AHIP Final Exam (2026) – Verified Edition with ALL
Q&A With Rationales
THIS EXAM CONTAINS:
• This question-and-answer set is designed to help insurance
agents, brokers, and marketing representatives prepare for
the AHIP certification exam (required to sell Medicare Advantage
and Part D plans) or to study for CMS compliance requirements.
• The rationales provide teaching points to reinforce correct
understanding of Medicare rules.
,1. Mr. Capadona would like to purchase a Medicare Advantage (MA)
plan and a Medigap plan. What should you tell him?
• A. 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.
• B. He can purchase both as long as he uses the same insurance
company for both.
• C. Medigap plans work alongside MA plans to cover deductibles
and coinsurance.
• D. He should enroll in MA first, then Medigap will automatically
coordinate benefits.
Rationale: Medigap only works with Original Medicare; it is illegal to sell
Medigap to someone enrolled in an MA plan.
2. Agent John Miller is meeting with Jerry Smith, who has Parts A, B, and
a Medigap plan without drug benefits. How should Agent Miller
proceed?
• A. Tell Jerry he should consider adding a standalone Part D
prescription drug plan to his present coverage.
• B. Tell Jerry to drop his Medigap plan and enroll in an MA-PD plan.
• C. Tell Jerry that his Medigap plan will cover drugs if he pays an
extra premium.
, • D. Tell Jerry he cannot get drug coverage because he has Medigap.
Rationale: Medigap plans (post-2006) do not cover drugs; a standalone
Part D plan is the correct solution.
3. Mr. Wu has limited resources but failed to qualify for the Part D low-
income subsidy. Where might he turn for help?
• A. Mr. Wu may still qualify for help through his State
Pharmaceutical Assistance Program (SPAP).
• B. Mr. Wu can apply for a Medicare Savings Program.
• C. Mr. Wu can request an exception from Medicare.
• D. Mr. Wu has no other options for drug cost assistance.
Rationale: SPAPs are state programs that can help with Part D costs
even if LIS is not available.
4. Mr. Vasquez wants to understand inpatient hospital costs under
Original Medicare. What should you tell him?
• A. Under Original Medicare, there is a single deductible for the
first 60 days, then per-day coinsurance through day 90, then a
lifetime reserve amount, after which he pays all costs.
• B. Medicare covers all inpatient hospital costs with no out-of-
pocket costs.
, • C. He pays 20% of all hospital charges with no deductible.
• D. He pays a flat daily rate from day one with no deductible.
Rationale: Correctly describes Part A inpatient hospital cost-sharing
(deductible → coinsurance → lifetime reserve days → all costs).
5. Mr. Moy wants to know what Medicare Supplemental Insurance
(Medigap) provides. What could you tell him?
• A. Medicare Supplemental Insurance would help cover his Part A
deductible and Part B coinsurance or copayments in Original Fee-
for-Service Medicare as well as possibly some services that
Medicare does not cover.
• B. Medigap only covers prescription drugs.
• C. Medigap replaces Original Medicare.
• D. Medigap only works with Medicare Advantage plans.
Rationale: Medigap helps cover Part A and B cost-sharing and some
non-Medicare-covered services in Original Medicare.
6. Juan Perez, age 65, works at Smallcap (15 employees). If he enrolls in
Medicare, how does that impact his employer coverage?
Q&A With Rationales
THIS EXAM CONTAINS:
• This question-and-answer set is designed to help insurance
agents, brokers, and marketing representatives prepare for
the AHIP certification exam (required to sell Medicare Advantage
and Part D plans) or to study for CMS compliance requirements.
• The rationales provide teaching points to reinforce correct
understanding of Medicare rules.
,1. Mr. Capadona would like to purchase a Medicare Advantage (MA)
plan and a Medigap plan. What should you tell him?
• A. 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.
• B. He can purchase both as long as he uses the same insurance
company for both.
• C. Medigap plans work alongside MA plans to cover deductibles
and coinsurance.
• D. He should enroll in MA first, then Medigap will automatically
coordinate benefits.
Rationale: Medigap only works with Original Medicare; it is illegal to sell
Medigap to someone enrolled in an MA plan.
2. Agent John Miller is meeting with Jerry Smith, who has Parts A, B, and
a Medigap plan without drug benefits. How should Agent Miller
proceed?
• A. Tell Jerry he should consider adding a standalone Part D
prescription drug plan to his present coverage.
• B. Tell Jerry to drop his Medigap plan and enroll in an MA-PD plan.
• C. Tell Jerry that his Medigap plan will cover drugs if he pays an
extra premium.
, • D. Tell Jerry he cannot get drug coverage because he has Medigap.
Rationale: Medigap plans (post-2006) do not cover drugs; a standalone
Part D plan is the correct solution.
3. Mr. Wu has limited resources but failed to qualify for the Part D low-
income subsidy. Where might he turn for help?
• A. Mr. Wu may still qualify for help through his State
Pharmaceutical Assistance Program (SPAP).
• B. Mr. Wu can apply for a Medicare Savings Program.
• C. Mr. Wu can request an exception from Medicare.
• D. Mr. Wu has no other options for drug cost assistance.
Rationale: SPAPs are state programs that can help with Part D costs
even if LIS is not available.
4. Mr. Vasquez wants to understand inpatient hospital costs under
Original Medicare. What should you tell him?
• A. Under Original Medicare, there is a single deductible for the
first 60 days, then per-day coinsurance through day 90, then a
lifetime reserve amount, after which he pays all costs.
• B. Medicare covers all inpatient hospital costs with no out-of-
pocket costs.
, • C. He pays 20% of all hospital charges with no deductible.
• D. He pays a flat daily rate from day one with no deductible.
Rationale: Correctly describes Part A inpatient hospital cost-sharing
(deductible → coinsurance → lifetime reserve days → all costs).
5. Mr. Moy wants to know what Medicare Supplemental Insurance
(Medigap) provides. What could you tell him?
• A. Medicare Supplemental Insurance would help cover his Part A
deductible and Part B coinsurance or copayments in Original Fee-
for-Service Medicare as well as possibly some services that
Medicare does not cover.
• B. Medigap only covers prescription drugs.
• C. Medigap replaces Original Medicare.
• D. Medigap only works with Medicare Advantage plans.
Rationale: Medigap helps cover Part A and B cost-sharing and some
non-Medicare-covered services in Original Medicare.
6. Juan Perez, age 65, works at Smallcap (15 employees). If he enrolls in
Medicare, how does that impact his employer coverage?
