AHIP - 2026 - Modules 1-5
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1. 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?: 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.
2. Agent John Miller is meeting with Jerry Smith, a new prospect. Jerry is cur-
rently 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?: Tell prospect Jerry Smith that he should consider adding a standalone Part D prescription drug
coverage policy to his present coverage.
3. Mr. Wu is eligible for Medicare. He has limited financial resources but failed
to qualify for the Part D low-income subsidy. Where might he turn for help with
his prescription drug costs?: Mr. Wu may still qualify for help in paying Part D costs through his State
Pharmaceutical Assistance Program (SPAP).
4. Mr. Vasquez is in good health and is preparing a budget in anticipation of his
retirement when he turns 66. He wants to understand the health care costs
he might be exposed to under Medicare if he were to require hospitalization
because of an illness. In general terms, what could you tell him about his costs
for inpatient hospital services under Original Medicare?: Under Original Medicare, there is
a single deductible amount due for the first 60 days of any inpatient hospital stay, after which it converts into a per-day
coinsurance amount through day 90. After day 90, he would pay a daily amount up to 60 days over his lifetime, after
which he would be responsible for all costs.
5. Mr. Moy will soon turn age 65. He is slightly younger than his wife. Mr. Moy's
wife has a Medicare Advantage plan, but he wants to understand what cover-
age Medicare Supplemental Insurance provides since his health care needs are
different from his wife's needs. What could you tell Mr. Moy?: Medicare Supplemental
Insurance would help cover his Part A deductible and Part B coinsurance or copayments in Original Fee-for-Service
(FFS) Medicare as well as possibly some services that Medicare does not cover.
6. 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 employ-
ees and offers employer-sponsored healthcare coverage. Juan is a naturalized
citizen and has contributed to the Medicare system for over 20 years. Juan asks
, AHIP - 2026 - Modules 1-5
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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?: 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. 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 but Smallcap must continue to offer
him coverage under its employer-sponsored group health plan and would become a secondary payor.
7. Ms. Kumar 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 con-
cerned that her income will make it impossible for her to qualify for Medicare.
What could you tell her to address her concern?: 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.
8. Mrs. Ellis recently turned 66 and decided after many years of work to re-
tire and begin receiving Social Security benefits. Shortly thereafter Mrs. Ellis
received a letter informing her that she had been automatically enrolled in
Medicare Part B. She wants to understand what this means. What should you
tell Mrs. Ellis?: Part B primarily covers physician services. She will be paying a monthly premium and, except for
many preventive and screening tests, generally will have 20% co-payments for these services, in addition to an annual
deductible.
9. Mr. Singh would like drug coverage but does not want to be enrolled in a
Medicare Advantage plan. What should you tell him?: 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.
10. Mrs. Cook is an elderly retiree. Mrs. Cook has a low fixed income. What could
you tell Mrs. Cook that might be of assistance?: 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.
11. 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?: To obtain Part B coverage,
she must pay a standard monthly premium, though it is higher for individuals with higher incomes.
, AHIP - 2026 - Modules 1-5
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12. Mr. Bauer is 49 years old, but eighteen months ago he was declared dis-
abled 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?: After receiving such disability payments for 24 months, he will be automatically
enrolled in Medicare, regardless of age.
13. 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?: 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.
14. Anthony Boniface turned 65 in 2024. 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?: Anthony is eligible for a special enrollment
period (SEP) because he missed an enrollment period due to the impact of the Federally declared disaster. This SEP
will allow Anthony to enroll in Part B up to six months after the end of the emergency declaration. Anthony may enroll
in premium-free Part A at any time and his Part A coverage will be retroactive for up to 6 months.
15. Ms. Lewis has aggressive cancer and would like to know if Medicare will cover
hospice services in case she needs them. What should you tell her?: Medicare covers
hospice services, and they will be available for her.
16. Edward 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?: 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.
Study online at https://quizlet.com/_hgxyw6
1. 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?: 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.
2. Agent John Miller is meeting with Jerry Smith, a new prospect. Jerry is cur-
rently 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?: Tell prospect Jerry Smith that he should consider adding a standalone Part D prescription drug
coverage policy to his present coverage.
3. Mr. Wu is eligible for Medicare. He has limited financial resources but failed
to qualify for the Part D low-income subsidy. Where might he turn for help with
his prescription drug costs?: Mr. Wu may still qualify for help in paying Part D costs through his State
Pharmaceutical Assistance Program (SPAP).
4. Mr. Vasquez is in good health and is preparing a budget in anticipation of his
retirement when he turns 66. He wants to understand the health care costs
he might be exposed to under Medicare if he were to require hospitalization
because of an illness. In general terms, what could you tell him about his costs
for inpatient hospital services under Original Medicare?: Under Original Medicare, there is
a single deductible amount due for the first 60 days of any inpatient hospital stay, after which it converts into a per-day
coinsurance amount through day 90. After day 90, he would pay a daily amount up to 60 days over his lifetime, after
which he would be responsible for all costs.
5. Mr. Moy will soon turn age 65. He is slightly younger than his wife. Mr. Moy's
wife has a Medicare Advantage plan, but he wants to understand what cover-
age Medicare Supplemental Insurance provides since his health care needs are
different from his wife's needs. What could you tell Mr. Moy?: Medicare Supplemental
Insurance would help cover his Part A deductible and Part B coinsurance or copayments in Original Fee-for-Service
(FFS) Medicare as well as possibly some services that Medicare does not cover.
6. 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 employ-
ees and offers employer-sponsored healthcare coverage. Juan is a naturalized
citizen and has contributed to the Medicare system for over 20 years. Juan asks
, AHIP - 2026 - Modules 1-5
Study online at https://quizlet.com/_hgxyw6
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?: 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. 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 but Smallcap must continue to offer
him coverage under its employer-sponsored group health plan and would become a secondary payor.
7. Ms. Kumar 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 con-
cerned that her income will make it impossible for her to qualify for Medicare.
What could you tell her to address her concern?: 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.
8. Mrs. Ellis recently turned 66 and decided after many years of work to re-
tire and begin receiving Social Security benefits. Shortly thereafter Mrs. Ellis
received a letter informing her that she had been automatically enrolled in
Medicare Part B. She wants to understand what this means. What should you
tell Mrs. Ellis?: Part B primarily covers physician services. She will be paying a monthly premium and, except for
many preventive and screening tests, generally will have 20% co-payments for these services, in addition to an annual
deductible.
9. Mr. Singh would like drug coverage but does not want to be enrolled in a
Medicare Advantage plan. What should you tell him?: 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.
10. Mrs. Cook is an elderly retiree. Mrs. Cook has a low fixed income. What could
you tell Mrs. Cook that might be of assistance?: 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.
11. 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?: To obtain Part B coverage,
she must pay a standard monthly premium, though it is higher for individuals with higher incomes.
, AHIP - 2026 - Modules 1-5
Study online at https://quizlet.com/_hgxyw6
12. Mr. Bauer is 49 years old, but eighteen months ago he was declared dis-
abled 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?: After receiving such disability payments for 24 months, he will be automatically
enrolled in Medicare, regardless of age.
13. 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?: 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.
14. Anthony Boniface turned 65 in 2024. 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?: Anthony is eligible for a special enrollment
period (SEP) because he missed an enrollment period due to the impact of the Federally declared disaster. This SEP
will allow Anthony to enroll in Part B up to six months after the end of the emergency declaration. Anthony may enroll
in premium-free Part A at any time and his Part A coverage will be retroactive for up to 6 months.
15. Ms. Lewis has aggressive cancer and would like to know if Medicare will cover
hospice services in case she needs them. What should you tell her?: Medicare covers
hospice services, and they will be available for her.
16. Edward 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?: 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.
