AHIP Final Exam 2026– Verified Edition with
Complete Answers and Rationales
Questions with Answers
Below are 50 verified questions from the 2026 AHIP Final Exam, covering Medicare
basics, enrollment, plan types, fraud/abuse, and compliance. Each includes the correct
answer and a detailed rationale based on CMS guidelines and AHIP content.
1. Mr. Davis is 52 years old and has recently been diagnosed with -stage
end renal
disease (ESRD) and will soon begin dialysis. He is wondering if he can obtain
coverage under Medicare. What should you tell him?
A) He is not eligible until age 65.
B) He may sign up for Medicare at any time; coverage begins on the fourth month
after dialysis starts.
C) He must wait 24 months from diagnosis.
D) ESRD does not qualify for Medicare.
Answer: B) He may sign up for Medicare at any time; coverage begins on the
fourth month after dialysis starts.
Rationale: Medicare eligibility for ESRD allows enrollment at any time, with Part A
coverage starting the first month of dialysis, but full benefits (Parts A, B, D) begin
after the third month, per CMS ESRD rules.
2. Mrs. Shields is covered by Original Medicare. She sustained a hip fracture and is
being successfully treated for that condition. She is concerned about whether or
not Medicare will cover her doctor's office visits for follow
-up care. What should
you tell her?
A) Original Medicare covers follow -up visits.
B) Follow-up visits are not covered under Original Medicare.
C) She needs a Medicare Advantage plan for coverage.
D) Coverage depends on the doctor's network.
Answer: A) Original Medicare covers follow -up visits.
Rationale: Original Medicare (Parts A and B) covers medically necessary-up follow
Complete Answers and Rationales
Questions with Answers
Below are 50 verified questions from the 2026 AHIP Final Exam, covering Medicare
basics, enrollment, plan types, fraud/abuse, and compliance. Each includes the correct
answer and a detailed rationale based on CMS guidelines and AHIP content.
1. Mr. Davis is 52 years old and has recently been diagnosed with -stage
end renal
disease (ESRD) and will soon begin dialysis. He is wondering if he can obtain
coverage under Medicare. What should you tell him?
A) He is not eligible until age 65.
B) He may sign up for Medicare at any time; coverage begins on the fourth month
after dialysis starts.
C) He must wait 24 months from diagnosis.
D) ESRD does not qualify for Medicare.
Answer: B) He may sign up for Medicare at any time; coverage begins on the
fourth month after dialysis starts.
Rationale: Medicare eligibility for ESRD allows enrollment at any time, with Part A
coverage starting the first month of dialysis, but full benefits (Parts A, B, D) begin
after the third month, per CMS ESRD rules.
2. Mrs. Shields is covered by Original Medicare. She sustained a hip fracture and is
being successfully treated for that condition. She is concerned about whether or
not Medicare will cover her doctor's office visits for follow
-up care. What should
you tell her?
A) Original Medicare covers follow -up visits.
B) Follow-up visits are not covered under Original Medicare.
C) She needs a Medicare Advantage plan for coverage.
D) Coverage depends on the doctor's network.
Answer: A) Original Medicare covers follow -up visits.
Rationale: Original Medicare (Parts A and B) covers medically necessary-up follow
