AHIP 2025-2026 Medicare Training Final Exam - 160
Comprehensive Questions and Answers America’s Health
Insurance Plans (2026 Edition) – Expert-Reviewed to
Help You Pass on Your First Attempt and Avoid Resits
1. Mr. Wendt suffers from diabetes which has gotten progressively worse during
the last year. He is currently enrolled in Original Medicare (Parts A and B) and a
Part D prescription drug plan and did not enroll in a Medicare Advantage (MA)
plan during the last annual open enrollment period (AEP) which has just closed.
Mr. Wendt has heard that there are certain MA plans that might provide him with
more specialized coverage for his diabetes and wants to know if he must wait until
the next annual open enrollment period (AEP) before enrolling in such a plan.
What should you tell him?
• answer--d. If there is a special needs plan (SNP) in Mr. Wendt's area
that specializes in caring for individuals with diabetes, he may enroll in
the SNP at any time under a special enrollment period (SEP). Correct
2. 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?
• answer--d. Tell prospect Jerry Smith that he should consider adding a
standalone Part D prescription drug coverage policy to his present
coverage. Correct
3. Anita Magri will turn age 65 in August 2020. Anita intends to enroll in Original
Medicare Part A and Part B. She would also like to enroll in a Medicare
Supplement (Medigap) plan. Anita's older neighbor Mel has told her about the
Medigap Part F plan in which he is enrolled. It not only provides foreign travel
,emergency benefits but also covers his Medicare Part B deductible. Anita comes to
you for advice. What should you tell her?
• answer--a. You are sorry to disappoint Anita but a Medigap Part F plan
is no longer available to those who turn age 65 after January 1, 2020.
Anita might instead consider other Medigap plans that offer foreign
travel benefits but do not cover the Part B deductible. Correct
4. Juan Perez, who is turning age 65 next month, intends to work for several more
years at Smallcap, Incorporated. Smallcap has a workforce of 15 employees and
offers employer-sponsored healthcare coverage. Juan is a naturalized citizen and
has contributed to the Medicare system for over 20 years. Juan asks you if he will
be entitled to Medicare and if he enrolls how that will impact his employer-
sponsored healthcare coverage. How would you respond?
• answer--d. Juan is likely to be eligible for Medicare once he turns age 65
and if he enrolls Medicare would become the primary payor of his
healthcare claims and Smallcap does not have to continue to offer him
coverage comparable to those under age 65 under its employer-
sponsored group health plan. Correct
5. 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--b. 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 to
her substantial income. Correct
,6. 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?
• answer--b. After receiving such disability payments for 24 months, he
will be automatically enrolled in Medicare, regardless of age. Correct
7. 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?
• answer--b. He may sign-up for Medicare at any time; however, coverage
usually begins on the fourth month after dialysis treatments
start. Correct
8. 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?
• answer--d. Mr. Diaz will not pay any penalty because he had continuous
coverage under his employer's plan. Correct
9. 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?
• answer--b. Medicare Supplemental Insurance would help cover his Part
A and Part B cost sharing in Original Fee-for-Service (FFS) Medicare
as well as possibly some services that Medicare does not cover. Correct
10. 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?
• answer--a. 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. Correct
11. 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?
• answer--b. 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. Correct
12. 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--c. 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. Correct
13. Mr. Singh would like drug coverage but does not want to be enrolled in a
Medicare Advantage plan. What should you tell him?
• answer--d. Mr. Singh can enroll in a stand-alone prescription drug plan
and continue to be covered for Part A and Part B services through
Original Fee-for-Service Medicare. Correct
14. Mrs. Paterson is concerned about the deductibles and co-payments associated
with Original Medicare. What can you tell her about Medigap as an option to
address this concern?
Comprehensive Questions and Answers America’s Health
Insurance Plans (2026 Edition) – Expert-Reviewed to
Help You Pass on Your First Attempt and Avoid Resits
1. Mr. Wendt suffers from diabetes which has gotten progressively worse during
the last year. He is currently enrolled in Original Medicare (Parts A and B) and a
Part D prescription drug plan and did not enroll in a Medicare Advantage (MA)
plan during the last annual open enrollment period (AEP) which has just closed.
Mr. Wendt has heard that there are certain MA plans that might provide him with
more specialized coverage for his diabetes and wants to know if he must wait until
the next annual open enrollment period (AEP) before enrolling in such a plan.
What should you tell him?
• answer--d. If there is a special needs plan (SNP) in Mr. Wendt's area
that specializes in caring for individuals with diabetes, he may enroll in
the SNP at any time under a special enrollment period (SEP). Correct
2. 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?
• answer--d. Tell prospect Jerry Smith that he should consider adding a
standalone Part D prescription drug coverage policy to his present
coverage. Correct
3. Anita Magri will turn age 65 in August 2020. Anita intends to enroll in Original
Medicare Part A and Part B. She would also like to enroll in a Medicare
Supplement (Medigap) plan. Anita's older neighbor Mel has told her about the
Medigap Part F plan in which he is enrolled. It not only provides foreign travel
,emergency benefits but also covers his Medicare Part B deductible. Anita comes to
you for advice. What should you tell her?
• answer--a. You are sorry to disappoint Anita but a Medigap Part F plan
is no longer available to those who turn age 65 after January 1, 2020.
Anita might instead consider other Medigap plans that offer foreign
travel benefits but do not cover the Part B deductible. Correct
4. Juan Perez, who is turning age 65 next month, intends to work for several more
years at Smallcap, Incorporated. Smallcap has a workforce of 15 employees and
offers employer-sponsored healthcare coverage. Juan is a naturalized citizen and
has contributed to the Medicare system for over 20 years. Juan asks you if he will
be entitled to Medicare and if he enrolls how that will impact his employer-
sponsored healthcare coverage. How would you respond?
• answer--d. Juan is likely to be eligible for Medicare once he turns age 65
and if he enrolls Medicare would become the primary payor of his
healthcare claims and Smallcap does not have to continue to offer him
coverage comparable to those under age 65 under its employer-
sponsored group health plan. Correct
5. 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--b. 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 to
her substantial income. Correct
,6. 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?
• answer--b. After receiving such disability payments for 24 months, he
will be automatically enrolled in Medicare, regardless of age. Correct
7. 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?
• answer--b. He may sign-up for Medicare at any time; however, coverage
usually begins on the fourth month after dialysis treatments
start. Correct
8. 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?
• answer--d. Mr. Diaz will not pay any penalty because he had continuous
coverage under his employer's plan. Correct
9. 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?
• answer--b. Medicare Supplemental Insurance would help cover his Part
A and Part B cost sharing in Original Fee-for-Service (FFS) Medicare
as well as possibly some services that Medicare does not cover. Correct
10. 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?
• answer--a. 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. Correct
11. 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?
• answer--b. 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. Correct
12. 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--c. 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. Correct
13. Mr. Singh would like drug coverage but does not want to be enrolled in a
Medicare Advantage plan. What should you tell him?
• answer--d. Mr. Singh can enroll in a stand-alone prescription drug plan
and continue to be covered for Part A and Part B services through
Original Fee-for-Service Medicare. Correct
14. Mrs. Paterson is concerned about the deductibles and co-payments associated
with Original Medicare. What can you tell her about Medigap as an option to
address this concern?
