AHIP PRACTICE EXAMINATION 2026
QUESTIONS WITH ANSWERS GRADED A+
◍ Mr. Ford enrolled in an MA-only plan in mid-November during the Annual
Election Period (AEP). On December 1, he calls you up and says that he has
changed his mind and would like to enroll into a MA-PD plan. What
enrollment rules would apply in this case?.
Answer: He can make as many enrollment changes as he likes during the
Annual Election Period and the last choice made prior to the end of the
period will be the effective one as of January 1.
◍ Mrs. Duarte is enrolled in Original Medicare Parts A and
B. She has recently reviewed her Medicare Summary Notice (MSN) and
disagrees with a determination that partially denied one of her claims for
services. What advice would you give her?.
Answer: Mrs. Duarte should file an appeal of this initial determination
within 120 days of the date she received the MSN in the mail.
◍ 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.
◍ You are visiting with Mr. Tully and his daughter at her request. He has
advanced Alzheimer's and is incapable of understanding the implications of
choosing a Medicare Advantage or prescription drug plan. Can his daughter
fill out the enrollment form and sign it for him?.
Answer: Mr. Tully's daughter can do so only, if she is authorized under state
, law as a court-appointed legal guardian, has a durable power of attorney for
health care decisions, or is authorized under state surrogate consent laws to
make health decisions.
◍ Ms. Thomas has worked for many years and is turning 68 in June. She is
eligible for Medicare Part A and did not enroll for Part B when first eligible
because she has insurance through her employer - Coffee Brew, Inc. She
also did not enroll in Part D because she had creditable coverage. She would
like to retire in June and enroll in a Medicare Advantage plan. She has been
informed that her group coverage will end on her retirement effective date.
How would you advise Ms. Thomas?.
Answer: Ms. Thomas can enroll in Part B without a late penalty at any time
she is still covered by her employer group and 8 months after her last month
of employer group coverage without a penalty. However, because she wants
to enroll in a MA plan after retirement, she should make sure her Part B
coverage is effective in time to use the Medicare Advantage/Part D special
election period for individuals changing from employer group coverage to
enroll in a MA plan or MA-PD. The SEP begins while she has employer
group coverage and will last until 2 months after the month after the month
her employer coverage ends. If she wants Part D coverage she should enroll
in an MA-PD or a PDP (depending on how she decides to receive her Part A
and B benefits) during this time.
◍ Mr. Garrett has just entered his MA Initial Coverage Election Period
(ICEP). What action could you help him take during this time?.
Answer: He will have one opportunity to enroll in a Medicare Advantage
plan.
◍ Mrs. Turner is comparing her employer's retiree insurance to Original
Medicare and would like to know which of the following services Original
Medicare will cover if the appropriate criteria are met? What could you tell
her?.
Answer: Original Medicare covers ambulance services
◍ Mrs. Johnson calls to tell you she has not received her new plan ID card yet,
, but she needs to see a doctor. What can she expect to receive from the plan
after the plan has received her enrollment form?.
Answer: Evidence of plan membership, information on how to obtain
services, and the effective date of coverage.
◍ Mr. Robinson was quite ill recently and forgot to pay his monthly premium
for his MA-PD plan. He is worried that he will lose his coverage now when
he needs it the most. He is certain his plan will disenroll him because that is
what happened to a friend of his in a similar type of plan. What can you tell
Mr. Robinson about his situation?.
Answer: Plan sponsors have the option to do nothing when a plan member
does not pay their premiums or disenroll the member after a grace period
and notice.
◍ Madeline Martinez was widowed several years ago. Her husband worked for
many years and contributed into the Medicare system. He also left a
substantial estate which provides Madeline with an annual income of
approximately $130,000. Madeline, who has only worked part-time for the
last three years, will soon turn age 65 and hopes to enroll in Original
Medicare. She comes to you for advice. What should you tell her?.
Answer: You should tell Madeline that she will be able to enroll in Medicare
Part A without paying monthly premiums due to her husband's long work
record and participation in the Medicare system. You should also tell
Madeline that she will pay Part B premiums at more than the standard
lowest rate but less than the highest rate due her substantial income.
◍ Mrs. Geisler's neighbor told her she should look at her Part D options during
the annual Medicare enrollment period because features of Part D might
have changed. Mrs. Geisler can't remember what Part D is so she called you
to ask what her neighbor was talking about. What could you tell her?.
Answer: Part D covers prescription drugs and she should look at her
premiums, formulary, and cost-sharing among other factors to see if they
have changed.
◍ Mr. White has Medicare Parts A and B with a Part D plan. Last year, he
QUESTIONS WITH ANSWERS GRADED A+
◍ Mr. Ford enrolled in an MA-only plan in mid-November during the Annual
Election Period (AEP). On December 1, he calls you up and says that he has
changed his mind and would like to enroll into a MA-PD plan. What
enrollment rules would apply in this case?.
Answer: He can make as many enrollment changes as he likes during the
Annual Election Period and the last choice made prior to the end of the
period will be the effective one as of January 1.
◍ Mrs. Duarte is enrolled in Original Medicare Parts A and
B. She has recently reviewed her Medicare Summary Notice (MSN) and
disagrees with a determination that partially denied one of her claims for
services. What advice would you give her?.
Answer: Mrs. Duarte should file an appeal of this initial determination
within 120 days of the date she received the MSN in the mail.
◍ 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.
◍ You are visiting with Mr. Tully and his daughter at her request. He has
advanced Alzheimer's and is incapable of understanding the implications of
choosing a Medicare Advantage or prescription drug plan. Can his daughter
fill out the enrollment form and sign it for him?.
Answer: Mr. Tully's daughter can do so only, if she is authorized under state
, law as a court-appointed legal guardian, has a durable power of attorney for
health care decisions, or is authorized under state surrogate consent laws to
make health decisions.
◍ Ms. Thomas has worked for many years and is turning 68 in June. She is
eligible for Medicare Part A and did not enroll for Part B when first eligible
because she has insurance through her employer - Coffee Brew, Inc. She
also did not enroll in Part D because she had creditable coverage. She would
like to retire in June and enroll in a Medicare Advantage plan. She has been
informed that her group coverage will end on her retirement effective date.
How would you advise Ms. Thomas?.
Answer: Ms. Thomas can enroll in Part B without a late penalty at any time
she is still covered by her employer group and 8 months after her last month
of employer group coverage without a penalty. However, because she wants
to enroll in a MA plan after retirement, she should make sure her Part B
coverage is effective in time to use the Medicare Advantage/Part D special
election period for individuals changing from employer group coverage to
enroll in a MA plan or MA-PD. The SEP begins while she has employer
group coverage and will last until 2 months after the month after the month
her employer coverage ends. If she wants Part D coverage she should enroll
in an MA-PD or a PDP (depending on how she decides to receive her Part A
and B benefits) during this time.
◍ Mr. Garrett has just entered his MA Initial Coverage Election Period
(ICEP). What action could you help him take during this time?.
Answer: He will have one opportunity to enroll in a Medicare Advantage
plan.
◍ Mrs. Turner is comparing her employer's retiree insurance to Original
Medicare and would like to know which of the following services Original
Medicare will cover if the appropriate criteria are met? What could you tell
her?.
Answer: Original Medicare covers ambulance services
◍ Mrs. Johnson calls to tell you she has not received her new plan ID card yet,
, but she needs to see a doctor. What can she expect to receive from the plan
after the plan has received her enrollment form?.
Answer: Evidence of plan membership, information on how to obtain
services, and the effective date of coverage.
◍ Mr. Robinson was quite ill recently and forgot to pay his monthly premium
for his MA-PD plan. He is worried that he will lose his coverage now when
he needs it the most. He is certain his plan will disenroll him because that is
what happened to a friend of his in a similar type of plan. What can you tell
Mr. Robinson about his situation?.
Answer: Plan sponsors have the option to do nothing when a plan member
does not pay their premiums or disenroll the member after a grace period
and notice.
◍ Madeline Martinez was widowed several years ago. Her husband worked for
many years and contributed into the Medicare system. He also left a
substantial estate which provides Madeline with an annual income of
approximately $130,000. Madeline, who has only worked part-time for the
last three years, will soon turn age 65 and hopes to enroll in Original
Medicare. She comes to you for advice. What should you tell her?.
Answer: You should tell Madeline that she will be able to enroll in Medicare
Part A without paying monthly premiums due to her husband's long work
record and participation in the Medicare system. You should also tell
Madeline that she will pay Part B premiums at more than the standard
lowest rate but less than the highest rate due her substantial income.
◍ Mrs. Geisler's neighbor told her she should look at her Part D options during
the annual Medicare enrollment period because features of Part D might
have changed. Mrs. Geisler can't remember what Part D is so she called you
to ask what her neighbor was talking about. What could you tell her?.
Answer: Part D covers prescription drugs and she should look at her
premiums, formulary, and cost-sharing among other factors to see if they
have changed.
◍ Mr. White has Medicare Parts A and B with a Part D plan. Last year, he
