AHIP 2026: Modules 1-5, Final, and FWA JACKPOT
Study online at https://quizlet.com/_hihcf6
1. What happens after Mr. Bauer has received disability payments for 24
months?: He will be automatically enrolled in Medicare, regardless of age.
2. Why did Edward become eligible for Medicare coverage?: Due to end-stage renal
disease (ESRD).
3. How long does Medicare coverage generally last for individuals eligible based
on ESRD after a kidney transplant?: Eligibility generally lasts for 36 months after the month in which
the individual receives a kidney transplant.
4. What can Edward do regarding Part B coverage after his kidney transplant?: He
may remain enrolled in Part B solely for coverage of immunosuppressive drugs if he has no other health care coverage
for those drugs.
5. What special enrollment option does Anthony have after missing his initial
enrollment period due to a disaster?: He is eligible for a special enrollment period (SEP) to enroll
in Part B up to six months after the end of the emergency declaration.
6. When can Anthony enroll in premium-free Part A?: He may enroll in premium-free Part A
at any time, with coverage retroactive for up to 6 months.
7. What should you tell Mr. Capadona about purchasing a Medigap plan while
enrolled in a Medicare Advantage plan?: It is illegal to sell him a Medigap plan if he is enrolled in
an MA plan, as Medigap only works with Original Medicare.
8. Will Mildred's hospice care be covered under her Allcare Medicare Advantage
plan?: Yes, hospice benefits will be paid for by Original Medicare under Part A, and Allcare will continue to pay for
any non-hospice services.
9. What must Ms. Henderson do to obtain Part B coverage?: She must pay a standard
monthly premium, which may be higher for individuals with higher incomes.
10. What assistance can Mrs. Cook seek due to her low fixed income?: She should
contact her state Medicaid agency to see if she qualifies for programs that help with Medicare costs.
11. What does Medicare Supplemental Insurance cover for Mr. Moy?: It helps cover
his Part A deductible and Part B coinsurance or copayments in Original Fee-for-Service (FFS) Medicare.
12. What is Juan Perez's situation regarding Medicare as he turns 65?: He intends to
work for several more years at Smallcap, which offers employer-sponsored healthcare coverage.
13. What is the eligibility requirement for premium-free Part A?: Individuals must have
worked and paid Medicare taxes for a sufficient period, typically 40 quarters.
, AHIP 2026: Modules 1-5, Final, and FWA JACKPOT
Study online at https://quizlet.com/_hihcf6
14. What happens if an individual does not enroll in Medicare during their
initial enrollment period?: They may qualify for a special enrollment period if they missed it due to certain
circumstances, such as a natural disaster.
15. How does Medicare coverage differ for individuals based on age versus
disability?: Individuals under 65 can qualify for Medicare due to disability after 24 months of receiving disability
payments, while those 65 and older qualify based on age.
16. What is the role of Medigap insurance?: Medigap insurance helps cover costs not covered by
Original Medicare, such as deductibles and coinsurance.
17. What is the maximum duration of Medicare coverage after a kidney trans-
plant for those eligible due to ESRD?: 36 months after the month of the transplant.
18. What should individuals do if they are unsure about their Medicare eligibili-
ty?: They should contact the Social Security Administration or their state Medicaid agency for guidance.
19. What is the significance of a Federally declared disaster in relation to
Medicare enrollment?: It allows individuals who missed their enrollment period to qualify for a special
enrollment period.
20. What is the difference between Medicare Advantage and Original Medicare
regarding coverage?: Medicare Advantage plans may offer additional benefits but cannot be combined with
Medigap plans.
21. What is the importance of immunosuppressive drug coverage for kidney
transplant patients?: It is critical for preventing organ rejection and maintaining health post-transplant.
22. How does income affect the premium for Part B coverage?: Individuals with higher
incomes may pay a higher monthly premium for Part B.
23. What is Juan likely entitled to when he turns age 65 regarding Medicare?: Juan
is likely to be eligible for Medicare.
24. How would enrolling in Medicare impact Juan's employer-sponsored health-
care coverage?: If Juan enrolls, Medicare becomes the primary payor of his healthcare claims, and his employ-
er's plan becomes a secondary payor.
25. What eligibility criteria does Ms. Kumar meet for Medicare despite her con-
cerns about income?: Medicare is available for people age 65 or older, so Ms. Kumar will be eligible
regardless of her income.
26. Will Medicare cover hospice services for Ms. Lewis, who has aggressive
cancer?: Yes, Medicare covers hospice services.
, AHIP 2026: Modules 1-5, Final, and FWA JACKPOT
Study online at https://quizlet.com/_hihcf6
27. What does Original Fee-for-Service (FFS) Medicare cover according to Mr.
Schmidt's inquiry?: Original Medicare covers Part A (hospital, skilled nursing facility, hospice, and home health
services) and Part B (professional services such as those provided by a doctor).
28. What is the coverage for skilled nursing services under Original Medicare for
Mrs. Foster?: Medicare covers skilled nursing services for the first 20 days, after which there is a copay until the
100-day limit.
29. What should Mrs. Thomas know about enrolling in Part B while covered
under an employer plan?: She can enroll at any time while covered under her employer plan and has
a special eight-month enrollment period after leaving the plan.
30. What advice should be given to Madeline Martinez regarding her Medicare
enrollment?: Madeline can enroll in Medicare Part A without premiums due to her husband's work record and
will pay Part B premiums at a rate based on her income.
31. What should Agent John Miller advise Jerry Smith regarding his Medicare
Supplement plan?: Jerry Smith should consider adding a standalone Part D prescription drug coverage policy.
32. What costs might Mr. Vasquez expect for inpatient hospital services under
Original Medicare?: There is a single deductible for the first 60 days of hospitalization, after which a per-day
coinsurance applies through day 90.
33. What happens after day 90 regarding costs for Mr. Wu?: After day 90, Mr. Wu would
pay a daily amount for up to 60 days over his lifetime, after which he would be responsible for all costs.
34. Where can Mr. Wu turn for help with his prescription drug costs?: Mr. Wu may
qualify for help through his State Pharmaceutical Assistance Program (SPAP).
35. What option does Mr. Singh have for drug coverage without enrolling in
a Medicare Advantage plan?: Mr. Singh can enroll in a stand-alone prescription drug plan while
maintaining coverage for Part A and Part B services through Original Fee-for-Service Medicare.
36. What does Medicare Part B primarily cover for Mrs. Ellis?: Medicare Part B primarily
covers physician services, with a monthly premium and generally 20% co-payments for services, plus an annual
deductible.
37. What benefits do FIDE-SNPs provide?: FIDE-SNPs provide access to Medicare and Medicaid
benefits under a single organization with both Medicare Advantage and Medicaid managed care contracts.
38. What are the key characteristics of MSA plans?: MSA plans may have a partial network, full
network, or no network of providers; cover Part A and Part B benefits but not Part D; require a minimal deductible of
$500 indexed for inflation; and non-network providers must accept Original Medicare payment as full.
Study online at https://quizlet.com/_hihcf6
1. What happens after Mr. Bauer has received disability payments for 24
months?: He will be automatically enrolled in Medicare, regardless of age.
2. Why did Edward become eligible for Medicare coverage?: Due to end-stage renal
disease (ESRD).
3. How long does Medicare coverage generally last for individuals eligible based
on ESRD after a kidney transplant?: Eligibility generally lasts for 36 months after the month in which
the individual receives a kidney transplant.
4. What can Edward do regarding Part B coverage after his kidney transplant?: He
may remain enrolled in Part B solely for coverage of immunosuppressive drugs if he has no other health care coverage
for those drugs.
5. What special enrollment option does Anthony have after missing his initial
enrollment period due to a disaster?: He is eligible for a special enrollment period (SEP) to enroll
in Part B up to six months after the end of the emergency declaration.
6. When can Anthony enroll in premium-free Part A?: He may enroll in premium-free Part A
at any time, with coverage retroactive for up to 6 months.
7. What should you tell Mr. Capadona about purchasing a Medigap plan while
enrolled in a Medicare Advantage plan?: It is illegal to sell him a Medigap plan if he is enrolled in
an MA plan, as Medigap only works with Original Medicare.
8. Will Mildred's hospice care be covered under her Allcare Medicare Advantage
plan?: Yes, hospice benefits will be paid for by Original Medicare under Part A, and Allcare will continue to pay for
any non-hospice services.
9. What must Ms. Henderson do to obtain Part B coverage?: She must pay a standard
monthly premium, which may be higher for individuals with higher incomes.
10. What assistance can Mrs. Cook seek due to her low fixed income?: She should
contact her state Medicaid agency to see if she qualifies for programs that help with Medicare costs.
11. What does Medicare Supplemental Insurance cover for Mr. Moy?: It helps cover
his Part A deductible and Part B coinsurance or copayments in Original Fee-for-Service (FFS) Medicare.
12. What is Juan Perez's situation regarding Medicare as he turns 65?: He intends to
work for several more years at Smallcap, which offers employer-sponsored healthcare coverage.
13. What is the eligibility requirement for premium-free Part A?: Individuals must have
worked and paid Medicare taxes for a sufficient period, typically 40 quarters.
, AHIP 2026: Modules 1-5, Final, and FWA JACKPOT
Study online at https://quizlet.com/_hihcf6
14. What happens if an individual does not enroll in Medicare during their
initial enrollment period?: They may qualify for a special enrollment period if they missed it due to certain
circumstances, such as a natural disaster.
15. How does Medicare coverage differ for individuals based on age versus
disability?: Individuals under 65 can qualify for Medicare due to disability after 24 months of receiving disability
payments, while those 65 and older qualify based on age.
16. What is the role of Medigap insurance?: Medigap insurance helps cover costs not covered by
Original Medicare, such as deductibles and coinsurance.
17. What is the maximum duration of Medicare coverage after a kidney trans-
plant for those eligible due to ESRD?: 36 months after the month of the transplant.
18. What should individuals do if they are unsure about their Medicare eligibili-
ty?: They should contact the Social Security Administration or their state Medicaid agency for guidance.
19. What is the significance of a Federally declared disaster in relation to
Medicare enrollment?: It allows individuals who missed their enrollment period to qualify for a special
enrollment period.
20. What is the difference between Medicare Advantage and Original Medicare
regarding coverage?: Medicare Advantage plans may offer additional benefits but cannot be combined with
Medigap plans.
21. What is the importance of immunosuppressive drug coverage for kidney
transplant patients?: It is critical for preventing organ rejection and maintaining health post-transplant.
22. How does income affect the premium for Part B coverage?: Individuals with higher
incomes may pay a higher monthly premium for Part B.
23. What is Juan likely entitled to when he turns age 65 regarding Medicare?: Juan
is likely to be eligible for Medicare.
24. How would enrolling in Medicare impact Juan's employer-sponsored health-
care coverage?: If Juan enrolls, Medicare becomes the primary payor of his healthcare claims, and his employ-
er's plan becomes a secondary payor.
25. What eligibility criteria does Ms. Kumar meet for Medicare despite her con-
cerns about income?: Medicare is available for people age 65 or older, so Ms. Kumar will be eligible
regardless of her income.
26. Will Medicare cover hospice services for Ms. Lewis, who has aggressive
cancer?: Yes, Medicare covers hospice services.
, AHIP 2026: Modules 1-5, Final, and FWA JACKPOT
Study online at https://quizlet.com/_hihcf6
27. What does Original Fee-for-Service (FFS) Medicare cover according to Mr.
Schmidt's inquiry?: Original Medicare covers Part A (hospital, skilled nursing facility, hospice, and home health
services) and Part B (professional services such as those provided by a doctor).
28. What is the coverage for skilled nursing services under Original Medicare for
Mrs. Foster?: Medicare covers skilled nursing services for the first 20 days, after which there is a copay until the
100-day limit.
29. What should Mrs. Thomas know about enrolling in Part B while covered
under an employer plan?: She can enroll at any time while covered under her employer plan and has
a special eight-month enrollment period after leaving the plan.
30. What advice should be given to Madeline Martinez regarding her Medicare
enrollment?: Madeline can enroll in Medicare Part A without premiums due to her husband's work record and
will pay Part B premiums at a rate based on her income.
31. What should Agent John Miller advise Jerry Smith regarding his Medicare
Supplement plan?: Jerry Smith should consider adding a standalone Part D prescription drug coverage policy.
32. What costs might Mr. Vasquez expect for inpatient hospital services under
Original Medicare?: There is a single deductible for the first 60 days of hospitalization, after which a per-day
coinsurance applies through day 90.
33. What happens after day 90 regarding costs for Mr. Wu?: After day 90, Mr. Wu would
pay a daily amount for up to 60 days over his lifetime, after which he would be responsible for all costs.
34. Where can Mr. Wu turn for help with his prescription drug costs?: Mr. Wu may
qualify for help through his State Pharmaceutical Assistance Program (SPAP).
35. What option does Mr. Singh have for drug coverage without enrolling in
a Medicare Advantage plan?: Mr. Singh can enroll in a stand-alone prescription drug plan while
maintaining coverage for Part A and Part B services through Original Fee-for-Service Medicare.
36. What does Medicare Part B primarily cover for Mrs. Ellis?: Medicare Part B primarily
covers physician services, with a monthly premium and generally 20% co-payments for services, plus an annual
deductible.
37. What benefits do FIDE-SNPs provide?: FIDE-SNPs provide access to Medicare and Medicaid
benefits under a single organization with both Medicare Advantage and Medicaid managed care contracts.
38. What are the key characteristics of MSA plans?: MSA plans may have a partial network, full
network, or no network of providers; cover Part A and Part B benefits but not Part D; require a minimal deductible of
$500 indexed for inflation; and non-network providers must accept Original Medicare payment as full.
