AHIP 2026: Modules 1-5, Final, and FWA JACKPOT
What happens after Mr. Bauer has received disability payments for 24 months?: He will be automatically enrolled in
Medicare, regardless of age.
1. Why did Edward become eligible for Medicare coverage?: Due to end-stage renal
disease (ESRD).
2. 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.
3. 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.
4. 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.
5. 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.
6. 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.
7. Will Mildred's hospice care be covered under her All care Medicare Advantage plan?: Yes, hospice benefits will be
paid for by Original Medicare under Part A, and All care will continue to pay for any non-hospice services.
8. 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.
, 9. 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.
10. 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.
11. What is Juan Perez's situation regarding Medicare as he turns 65?: He intends to work for several more years
at Small cap, which otters employer-sponsored healthcare coverage.
12. 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.
13. 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.
14. 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.
15. What is the role of Medigap insurance?: Medigap insurance helps cover costs not covered by Original Medicare, such
as deductibles and coinsurance.
16. 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.
17. What should individuals do if they are unsure about their Medicare eligibility?: They should contact the
Social Security Administration or their state Medicaid agency for guidance.
18. 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.
, 19. What is the difference between Medicare Advantage and Original Medicare regarding coverage?:
Medicare Advantage plans may otter additional benefits but cannot be combined with Medigap plans.
20. What is the importance of immunosuppressive drug coverage for kidney transplant patients?: It is
critical for preventing organ rejection and maintaining health post-transplant.
21. How does income affect the premium for Part B coverage?: Individuals with higher
incomes may pay a higher monthly premium for Part B.
22. What is Juan likely entitled to when he turns age 65 regarding Medicare?: Juan is likely to be eligible for
Medicare.
23. 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 employer's plan becomes a secondary payor.
24. What eligibility criteria does Ms. Kumar meet for Medicare despite her concerns about income?:
Medicare is available for people age 65 or older, so Ms. Kumar will be eligible regardless of her income.
25. Will Medicare cover hospice services for Ms. Lewis, who has aggressive cancer?: Yes, Medicare covers
hospice services.
26. 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).
27. 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.
28. 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.
What happens after Mr. Bauer has received disability payments for 24 months?: He will be automatically enrolled in
Medicare, regardless of age.
1. Why did Edward become eligible for Medicare coverage?: Due to end-stage renal
disease (ESRD).
2. 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.
3. 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.
4. 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.
5. 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.
6. 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.
7. Will Mildred's hospice care be covered under her All care Medicare Advantage plan?: Yes, hospice benefits will be
paid for by Original Medicare under Part A, and All care will continue to pay for any non-hospice services.
8. 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.
, 9. 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.
10. 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.
11. What is Juan Perez's situation regarding Medicare as he turns 65?: He intends to work for several more years
at Small cap, which otters employer-sponsored healthcare coverage.
12. 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.
13. 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.
14. 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.
15. What is the role of Medigap insurance?: Medigap insurance helps cover costs not covered by Original Medicare, such
as deductibles and coinsurance.
16. 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.
17. What should individuals do if they are unsure about their Medicare eligibility?: They should contact the
Social Security Administration or their state Medicaid agency for guidance.
18. 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.
, 19. What is the difference between Medicare Advantage and Original Medicare regarding coverage?:
Medicare Advantage plans may otter additional benefits but cannot be combined with Medigap plans.
20. What is the importance of immunosuppressive drug coverage for kidney transplant patients?: It is
critical for preventing organ rejection and maintaining health post-transplant.
21. How does income affect the premium for Part B coverage?: Individuals with higher
incomes may pay a higher monthly premium for Part B.
22. What is Juan likely entitled to when he turns age 65 regarding Medicare?: Juan is likely to be eligible for
Medicare.
23. 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 employer's plan becomes a secondary payor.
24. What eligibility criteria does Ms. Kumar meet for Medicare despite her concerns about income?:
Medicare is available for people age 65 or older, so Ms. Kumar will be eligible regardless of her income.
25. Will Medicare cover hospice services for Ms. Lewis, who has aggressive cancer?: Yes, Medicare covers
hospice services.
26. 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).
27. 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.
28. 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.
