra Help (Low-Income Subsidy) program
but still have limited financial resources.
Incorrect (A): SPAPs provide an additional layer of assistance beyond
federal programs.
Incorrect (C): Medicaid is one option but not the only option; SPAPs exist
independently.
Incorrect (D): SPAPs can significantly reduce out-of-pocket costs.
Study Tip: "SPAP = state help for drug costs. 'If Extra Help says no, ask your
state.'"
Source:
Question 3
Mr. Vasquez 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?
A) There are no costs for inpatient hospitalization.
B) He pays a deductible for the first 60 days, then daily coinsurance rates
apply for days 61-90.
C) He pays a flat rate regardless of length of stay.
D) He pays a premium for each hospital stay.
Correct Answer: B
Study Guide |
Medicare
Training, Plans,
Compliance, and
Enrollment
Strategies
Reference: AHIP (America's Health Insurance Plans). (2026). Medicare +
Fraud, Waste, and Abuse Training. AHIP.
This study guide contains original questions and rationales created from official
AHIP Medicare training materials and CMS regulations for the 2026
certification cycle.
,Exam Overview
Feature Detail
Exam Format Open-book, open-note
Number of Questions 50
Time Limit 2 hours
Passing Score 90% (45 correct out of 50)
Attempts Allowed 3 (carriers may limit after 1 failure)
Validity Annual – must renew each year
Source:
Domain 1: Medicare Fundamentals (Parts A and B)
Question 1
Edward 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?
A) His Medicare coverage will end 12 months after transplant surgery,
regardless of his age.
B) His Medicare coverage will continue as long as he receives follow-up care
for the transplant.
,C) His Medicare coverage will end 36 months after the transplant unless he
otherwise qualifies.
D) His Medicare coverage ends immediately after transplant surgery.
Correct Answer: C
Rationale:
Correct (C): For individuals eligible for Medicare due to ESRD, coverage
ends 36 months after a successful kidney transplant unless they qualify for
Medicare due to age (65+) or disability. Edward's coverage will continue for 3
years post-transplant unless he turns 65 or qualifies for disability before then.
Incorrect (A): The post-transplant coverage period is 36 months, not 12
months.
Incorrect (B): Follow-up care alone does not extend coverage; the 36-
month rule applies regardless.
Incorrect (D): Coverage does not end immediately; there is a 36-month
continuation period.
Study Tip: "ESRD transplant = 36 months of continued coverage. 'Three years
post-kidney.'"
Source:
Question 2
Mr. Wu is eligible for Medicare. He has limited financial resources but failed to
qualify for the Part D low-income subsidy (Extra Help due to assets slightly
exceeding the limit), where might he turn for help with his prescription drug
costs?
A) He is ineligible for any further assistance.
B) State Pharmaceutical Assistance Program (SPAP) may help.
C) Only Medicaid can cover his drug costs.
D) He must pay full cost for medications.
, Correct Answer: B
Rationale:
Correct (B): Many states offer State Pharmaceutical Assistance Programs
(SPAPs) to help residents with prescription drug costs, particularly for those
who do not qualify for the federal Extra Help (Low-Income Subsidy) program
but still have limited financial resources.
Incorrect (A): SPAPs provide an additional layer of assistance beyond
federal programs.
Incorrect (C): Medicaid is one option but not the only option; SPAPs exist
independently.
Incorrect (D): SPAPs can significantly reduce out-of-pocket costs.
Study Tip: "SPAP = state help for drug costs. 'If Extra Help says no, ask your
state.'"
Source:
Question 3
Mr. Vasquez 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?
A) There are no costs for inpatient hospitalization.
B) He pays a deductible for the first 60 days, then daily coinsurance rates
apply for days 61-90.
C) He pays a flat rate regardless of length of stay.
D) He pays a premium for each hospital stay.
Correct Answer: B
