2025/2026 AHIP Module 1, 2, 3, 4, 5 (ACTUAL TEST) Questions and Answers
GRADED A ALL COREECT
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? ✓Medicare Supplemental Insurance would
help cover his Part A and Part B deductibles or coinsurance in Original Fee-for-Service
(FFS) Medicare as well as possibly someservices that Medicare does not cover.
Mrs. Peňa is 66 years old, has coverage under an employer plan, and will retire next
year. She heard she must enroll in Part B at the beginning of the year to ensureno gap
in coverage. What can you tell her? ✓She may enroll at any time while she is covered
under her employer plan, but she will have a special eight-month enrollment period
after the last month on her employer plan that differs from the standard general
enrollment period, during which she may enroll in Medicare Part B.
Mrs. Chen will be 65 soon, has been a citizen for twelve years, has been
employedfull 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? ✓Most individuals who are citizens and age 65
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? ✓He may sign-up for Medicare at any time
however coverage usually begins on the fourth month afterdialysis treatments start.
Juan Perez, who is turning age 65 next month, intends to work for several more years at
Smallcap, Incorporated. Smallcap has a workforce of15 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 willbe 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 tocontinue to offer him coverage comparable to those under age 65 under
its employer-sponsored group health plan.
,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.
Mrs. Gonzalez is enrolled in Original Medicare and has a Medigap policy as well,but it
provides no drug coverage. She would like to keep the coverage she has butreplace her
existing Medigap plan with one that provides drug coverage. What should you tell her? ✓
✓ Mrs. Gonzalez cannot purchase a Medigap plan that covers drugs, but she
could keep her Medigap policy and enroll in a Part D prescription drug plan.
Mrs. West wears glasses and dentures and has enjoyed considerable pain relief
from arthritis through massage therapy. She is concerned about whether or not
Medicare will cover these items and services. What should you tell her?
✓✓Medicare does not cover massage therapy, or, in general, glasses or dentures.
Mr. Patel 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 mightbe exposed to
under Medicare if he were to require hospitalization as a result of anillness. 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 wouldbe responsible for all costs.
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 yearsand 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.
Mr. Alonso receives some help paying for his two generic prescription drugs
fromhis employer's retiree coverage, but he wants to compare it to a Part D
prescriptiondrug plan. He asks you what costs he would generally expect to
encounter when enrolling into a standard MedicarePart D prescription drug
plan. What should you tell him? ✓✓He generally would pay a monthly
premium, annual deductible, and per-prescription cost-sharing.
,Ms. Moore plans to retire when she turns 65 in a few months. She is in excellenthealth
and will have considerable income when she retires. She is concerned thather 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 65or 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.
Mr. Xi will soon turn age 65 and has come to you for advice as to what services areprovided
under Original Medicare. What should you tell Mr. Xi that best describesthe health coverage
provided to Medicare beneficiaries? ✓✓Beneficiaries under Original Medicare have no
cost-sharing for most preventive services which includeimmunizations
such as annual flu shots.
Mrs. Duarte is enrolled in Original Medicare Parts A and B. She has recently
reviewed her Medicare Summary Notice (MSN) and disagrees with a
determination that partially denied one of her claims for services. What
advicewould you give her? ✓✓Mrs. Duarte should file an appeal of this initial
determination within 120 days of the date she received the MSN in the mail.
Mr. Capadona would like to purchase a Medicare Advantage (MA) plan
and aMedigap 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 Medigapplan if he
is enrolled in an MA plan, and besides, Medigap only works with Original Medicare.
Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What could youtell Mrs.
Park 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.
Mr. Rainey is experiencing paranoid delusions and his physician feels that he
should be hospitalized. What should you tell Mr. Rainey (or his representative)
about the length of an inpatient psychiatric hospital stay that Medicare will cover?
✓✓Medicare will cover a total of 190 days of inpatient psychiatric care
during Mr.Rainey's entire lifetime.
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?
✓✓PartA, which covers hospital, skilled nursing facility, hospice, and home health
, services and Part B, which covers professional services such as those
provided by adoctor are covered under Original Medicare.
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
plandoes not provide drug benefits. How would you advise Agent John Miller to
proceed? ✓✓Tell prospect Jerry Smith that he should consider adding a
standalonePart D prescription drug coverage policy to his present coverage.
Mr. Bauer is 49 years old, but eighteen months ago he was declared disabled by theSocial
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.
Mr. Buck has several family members who died from different cancers.
He wantsto know if Medicare covers cancer screening.
What should you tell him? ✓✓Medicare covers the periodic performance of a range
of screening tests that are meant to provide early detection of disease. Mr. Buck will
need to check specific tests before obtaining them to see if they will becovered.
Which of the following statement is/are correct about a Medicare
Savings Account(MSA) Plans?
I. MSAs may have either a partial network, full network, or
no network of providers.
II. MSA plans cover Part A and Part B benefits but not Part D prescription drugbenefits.
III. An individual who is enrolled in an MSA plan is responsible for a
minimaldeductible of $500 indexed for inflation.
IV. Non-network providers must accept the same amount that Original
Medicarewould pay them as payment in full. ✓✓I, II, and IV only
Mr. Lombardi is interested in a Medicare Advantage (MA) PPO plan that
yourepresent. It is one of three plans operated by the same organization in Mr.
Lombardi's area. The MA PPO plan does not include drug coverage, but the other
two plans do. Mr. Lombardi likes the PPO plan that does not include drug
coverageand intends to obtain his drug coverage through a stand-alone Medicare
GRADED A ALL COREECT
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? ✓Medicare Supplemental Insurance would
help cover his Part A and Part B deductibles or coinsurance in Original Fee-for-Service
(FFS) Medicare as well as possibly someservices that Medicare does not cover.
Mrs. Peňa is 66 years old, has coverage under an employer plan, and will retire next
year. She heard she must enroll in Part B at the beginning of the year to ensureno gap
in coverage. What can you tell her? ✓She may enroll at any time while she is covered
under her employer plan, but she will have a special eight-month enrollment period
after the last month on her employer plan that differs from the standard general
enrollment period, during which she may enroll in Medicare Part B.
Mrs. Chen will be 65 soon, has been a citizen for twelve years, has been
employedfull 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? ✓Most individuals who are citizens and age 65
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? ✓He may sign-up for Medicare at any time
however coverage usually begins on the fourth month afterdialysis treatments start.
Juan Perez, who is turning age 65 next month, intends to work for several more years at
Smallcap, Incorporated. Smallcap has a workforce of15 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 willbe 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 tocontinue to offer him coverage comparable to those under age 65 under
its employer-sponsored group health plan.
,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.
Mrs. Gonzalez is enrolled in Original Medicare and has a Medigap policy as well,but it
provides no drug coverage. She would like to keep the coverage she has butreplace her
existing Medigap plan with one that provides drug coverage. What should you tell her? ✓
✓ Mrs. Gonzalez cannot purchase a Medigap plan that covers drugs, but she
could keep her Medigap policy and enroll in a Part D prescription drug plan.
Mrs. West wears glasses and dentures and has enjoyed considerable pain relief
from arthritis through massage therapy. She is concerned about whether or not
Medicare will cover these items and services. What should you tell her?
✓✓Medicare does not cover massage therapy, or, in general, glasses or dentures.
Mr. Patel 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 mightbe exposed to
under Medicare if he were to require hospitalization as a result of anillness. 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 wouldbe responsible for all costs.
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 yearsand 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.
Mr. Alonso receives some help paying for his two generic prescription drugs
fromhis employer's retiree coverage, but he wants to compare it to a Part D
prescriptiondrug plan. He asks you what costs he would generally expect to
encounter when enrolling into a standard MedicarePart D prescription drug
plan. What should you tell him? ✓✓He generally would pay a monthly
premium, annual deductible, and per-prescription cost-sharing.
,Ms. Moore plans to retire when she turns 65 in a few months. She is in excellenthealth
and will have considerable income when she retires. She is concerned thather 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 65or 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.
Mr. Xi will soon turn age 65 and has come to you for advice as to what services areprovided
under Original Medicare. What should you tell Mr. Xi that best describesthe health coverage
provided to Medicare beneficiaries? ✓✓Beneficiaries under Original Medicare have no
cost-sharing for most preventive services which includeimmunizations
such as annual flu shots.
Mrs. Duarte is enrolled in Original Medicare Parts A and B. She has recently
reviewed her Medicare Summary Notice (MSN) and disagrees with a
determination that partially denied one of her claims for services. What
advicewould you give her? ✓✓Mrs. Duarte should file an appeal of this initial
determination within 120 days of the date she received the MSN in the mail.
Mr. Capadona would like to purchase a Medicare Advantage (MA) plan
and aMedigap 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 Medigapplan if he
is enrolled in an MA plan, and besides, Medigap only works with Original Medicare.
Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What could youtell Mrs.
Park 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.
Mr. Rainey is experiencing paranoid delusions and his physician feels that he
should be hospitalized. What should you tell Mr. Rainey (or his representative)
about the length of an inpatient psychiatric hospital stay that Medicare will cover?
✓✓Medicare will cover a total of 190 days of inpatient psychiatric care
during Mr.Rainey's entire lifetime.
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?
✓✓PartA, which covers hospital, skilled nursing facility, hospice, and home health
, services and Part B, which covers professional services such as those
provided by adoctor are covered under Original Medicare.
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
plandoes not provide drug benefits. How would you advise Agent John Miller to
proceed? ✓✓Tell prospect Jerry Smith that he should consider adding a
standalonePart D prescription drug coverage policy to his present coverage.
Mr. Bauer is 49 years old, but eighteen months ago he was declared disabled by theSocial
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.
Mr. Buck has several family members who died from different cancers.
He wantsto know if Medicare covers cancer screening.
What should you tell him? ✓✓Medicare covers the periodic performance of a range
of screening tests that are meant to provide early detection of disease. Mr. Buck will
need to check specific tests before obtaining them to see if they will becovered.
Which of the following statement is/are correct about a Medicare
Savings Account(MSA) Plans?
I. MSAs may have either a partial network, full network, or
no network of providers.
II. MSA plans cover Part A and Part B benefits but not Part D prescription drugbenefits.
III. An individual who is enrolled in an MSA plan is responsible for a
minimaldeductible of $500 indexed for inflation.
IV. Non-network providers must accept the same amount that Original
Medicarewould pay them as payment in full. ✓✓I, II, and IV only
Mr. Lombardi is interested in a Medicare Advantage (MA) PPO plan that
yourepresent. It is one of three plans operated by the same organization in Mr.
Lombardi's area. The MA PPO plan does not include drug coverage, but the other
two plans do. Mr. Lombardi likes the PPO plan that does not include drug
coverageand intends to obtain his drug coverage through a stand-alone Medicare
