AHIP QUESTIONS 2026 STUDY
GUIDE | PRACTICE QUESTIONS,
ANSWERS & RATIONALES
| GRADED A+ | GUARANTEED
SUCCESS
Updated 2026 Questions and Answers
100% Verified Exam Prep and Comprehensive
Rationales Included
,(W) Mrs. Billings enrolled in the ABC Medicare She may remain in her ABC MA plan or enroll in a Special Needs Plan (SNP) for
Advantage (MA) plan several years ago. Her doctor individuals suffering from ESRD if one is available in her area
recently confirmed a diagnosis of end-stage renal
disease (ESRD). What options does Mrs. Billings have in
regard to her MA plan during the next open enrollment
season?
Mr. Kumar is considering a Medicare Advantage HMO In most Medicare Advantage HMOs, Mr. Kumar must obtain his services only from
and has questions about his ability to access providers. providers who have a contractual relationship with the plan (except in an
What should you tell him? emergency).
Mrs. Ramos is considering a Medicare Advantage PPO Mrs. Ramos can obtain care from any provider who participates in Original
and has questions about which providers she can go to Medicare, but generally will be charged a lower co-payment if she goes to one of
for her health care. What should you tell her? the plan's preferred providers.
Mr. Sinclair has diabetes and heart trouble and is SNPs have special programs for enrollees with chronic conditions, like Mr. Sinclair,
generally satisfied with the care he has received under and they provide prescription drug coverage that could be very helpful as well
Original Medicare, but he would like to know more about
Medicare Advantage Special Needs Plans (SNPs). What
could you tell him?
(W) Mr. Greco is in excellent health, lives in his own home, SNPs limit enrollment to certain sub-populations of beneficiaries. Given his
and has a sizeable income from his investments. He has a current situation, he is unlikely to qualify and would not be able to enroll in the
friend enrolled in a Medicare Advantage Special Needs SNP.
Plan (SNP). His friend has mentioned that the SNP
charges very low cost-sharing amounts and Mr. Greco
would like to join that plan. What should you tell him?
(W) Mrs. Chen will be 65 soon, has been a citizen for Most individuals who are citizens and over age 65 are covered under Part A by
twelve years, has been employed full time, and paid virtue of having paid Medicare taxes while working, though some may be covered
taxes during that entire period. She is concerned that she as a result of paying monthly premiums.
will not qualify for coverage under part A because she
was not born in the United States. What should you tell
her?
(W) Mr. Bauer is 49 years old, but eighteen months ago After receiving such disability payments for 24 months, he will be automatically
he was declared disabled by the Social Security enrolled in Medicare, regardless of age.
Administration and has been receiving disability
payments. He is wondering whether he can obtain
coverage under Medicare. What should you tell him?
(W) Mr. Davis is 49 years old and has been receiving No, he cannot purchase a Medicare Advantage or Part D policy because he has
disability benefits from the Social Security Administration not received Social Security or Railroad Retirement disability benefits for 24
for 12 months. Can you sell him a Medicare Advantage or months.
Part D Prescription Drug policy?
(W) Ms. Henderson believes that she will qualify for In order to obtain Part B coverage, she must pay a standard monthly premium,
Medicare coverage when she turns 65, without paying though it is higher for individuals with higher incomes
any premiums, because she has been working for 40
years and paying Medicare taxes. What should you tell
her?
, (W) Mr. Diaz continued working with his company and Mr. Diaz will not pay any penalty because he had continuous coverage under his
was insured under his employer's group plan until he employer's plan.
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?
(W) Mrs. Peňa is 66 years old, has coverage under an She may enroll at any time while she is covered under her employer plan, but she
employer plan and will retire next year. She heard she will have a special eight-month enrollment period that differs from the standard
must enroll in Part B at the beginning of the year to general enrollment period, during which she may enroll in Medicare Part B
ensure no gap in coverage. What can you tell her?
(W) Mrs. Kelly is entitled to Part A, but is not yet enrolled In order to join a Medicare health plan, she also must enroll in Part B
in Part B. She is considering enrollment in a Medicare
health plan. What should you advise her to do before she
will be able to enroll into a Medicare health plan?
Mrs. Park has a low, fixed income. What could you tell her She should contact her state Medicaid agency to see if she qualifies for one of
that might be of assistance? several programs that can help with Medicare costs for which she is responsible
(W) Mr. Yu has limited income and resources so you have He might qualify for help with Part D prescription drug costs and help paying Part
encouraged him to see if he qualifies for some type of A and/or Part B premiums, deductibles, and/or cost sharing.
financial assistance. Mr. Yu is not sure it is worth the
trouble to apply and wants to know what the assistance
could do for him if he qualifies. What could you tell him?
(W) Mr. Patel is in good health and is preparing a budget Under Original Medicare, there is a single deductible amount due for the first 60
in anticipation of his retirement when he turns 66. He days of any inpatient hospital stay, after which it converts into a per-day amount
wants to understand the health care costs he might be through day 90. After day 90, he would pay a daily amount up to 60 days over his
exposed to under Medicare if he were to require lifetime, after which he would be responsible for all costs
hospitalization as a result of an illness. In general terms,
what could you tell him about his costs for inpatient
hospital services under Original Medicare?
(W) Mr. Rainey is experiencing paranoid delusions and his Medicare will cover a total of 190 days of inpatient psychiatric care during Mr.
physician feels that he should be hospitalized. What Rainey's entire lifetime.
should you tell Mr. Rainey (or his representative) about
the length of an inpatient psychiatric hospital stay that
Medicare will cover?
Mrs. Shields is covered by Original Medicare. She Medicare will cover Mrs. Shields' skilled nursing services provided during the first
sustained a hip fracture and is being successfully treated 20 days of her stay, after which she would have a coinsurance until she has been
for that condition. However, she and her physicians feel in the facility for 100 days.
that after her lengthy hospital stay she will need a month
or two of nursing and rehabilitative care. What should you
tell them about Original Medicare's coverage of care in a
skilled nursing facility?
Mrs. Quinn has just turned 65 and received a letter Part B primarily covers physician services. She will be paying a monthly premium
informing her that she has been automatically enrolled in and, with the exception of many preventive and screening tests, generally will
Medicare Part B. She wants to understand what this have 20% co-payments for these services, in addition to an annual deductible.
means. What should you tell Mrs. Quinn?
GUIDE | PRACTICE QUESTIONS,
ANSWERS & RATIONALES
| GRADED A+ | GUARANTEED
SUCCESS
Updated 2026 Questions and Answers
100% Verified Exam Prep and Comprehensive
Rationales Included
,(W) Mrs. Billings enrolled in the ABC Medicare She may remain in her ABC MA plan or enroll in a Special Needs Plan (SNP) for
Advantage (MA) plan several years ago. Her doctor individuals suffering from ESRD if one is available in her area
recently confirmed a diagnosis of end-stage renal
disease (ESRD). What options does Mrs. Billings have in
regard to her MA plan during the next open enrollment
season?
Mr. Kumar is considering a Medicare Advantage HMO In most Medicare Advantage HMOs, Mr. Kumar must obtain his services only from
and has questions about his ability to access providers. providers who have a contractual relationship with the plan (except in an
What should you tell him? emergency).
Mrs. Ramos is considering a Medicare Advantage PPO Mrs. Ramos can obtain care from any provider who participates in Original
and has questions about which providers she can go to Medicare, but generally will be charged a lower co-payment if she goes to one of
for her health care. What should you tell her? the plan's preferred providers.
Mr. Sinclair has diabetes and heart trouble and is SNPs have special programs for enrollees with chronic conditions, like Mr. Sinclair,
generally satisfied with the care he has received under and they provide prescription drug coverage that could be very helpful as well
Original Medicare, but he would like to know more about
Medicare Advantage Special Needs Plans (SNPs). What
could you tell him?
(W) Mr. Greco is in excellent health, lives in his own home, SNPs limit enrollment to certain sub-populations of beneficiaries. Given his
and has a sizeable income from his investments. He has a current situation, he is unlikely to qualify and would not be able to enroll in the
friend enrolled in a Medicare Advantage Special Needs SNP.
Plan (SNP). His friend has mentioned that the SNP
charges very low cost-sharing amounts and Mr. Greco
would like to join that plan. What should you tell him?
(W) Mrs. Chen will be 65 soon, has been a citizen for Most individuals who are citizens and over age 65 are covered under Part A by
twelve years, has been employed full time, and paid virtue of having paid Medicare taxes while working, though some may be covered
taxes during that entire period. She is concerned that she as a result of paying monthly premiums.
will not qualify for coverage under part A because she
was not born in the United States. What should you tell
her?
(W) Mr. Bauer is 49 years old, but eighteen months ago After receiving such disability payments for 24 months, he will be automatically
he was declared disabled by the Social Security enrolled in Medicare, regardless of age.
Administration and has been receiving disability
payments. He is wondering whether he can obtain
coverage under Medicare. What should you tell him?
(W) Mr. Davis is 49 years old and has been receiving No, he cannot purchase a Medicare Advantage or Part D policy because he has
disability benefits from the Social Security Administration not received Social Security or Railroad Retirement disability benefits for 24
for 12 months. Can you sell him a Medicare Advantage or months.
Part D Prescription Drug policy?
(W) Ms. Henderson believes that she will qualify for In order to obtain Part B coverage, she must pay a standard monthly premium,
Medicare coverage when she turns 65, without paying though it is higher for individuals with higher incomes
any premiums, because she has been working for 40
years and paying Medicare taxes. What should you tell
her?
, (W) Mr. Diaz continued working with his company and Mr. Diaz will not pay any penalty because he had continuous coverage under his
was insured under his employer's group plan until he employer's plan.
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?
(W) Mrs. Peňa is 66 years old, has coverage under an She may enroll at any time while she is covered under her employer plan, but she
employer plan and will retire next year. She heard she will have a special eight-month enrollment period that differs from the standard
must enroll in Part B at the beginning of the year to general enrollment period, during which she may enroll in Medicare Part B
ensure no gap in coverage. What can you tell her?
(W) Mrs. Kelly is entitled to Part A, but is not yet enrolled In order to join a Medicare health plan, she also must enroll in Part B
in Part B. She is considering enrollment in a Medicare
health plan. What should you advise her to do before she
will be able to enroll into a Medicare health plan?
Mrs. Park has a low, fixed income. What could you tell her She should contact her state Medicaid agency to see if she qualifies for one of
that might be of assistance? several programs that can help with Medicare costs for which she is responsible
(W) Mr. Yu has limited income and resources so you have He might qualify for help with Part D prescription drug costs and help paying Part
encouraged him to see if he qualifies for some type of A and/or Part B premiums, deductibles, and/or cost sharing.
financial assistance. Mr. Yu is not sure it is worth the
trouble to apply and wants to know what the assistance
could do for him if he qualifies. What could you tell him?
(W) Mr. Patel is in good health and is preparing a budget Under Original Medicare, there is a single deductible amount due for the first 60
in anticipation of his retirement when he turns 66. He days of any inpatient hospital stay, after which it converts into a per-day amount
wants to understand the health care costs he might be through day 90. After day 90, he would pay a daily amount up to 60 days over his
exposed to under Medicare if he were to require lifetime, after which he would be responsible for all costs
hospitalization as a result of an illness. In general terms,
what could you tell him about his costs for inpatient
hospital services under Original Medicare?
(W) Mr. Rainey is experiencing paranoid delusions and his Medicare will cover a total of 190 days of inpatient psychiatric care during Mr.
physician feels that he should be hospitalized. What Rainey's entire lifetime.
should you tell Mr. Rainey (or his representative) about
the length of an inpatient psychiatric hospital stay that
Medicare will cover?
Mrs. Shields is covered by Original Medicare. She Medicare will cover Mrs. Shields' skilled nursing services provided during the first
sustained a hip fracture and is being successfully treated 20 days of her stay, after which she would have a coinsurance until she has been
for that condition. However, she and her physicians feel in the facility for 100 days.
that after her lengthy hospital stay she will need a month
or two of nursing and rehabilitative care. What should you
tell them about Original Medicare's coverage of care in a
skilled nursing facility?
Mrs. Quinn has just turned 65 and received a letter Part B primarily covers physician services. She will be paying a monthly premium
informing her that she has been automatically enrolled in and, with the exception of many preventive and screening tests, generally will
Medicare Part B. She wants to understand what this have 20% co-payments for these services, in addition to an annual deductible.
means. What should you tell Mrs. Quinn?
