AHIP 2025 Final Exam – Verified Questions and Answers (2025-
2026) – Complete Exam Material for Certification Preparation
This document contains a comprehensive collection of verified questions and answers for
the AHIP 2025 Final Exam, updated for the 2025-2026 certification cycle. It covers all
major topics required for passing the Medicare training and certification exam, including
Medicare Advantage, Part D plans, fraud and abuse prevention, and marketing guidelines.
Ideal for agents and brokers preparing to recertify or certify for the first time with
confidence.
1. 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?: Mr. Wu may still qualify for help in paying
Part D costs through his State Pharmaceutical Assistance Program.
2. Mr. Bauer is 49 years old, but eighteen months ago he was declared
disabled by the Social Security Administration and has been receiving
disability payments. He is wondering whether he can obtain coverage under
Medicare. What should you tell him?: After receiving such disability payments for
24 months, he will be automatically enrolled in Medicare, regardless of age.
3. Mildred Savage enrolled in Allcare Medicare Advantage plan several
years ago. Mildred recently learned that she is suffering from inoperable
cancer and has just a few months to live. She would like to spend these final
months in hospice care. Mildred's family asks you whether hospice benefits
will be paid for under the Allcare Medicare Advantage plan. What should you
,say?: Mildred may remain enrolled in Allcare and make a hospice election. Hospice
benefits will be paid for by Original Medicare under Part A and Allcare will continue
to pay for any non-hospice services.
4. Mr. Schmidt would like to plan for retirement and has asked you what is
covered under Original Fee-for-Service (FFS) Medicare. What could you tell
him?: Part A, which covers hospital, skilled nursing facility, hospice, and home
health services and Part B, which covers professional services such as those
provided by a doctor are covered under Original Medicare.
5. Agent John Miller is meeting with Jerry Smith, a new prospect. Jerry is
currently enrolled in Medicare Parts A and B. Jerry has also purchased a
Medicare Supplement (Medigap) plan which he has had for several years.
However, the plan does not provide drug benefits. How would you advise
Agent John Miller to proceed?: Tell prospect Jerry Smith that he should consider
adding a standalone Part D prescription drug coverage policy to his present
coverage.
6. 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?: He may sign-up
for Medicare at any time however coverage usually begins on the fourth month after
dialysis treatments start.
7. Mr. Diaz continued working with his company and was insured under his
employer's group plan until he reached age 68. He has heard that there is a
premium penalty for those who did not sign up for Part B when first eligible
and wants to know how much he will have to pay. What should you tell him?:
Mr. Diaz will not pay any penalty because he had continuous coverage under his
employer's plan.
8. 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?: You should tel
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.
9. 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?: 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.
10. Mrs. PeHa 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?: 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.
11. Mr. Capadona would like to purchase a Medicare Advantage (MA) plan
and a Medigap plan to pick up costs not covered by that plan. What should
you tell him?: It is illegal for you to sell Mr. Capadona a Medigap plan if he is
enrolled in an MA plan, and besides, Medigap only works with Original Medicare.
12. Ms. Henderson believes that she will qualify for Medicare Coverage when
she turns 65, without paying any premiums, because she has been working
2026) – Complete Exam Material for Certification Preparation
This document contains a comprehensive collection of verified questions and answers for
the AHIP 2025 Final Exam, updated for the 2025-2026 certification cycle. It covers all
major topics required for passing the Medicare training and certification exam, including
Medicare Advantage, Part D plans, fraud and abuse prevention, and marketing guidelines.
Ideal for agents and brokers preparing to recertify or certify for the first time with
confidence.
1. 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?: Mr. Wu may still qualify for help in paying
Part D costs through his State Pharmaceutical Assistance Program.
2. Mr. Bauer is 49 years old, but eighteen months ago he was declared
disabled by the Social Security Administration and has been receiving
disability payments. He is wondering whether he can obtain coverage under
Medicare. What should you tell him?: After receiving such disability payments for
24 months, he will be automatically enrolled in Medicare, regardless of age.
3. Mildred Savage enrolled in Allcare Medicare Advantage plan several
years ago. Mildred recently learned that she is suffering from inoperable
cancer and has just a few months to live. She would like to spend these final
months in hospice care. Mildred's family asks you whether hospice benefits
will be paid for under the Allcare Medicare Advantage plan. What should you
,say?: Mildred may remain enrolled in Allcare and make a hospice election. Hospice
benefits will be paid for by Original Medicare under Part A and Allcare will continue
to pay for any non-hospice services.
4. Mr. Schmidt would like to plan for retirement and has asked you what is
covered under Original Fee-for-Service (FFS) Medicare. What could you tell
him?: Part A, which covers hospital, skilled nursing facility, hospice, and home
health services and Part B, which covers professional services such as those
provided by a doctor are covered under Original Medicare.
5. Agent John Miller is meeting with Jerry Smith, a new prospect. Jerry is
currently enrolled in Medicare Parts A and B. Jerry has also purchased a
Medicare Supplement (Medigap) plan which he has had for several years.
However, the plan does not provide drug benefits. How would you advise
Agent John Miller to proceed?: Tell prospect Jerry Smith that he should consider
adding a standalone Part D prescription drug coverage policy to his present
coverage.
6. 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?: He may sign-up
for Medicare at any time however coverage usually begins on the fourth month after
dialysis treatments start.
7. Mr. Diaz continued working with his company and was insured under his
employer's group plan until he reached age 68. He has heard that there is a
premium penalty for those who did not sign up for Part B when first eligible
and wants to know how much he will have to pay. What should you tell him?:
Mr. Diaz will not pay any penalty because he had continuous coverage under his
employer's plan.
8. 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?: You should tel
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.
9. 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?: 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.
10. Mrs. PeHa 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?: 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.
11. Mr. Capadona would like to purchase a Medicare Advantage (MA) plan
and a Medigap plan to pick up costs not covered by that plan. What should
you tell him?: It is illegal for you to sell Mr. Capadona a Medigap plan if he is
enrolled in an MA plan, and besides, Medigap only works with Original Medicare.
12. Ms. Henderson believes that she will qualify for Medicare Coverage when
she turns 65, without paying any premiums, because she has been working
