AHIP FINAL EXAM LATEST (2025/2026) | VERIFIED
QUESTIONS AND CORRECT ANSWERS | A+ GRADED
Mr. Castillo, a naturalized citizen, previously enrolled in Medicare Part B but has recently stopped paying
his Part B premium. Mr. Castillo is still covered by Part A. He would like to enroll in a Medicare Advantage
(MA) plan and is still covered by Part A. What should you tell him? - CORRECT ANSWERS-He is
not eligible to enroll in a Medicare Advantage plan until he re-enrolls in Medicare Part B.
Mr. Kelly wants to know whether he is eligible to sign up for a Private fee-for-service (PFFS) plan. What
questions would you need to ask to determine his eligibility? - CORRECT ANSWERS-You would
need to ask Mr. Kelly if he is entitled to Part A, enrolled in Part B, and if he lives in the PFFS plan's service
area.
Dr. Elizabeth Brennan does not contract with the ABC PFFS plan but accepts the plan's terms and
conditions for payment. Mary Rodgers sees Dr. Brennan for treatment. How much may Dr. Brennan
charge? - CORRECT ANSWERS-Dr. Brennan can charge Mary Rogers no more than the cost
sharing specified in the PFFS plan's terms and condition of payment which may include balance billing up
to 15%of the Medicare rate.
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? -
CORRECT ANSWERS-Mr. Diaz will not pay any penalty because he had continuous coverage
under his employer's plan.
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? - CORRECT ANSWERS-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.
,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? - CORRECT ANSWERS-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? -
CORRECT ANSWERS-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.
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? - CORRECT ANSWERS-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.
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? - CORRECT ANSWERS-To obtain Part B coverage, she must pay a standard monthly
premium, though it is higher for individuals with higher incomes.
Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What could you tell Mrs. Park that might
be of assistance? - CORRECT ANSWERS-She should contact her state Medicaid agency to see
if she qualifies for one of several programs that can help with Medicare costs for which she is
responsible.
Shirly Thomas was enrolled in Medicaid during the Public Health Emergency (PHE). This coverage has
recently been terminated due to the end of the PHE. 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? - CORRECT ANSWERS-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.
, 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? - CORRECT
ANSWERS-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.
Mrs. Gonzalez is enrolled in Original Medicare and has a Medigap policy as well, but it provides no drug
coverage. She would like to keep the coverage she has but replace her existing Medigap plan with one
that provides drug coverage. What should you tell her? - CORRECT ANSWERS-Mrs. Gonzalez
cannot purchase a Medigap plan that covers drugs, but she could keep her Medigap policy and enroll in
a Part D prescription drug plan.
Mrs. Chen will be 65 soon, has been a citizen for twelve years, has been employed full time, and paid
taxes during that entire period. She is concerned that she will not qualify for coverage under part A
because she was not born in the United States. What should you tell her? - CORRECT
ANSWERS-Most individuals who are citizens and age 65 or over are covered under Part A by virtue
of having paid Medicare taxes while working, though some may be covered as a result of paying monthly
premiums.
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? - CORRECT ANSWERS-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? - CORRECT ANSWERS-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.
Anthony Boniface turned 65 in 2023. He was not receiving Social Security or Railroad Retirement
Benefits on his 65th birthday. He was interested in obtaining Medicare coverage and is eligible for
premium-free Part A. Before he could enroll in Medicare, his entire area was impacted by a hurricane
causing massive flooding and severe wind damage. The Federal government declared this to be a natural
disaster which has recently ended. During this period Anthony's initial enrollment period expired.
Anthony asks you how he can now obtain Medicare coverage. What should you say? - CORRECT
ANSWERS-Anthony is eligible for a special enrollment period (SEP) because he missed an
QUESTIONS AND CORRECT ANSWERS | A+ GRADED
Mr. Castillo, a naturalized citizen, previously enrolled in Medicare Part B but has recently stopped paying
his Part B premium. Mr. Castillo is still covered by Part A. He would like to enroll in a Medicare Advantage
(MA) plan and is still covered by Part A. What should you tell him? - CORRECT ANSWERS-He is
not eligible to enroll in a Medicare Advantage plan until he re-enrolls in Medicare Part B.
Mr. Kelly wants to know whether he is eligible to sign up for a Private fee-for-service (PFFS) plan. What
questions would you need to ask to determine his eligibility? - CORRECT ANSWERS-You would
need to ask Mr. Kelly if he is entitled to Part A, enrolled in Part B, and if he lives in the PFFS plan's service
area.
Dr. Elizabeth Brennan does not contract with the ABC PFFS plan but accepts the plan's terms and
conditions for payment. Mary Rodgers sees Dr. Brennan for treatment. How much may Dr. Brennan
charge? - CORRECT ANSWERS-Dr. Brennan can charge Mary Rogers no more than the cost
sharing specified in the PFFS plan's terms and condition of payment which may include balance billing up
to 15%of the Medicare rate.
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? -
CORRECT ANSWERS-Mr. Diaz will not pay any penalty because he had continuous coverage
under his employer's plan.
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? - CORRECT ANSWERS-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.
,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? - CORRECT ANSWERS-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? -
CORRECT ANSWERS-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.
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? - CORRECT ANSWERS-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.
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? - CORRECT ANSWERS-To obtain Part B coverage, she must pay a standard monthly
premium, though it is higher for individuals with higher incomes.
Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What could you tell Mrs. Park that might
be of assistance? - CORRECT ANSWERS-She should contact her state Medicaid agency to see
if she qualifies for one of several programs that can help with Medicare costs for which she is
responsible.
Shirly Thomas was enrolled in Medicaid during the Public Health Emergency (PHE). This coverage has
recently been terminated due to the end of the PHE. 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? - CORRECT ANSWERS-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.
, 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? - CORRECT
ANSWERS-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.
Mrs. Gonzalez is enrolled in Original Medicare and has a Medigap policy as well, but it provides no drug
coverage. She would like to keep the coverage she has but replace her existing Medigap plan with one
that provides drug coverage. What should you tell her? - CORRECT ANSWERS-Mrs. Gonzalez
cannot purchase a Medigap plan that covers drugs, but she could keep her Medigap policy and enroll in
a Part D prescription drug plan.
Mrs. Chen will be 65 soon, has been a citizen for twelve years, has been employed full time, and paid
taxes during that entire period. She is concerned that she will not qualify for coverage under part A
because she was not born in the United States. What should you tell her? - CORRECT
ANSWERS-Most individuals who are citizens and age 65 or over are covered under Part A by virtue
of having paid Medicare taxes while working, though some may be covered as a result of paying monthly
premiums.
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? - CORRECT ANSWERS-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? - CORRECT ANSWERS-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.
Anthony Boniface turned 65 in 2023. He was not receiving Social Security or Railroad Retirement
Benefits on his 65th birthday. He was interested in obtaining Medicare coverage and is eligible for
premium-free Part A. Before he could enroll in Medicare, his entire area was impacted by a hurricane
causing massive flooding and severe wind damage. The Federal government declared this to be a natural
disaster which has recently ended. During this period Anthony's initial enrollment period expired.
Anthony asks you how he can now obtain Medicare coverage. What should you say? - CORRECT
ANSWERS-Anthony is eligible for a special enrollment period (SEP) because he missed an
