AHIP 2026 FINAL EXAM MASTERY: 210
COMPREHENSIVE QUESTIONS
COMPLETE WITH 100% VERIFIED
ANSWERS | WITH EXPERT RATIONALES
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?
A) You can sell him a Medigap plan to help with costs not covered under Medicare
Advantage.
B) 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.
C) Medigap plans are designed to work alongside Medicare Advantage plans.
D) He must disenroll from his MA plan before buying a Medigap plan.
Correct Answer:
B) 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.
Expert Rationale:
Medigap plans are supplemental policies that fill gaps in Original Medicare (Parts
A and B) coverage. Federal law prohibits issuance of a Medigap policy to anyone
currently enrolled in a Medicare Advantage plan; Medigap cannot pay costs
associated with MA. This ensures coordination of benefits and prevents duplicate
coverage.
2. 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 plan does not provide drug benefits. How would you advise Agent
John Miller to proceed?
A) Advise Jerry to switch to a Medicare Advantage plan for drug coverage.
B) Tell prospect Jerry Smith that he should consider adding a standalone Part D
prescription drug coverage policy to his present coverage.
C) Inform Jerry that Medigap automatically covers prescription drugs.
D) Recommend canceling the Medigap plan.
Correct Answer:
B) Tell prospect Jerry Smith that he should consider adding a standalone Part D
prescription drug coverage policy to his present coverage.
Expert Rationale:
Medigap plans sold after 2006 do not include prescription drug coverage.
Beneficiaries needing drug coverage must enroll in a standalone Medicare Part D
plan. This allows individuals to retain their Medigap coverage while accessing
necessary medications through an appropriate channel.
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?
A) Apply for Medicaid to cover prescription costs.
B) Seek assistance from pharmaceutical company discount programs.
C) Mr. Wu may still qualify for help in paying Part D costs through his State
Pharmaceutical Assistance Program (SPAP).
D) Try to enroll in a Medigap plan with drug coverage.
Correct Answer:
C) Mr. Wu may still qualify for help in paying Part D costs through his State
Pharmaceutical Assistance Program (SPAP).
Expert Rationale:
States may offer SPAPs to assist residents who do not qualify for the federal Low
Income Subsidy but still need help with Part D drug costs. Eligibility and benefits
,vary by state, but these programs can provide meaningful financial support when
other federal options aren’t available.
4. Mrs. Chen is enrolled in a Medicare Advantage (MA) plan and wants to switch
to a Medigap plan because she is moving to a rural area where her MA plan has
no network providers. She has been in her MA plan for 10 months. What rights
does she have?
A) She can purchase any Medigap plan without underwriting because she is
moving.
B) She has a guaranteed issue right to purchase a Medigap Plan A, B, C, F, K, or L
because she is leaving a Medicare Advantage plan during her first 12 months of
enrollment.
C) She must wait for the Annual Enrollment Period to switch to Medigap.
D) She can keep her MA plan and add a Medigap plan to cover out-of-network
costs.
Correct Answer:
B) She has a guaranteed issue right to purchase a Medigap Plan A, B, C, F, K, or L
because she is leaving a Medicare Advantage plan during her first 12 months of
enrollment.
Expert Rationale:
Beneficiaries who enroll in a Medicare Advantage plan for the first time have a
12month "trial right" period. If they disenroll from the MA plan within the first 12
months, they have a guaranteed issue right to purchase certain Medigap plans
without medical underwriting.
5. Mr. Patel is 72 and has had a Medigap Plan G for five years. He wants to
switch to a different Medigap plan because he found a lower premium. What
should you advise him?
A) He can switch to any Medigap plan at any time with no underwriting.
B) He can switch only during the Annual Enrollment Period.
, C) He may switch Medigap plans, but the new insurer may require medical
underwriting unless he has a guaranteed issue right.
D) He cannot switch Medigap plans once he is over age 70.
Correct Answer:
C) He may switch Medigap plans, but the new insurer may require medical
underwriting unless he has a guaranteed issue right.
Expert Rationale:
Outside of a guaranteed issue situation, Medigap insurers can use medical
underwriting to determine eligibility and premiums when a beneficiary wants to
switch plans. There is no annual open enrollment period for Medigap switches like
there is for Medicare Advantage.
6. Ms. Garcia is enrolled in Original Medicare with a Medigap Plan N. She
recently moved to a new state. What happens to her Medigap coverage?
A) Her Medigap plan automatically terminates because Medigap plans are
statespecific.
B) She must purchase a new Medigap plan in her new state and will likely face
medical underwriting.
C) Her Medigap coverage continues, but she may have the right to purchase a
new Medigap plan in her new state without underwriting if she applies within a
specific timeframe.
D) She must wait until the next Annual Enrollment Period to establish coverage
in her new state.
Correct Answer:
C) Her Medigap coverage continues, but she may have the right to purchase a new
Medigap plan in her new state without underwriting if she applies within a specific
timeframe.
Expert Rationale:
When a Medigap beneficiary moves to a new state, coverage typically continues if
the insurer operates in that state. Additionally, moving out of a plan's service area
COMPREHENSIVE QUESTIONS
COMPLETE WITH 100% VERIFIED
ANSWERS | WITH EXPERT RATIONALES
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?
A) You can sell him a Medigap plan to help with costs not covered under Medicare
Advantage.
B) 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.
C) Medigap plans are designed to work alongside Medicare Advantage plans.
D) He must disenroll from his MA plan before buying a Medigap plan.
Correct Answer:
B) 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.
Expert Rationale:
Medigap plans are supplemental policies that fill gaps in Original Medicare (Parts
A and B) coverage. Federal law prohibits issuance of a Medigap policy to anyone
currently enrolled in a Medicare Advantage plan; Medigap cannot pay costs
associated with MA. This ensures coordination of benefits and prevents duplicate
coverage.
2. 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 plan does not provide drug benefits. How would you advise Agent
John Miller to proceed?
A) Advise Jerry to switch to a Medicare Advantage plan for drug coverage.
B) Tell prospect Jerry Smith that he should consider adding a standalone Part D
prescription drug coverage policy to his present coverage.
C) Inform Jerry that Medigap automatically covers prescription drugs.
D) Recommend canceling the Medigap plan.
Correct Answer:
B) Tell prospect Jerry Smith that he should consider adding a standalone Part D
prescription drug coverage policy to his present coverage.
Expert Rationale:
Medigap plans sold after 2006 do not include prescription drug coverage.
Beneficiaries needing drug coverage must enroll in a standalone Medicare Part D
plan. This allows individuals to retain their Medigap coverage while accessing
necessary medications through an appropriate channel.
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?
A) Apply for Medicaid to cover prescription costs.
B) Seek assistance from pharmaceutical company discount programs.
C) Mr. Wu may still qualify for help in paying Part D costs through his State
Pharmaceutical Assistance Program (SPAP).
D) Try to enroll in a Medigap plan with drug coverage.
Correct Answer:
C) Mr. Wu may still qualify for help in paying Part D costs through his State
Pharmaceutical Assistance Program (SPAP).
Expert Rationale:
States may offer SPAPs to assist residents who do not qualify for the federal Low
Income Subsidy but still need help with Part D drug costs. Eligibility and benefits
,vary by state, but these programs can provide meaningful financial support when
other federal options aren’t available.
4. Mrs. Chen is enrolled in a Medicare Advantage (MA) plan and wants to switch
to a Medigap plan because she is moving to a rural area where her MA plan has
no network providers. She has been in her MA plan for 10 months. What rights
does she have?
A) She can purchase any Medigap plan without underwriting because she is
moving.
B) She has a guaranteed issue right to purchase a Medigap Plan A, B, C, F, K, or L
because she is leaving a Medicare Advantage plan during her first 12 months of
enrollment.
C) She must wait for the Annual Enrollment Period to switch to Medigap.
D) She can keep her MA plan and add a Medigap plan to cover out-of-network
costs.
Correct Answer:
B) She has a guaranteed issue right to purchase a Medigap Plan A, B, C, F, K, or L
because she is leaving a Medicare Advantage plan during her first 12 months of
enrollment.
Expert Rationale:
Beneficiaries who enroll in a Medicare Advantage plan for the first time have a
12month "trial right" period. If they disenroll from the MA plan within the first 12
months, they have a guaranteed issue right to purchase certain Medigap plans
without medical underwriting.
5. Mr. Patel is 72 and has had a Medigap Plan G for five years. He wants to
switch to a different Medigap plan because he found a lower premium. What
should you advise him?
A) He can switch to any Medigap plan at any time with no underwriting.
B) He can switch only during the Annual Enrollment Period.
, C) He may switch Medigap plans, but the new insurer may require medical
underwriting unless he has a guaranteed issue right.
D) He cannot switch Medigap plans once he is over age 70.
Correct Answer:
C) He may switch Medigap plans, but the new insurer may require medical
underwriting unless he has a guaranteed issue right.
Expert Rationale:
Outside of a guaranteed issue situation, Medigap insurers can use medical
underwriting to determine eligibility and premiums when a beneficiary wants to
switch plans. There is no annual open enrollment period for Medigap switches like
there is for Medicare Advantage.
6. Ms. Garcia is enrolled in Original Medicare with a Medigap Plan N. She
recently moved to a new state. What happens to her Medigap coverage?
A) Her Medigap plan automatically terminates because Medigap plans are
statespecific.
B) She must purchase a new Medigap plan in her new state and will likely face
medical underwriting.
C) Her Medigap coverage continues, but she may have the right to purchase a
new Medigap plan in her new state without underwriting if she applies within a
specific timeframe.
D) She must wait until the next Annual Enrollment Period to establish coverage
in her new state.
Correct Answer:
C) Her Medigap coverage continues, but she may have the right to purchase a new
Medigap plan in her new state without underwriting if she applies within a specific
timeframe.
Expert Rationale:
When a Medigap beneficiary moves to a new state, coverage typically continues if
the insurer operates in that state. Additionally, moving out of a plan's service area
