AHIP Exam Latest (2025/2026) Complete
Questions and Correct Answers Complete
GRADED A+
1. Mrs. Burton is a retiree with substantial income. She is enrolled in an MA-PD
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plan and was disappointed with the service she received from her primary care
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physician because she was told she would have to wait five weeks to get an app
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o
intment when she was feeling ill. She called you to ask what she could do so she
g g g g g g g g g g g g g g g g g
w
ould not have to put up with such poor access to care. What could you tell her?: S
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he could file a grievance with her plan to complain about the lack of timeliness in getting
g g g g g g g g g g g g g g g g g
an appointment.
g
2. Edward IP suffered from serious kidney disease. As a result. Edward be-
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g came eligible for Medicare coverage due to end-
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stage renal disease (ESRD). A close relative donated their kidney and Edward s
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uccessfully underwent transplant surgery 12 months ago. Edward is now age 5 g g g g g g g g g g g
0 and asks you if his Medicare coverage will continue, what should you say?: In
g g g g g g g g g g g g g g
dividuals eligible for Medicare based on ESRD generally lose eligibility 36 months afte
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r the month in which the individual receives a kidney transplant unless they are eligible for
g g g g g g g g g g g g g g g g
Medicare on another basis such as age or disability. Edward may, however, remain enr
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olled in Part B but solely for coverage of immunosuppressive drugs if he has no other he
g g g g g g g g g g g g g g g g
alth care coverage that would cover the drugs.
g g g g g g g
,3. Mildred Savage enrolled in Allcare Medicare Advantage plan several years ag
g g g g g g g g g g
o. Mildred recently learned that she is suffering from inoperable cancer and has j
g g g g g g g g g g g g g
ust a few months to live. She would like to spend these final months in hospice c
g g g g g g g g g g g g g g g g
1g/g39
,are. Mildred's family asks you whether hospice benefits will be paid for under th
g g g g g g g g g g g g g
e Allcare Medicare Advantage plan. What should you say?: Mildred may remain en
g g g g g g g g g g g g
rolled in Allcare and make a hospice election. Hospice benefits will be paid for by Origi
g g g g g g g g g g g g g g g
nal Medicare under Part A and Allcare will continue to pay for any non-
g g g g g g g g g g g g g
hospice services. g
4. Mr. Diaz continued working with his company and was insured under his emp
g g g g g g g g g g g g
loyer's group plan until he reached age 68. He has heard that there is a premium
g g g g g g g g g g g g g g g g
penalty for those who did not sign up for Part B when first eligible and
g g g g g g g g g g g g g g g
wants to kno g g
w how much he will have to pay. What should you tell him?: Mr. Diaz will not pay an
g g g g g g g g g g g g g g g g g g
y penalty because he had continuous coverage under his employer's plan.
g g g g g g g g g g
5. Mr. Moy's wife has a Medicare Advantage plan, but he wants to under-
g g g g g g g g g g g g
g stand what coverage Medicare Supplemental Insurance provides since his he
g g g g g g g g g
alth care needs are different from his wife's needs. What could you tell Mr. Moy?
g g g g g g g g g g g g g g
: Medicare Supplemental Insurance would help cover his Part A and Part B deductible
g g g g g g g g g g g g g
s or coinsurance in Original Fee-for-
g g g g g
Service (FFS) Medicare as well as possibly some services that Medicare does not co ver.
g g g g g g g g g g g g g
6. Mrs. Chen will be 65 soon, has been a citizen for twelve years, has been emplo
g g g g g g g g g g g g g g g
yed full time, and paid taxes during that entire period. She is concerned
g g g g g g g g g g g g
2g/g39
, that she will not qualify for coverage under part A because she was not born in
g g g g g g g g g g g g g g g
the United States. What should you tell her?: Most individuals who are citizens and
g g g g g g g g g g g g g g
age 65 or over are covered under Part A by virtue of having paid Medicare taxes while
g g g g g g g g g g g g g g g g g
working, though some may be covered as a result of paying monthly premiums.
g g g g g g g g g g g g
7. Mr. Bauer is 49 years old, but eighteen months ago he was declared dis-
g g g g g g g g g g g g g
g abled by the Social Security Administration and has been receiving disability p
g g g g g g g g g g g
ayments. He is wondering whether he can obtain coverage under Medicare. Wh
g g g g g g g g g g g
at should you tell him?: After receiving such disability payments for 24 months, he will
g g g g g g g g g g g g g g g
be automatically enrolled in Medicare, regardless of age.
g g g g g g g
8.
Mr. Xi will soon turn age 65 and has come to you for advice as to what services
g g g g g g g g g g g g g g g g g
g are provided under Original Medicare. What should you tell Mr. Xi that
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best descri bes the health coverage provided to Medicare beneficiaries?: Ben-
g g g g g g g g g
g eficiaries under Original Medicare have no cost- g g g g g g
sharing for most preventive services which include immunizations such as annual flu s hots.
g g g g g g g g g g g g
9.
Mrs. PeaHis 66 years old, has coverage under an employer plan, and will retire n
g g g g g g g g g g g g g g
e
xt year. She heard she must enroll in Part B at the beginning of the year to ensur
g g g g g g g g g g g g g g g g g
e no gap in coverage. What can you tell her?: She may enroll at any time while she is
g g g g g g g g g g g g g g g g g g g
covered under her employer plan, but she will have a special eight-
g g g g g g g g g g g
month enrollment period after the last month on her employer plan that differs from the
g g g g g g g g g g g g g g
g standard general enrollment period, during which she may enroll in Medicare Part B.
g g g g g g g g g g g g
10. Mr. Davis is 52 years old and has recently been diagnosed with end-
g g g g g g g g g g g g
stage renal disease (ESRD) and will soon begin dialysis. He is wondering if he c
g g g g g g g g g g g g g g
Questions and Correct Answers Complete
GRADED A+
1. Mrs. Burton is a retiree with substantial income. She is enrolled in an MA-PD
g g g g g g g g g g g g g
plan and was disappointed with the service she received from her primary care
g g g g g g g g g g g g g
physician because she was told she would have to wait five weeks to get an app
g g g g g g g g g g g g g g g
o
intment when she was feeling ill. She called you to ask what she could do so she
g g g g g g g g g g g g g g g g g
w
ould not have to put up with such poor access to care. What could you tell her?: S
g g g g g g g g g g g g g g g g g
he could file a grievance with her plan to complain about the lack of timeliness in getting
g g g g g g g g g g g g g g g g g
an appointment.
g
2. Edward IP suffered from serious kidney disease. As a result. Edward be-
g g g g g g g g g g g
g came eligible for Medicare coverage due to end-
g g g g g g g
stage renal disease (ESRD). A close relative donated their kidney and Edward s
g g g g g g g g g g g g
uccessfully underwent transplant surgery 12 months ago. Edward is now age 5 g g g g g g g g g g g
0 and asks you if his Medicare coverage will continue, what should you say?: In
g g g g g g g g g g g g g g
dividuals eligible for Medicare based on ESRD generally lose eligibility 36 months afte
g g g g g g g g g g g g
r the month in which the individual receives a kidney transplant unless they are eligible for
g g g g g g g g g g g g g g g g
Medicare on another basis such as age or disability. Edward may, however, remain enr
g g g g g g g g g g g g g
olled in Part B but solely for coverage of immunosuppressive drugs if he has no other he
g g g g g g g g g g g g g g g g
alth care coverage that would cover the drugs.
g g g g g g g
,3. Mildred Savage enrolled in Allcare Medicare Advantage plan several years ag
g g g g g g g g g g
o. Mildred recently learned that she is suffering from inoperable cancer and has j
g g g g g g g g g g g g g
ust a few months to live. She would like to spend these final months in hospice c
g g g g g g g g g g g g g g g g
1g/g39
,are. Mildred's family asks you whether hospice benefits will be paid for under th
g g g g g g g g g g g g g
e Allcare Medicare Advantage plan. What should you say?: Mildred may remain en
g g g g g g g g g g g g
rolled in Allcare and make a hospice election. Hospice benefits will be paid for by Origi
g g g g g g g g g g g g g g g
nal Medicare under Part A and Allcare will continue to pay for any non-
g g g g g g g g g g g g g
hospice services. g
4. Mr. Diaz continued working with his company and was insured under his emp
g g g g g g g g g g g g
loyer's group plan until he reached age 68. He has heard that there is a premium
g g g g g g g g g g g g g g g g
penalty for those who did not sign up for Part B when first eligible and
g g g g g g g g g g g g g g g
wants to kno g g
w how much he will have to pay. What should you tell him?: Mr. Diaz will not pay an
g g g g g g g g g g g g g g g g g g
y penalty because he had continuous coverage under his employer's plan.
g g g g g g g g g g
5. Mr. Moy's wife has a Medicare Advantage plan, but he wants to under-
g g g g g g g g g g g g
g stand what coverage Medicare Supplemental Insurance provides since his he
g g g g g g g g g
alth care needs are different from his wife's needs. What could you tell Mr. Moy?
g g g g g g g g g g g g g g
: Medicare Supplemental Insurance would help cover his Part A and Part B deductible
g g g g g g g g g g g g g
s or coinsurance in Original Fee-for-
g g g g g
Service (FFS) Medicare as well as possibly some services that Medicare does not co ver.
g g g g g g g g g g g g g
6. Mrs. Chen will be 65 soon, has been a citizen for twelve years, has been emplo
g g g g g g g g g g g g g g g
yed full time, and paid taxes during that entire period. She is concerned
g g g g g g g g g g g g
2g/g39
, that she will not qualify for coverage under part A because she was not born in
g g g g g g g g g g g g g g g
the United States. What should you tell her?: Most individuals who are citizens and
g g g g g g g g g g g g g g
age 65 or over are covered under Part A by virtue of having paid Medicare taxes while
g g g g g g g g g g g g g g g g g
working, though some may be covered as a result of paying monthly premiums.
g g g g g g g g g g g g
7. Mr. Bauer is 49 years old, but eighteen months ago he was declared dis-
g g g g g g g g g g g g g
g abled by the Social Security Administration and has been receiving disability p
g g g g g g g g g g g
ayments. He is wondering whether he can obtain coverage under Medicare. Wh
g g g g g g g g g g g
at should you tell him?: After receiving such disability payments for 24 months, he will
g g g g g g g g g g g g g g g
be automatically enrolled in Medicare, regardless of age.
g g g g g g g
8.
Mr. Xi will soon turn age 65 and has come to you for advice as to what services
g g g g g g g g g g g g g g g g g
g are provided under Original Medicare. What should you tell Mr. Xi that
g g g g g g g g g g g g
best descri bes the health coverage provided to Medicare beneficiaries?: Ben-
g g g g g g g g g
g eficiaries under Original Medicare have no cost- g g g g g g
sharing for most preventive services which include immunizations such as annual flu s hots.
g g g g g g g g g g g g
9.
Mrs. PeaHis 66 years old, has coverage under an employer plan, and will retire n
g g g g g g g g g g g g g g
e
xt year. She heard she must enroll in Part B at the beginning of the year to ensur
g g g g g g g g g g g g g g g g g
e no gap in coverage. What can you tell her?: She may enroll at any time while she is
g g g g g g g g g g g g g g g g g g g
covered under her employer plan, but she will have a special eight-
g g g g g g g g g g g
month enrollment period after the last month on her employer plan that differs from the
g g g g g g g g g g g g g g
g standard general enrollment period, during which she may enroll in Medicare Part B.
g g g g g g g g g g g g
10. Mr. Davis is 52 years old and has recently been diagnosed with end-
g g g g g g g g g g g g
stage renal disease (ESRD) and will soon begin dialysis. He is wondering if he c
g g g g g g g g g g g g g g
