AHIP - 2026 - MODULES 1-5 EXAM
QUESTIONS AND ANSWERS (VERIFIED
AND UPDATED)
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? - ANS 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.
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? - ANS Tell prospect Jerry Smith that he should consider
adding a standalone Part D prescription drug coverage policy to his present coverage.
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? -
ANS Mr. Wu may still qualify for help in paying Part D costs through his State Pharmaceutical
Assistance Program (SPAP).
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? -
ANS 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.
@2026/2027 ALLRIGHTS RESERVED.
,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 coverage Medicare Supplemental
Insurance provides since his health care needs are different from his wife's needs. What could
you tell Mr. Moy? - ANS 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.
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 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 will be entitled to Medicare and if he
enrolls how that will impact his employer- sponsored healthcare coverage. How would you
respond? - ANS 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.
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 concerned that her income will make it
impossible for her to qualify for Medicare. What could you tell her to address her concern? -
ANS 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.
Mrs. Ellis recently turned 66 and decided after many years of work to retire 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? - ANS 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.
Mr. Singh would like drug coverage but does not want to be enrolled in a Medicare Advantage
plan. What should you tell him? - ANS Mr. Singh can enroll in a stand-alone prescription drug
@2026/2027 ALLRIGHTS RESERVED.
, plan and continue to be covered for Part A and Part B services through Original Fee-for-Service
Medicare.
Mrs. Cook is an elderly retiree. Mrs. Cook has a low fixed income. What could you tell Mrs. Cook
that might be of assistance? - ANS 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.
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? - ANS To obtain Part B coverage, she must pay a standard monthly
premium, though it is higher for individuals with higher incomes.
Mr. Bauer is 49 years old, but eighteen months ago he was declared disabled 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? - ANS After receiving
such disability payments for 24 months, he will be automatically enrolled in Medicare,
regardless of age.
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? - ANS 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.
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? - ANS 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.
@2026/2027 ALLRIGHTS RESERVED.
QUESTIONS AND ANSWERS (VERIFIED
AND UPDATED)
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? - ANS 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.
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? - ANS Tell prospect Jerry Smith that he should consider
adding a standalone Part D prescription drug coverage policy to his present coverage.
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? -
ANS Mr. Wu may still qualify for help in paying Part D costs through his State Pharmaceutical
Assistance Program (SPAP).
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? -
ANS 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.
@2026/2027 ALLRIGHTS RESERVED.
,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 coverage Medicare Supplemental
Insurance provides since his health care needs are different from his wife's needs. What could
you tell Mr. Moy? - ANS 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.
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 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 will be entitled to Medicare and if he
enrolls how that will impact his employer- sponsored healthcare coverage. How would you
respond? - ANS 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.
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 concerned that her income will make it
impossible for her to qualify for Medicare. What could you tell her to address her concern? -
ANS 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.
Mrs. Ellis recently turned 66 and decided after many years of work to retire 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? - ANS 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.
Mr. Singh would like drug coverage but does not want to be enrolled in a Medicare Advantage
plan. What should you tell him? - ANS Mr. Singh can enroll in a stand-alone prescription drug
@2026/2027 ALLRIGHTS RESERVED.
, plan and continue to be covered for Part A and Part B services through Original Fee-for-Service
Medicare.
Mrs. Cook is an elderly retiree. Mrs. Cook has a low fixed income. What could you tell Mrs. Cook
that might be of assistance? - ANS 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.
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? - ANS To obtain Part B coverage, she must pay a standard monthly
premium, though it is higher for individuals with higher incomes.
Mr. Bauer is 49 years old, but eighteen months ago he was declared disabled 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? - ANS After receiving
such disability payments for 24 months, he will be automatically enrolled in Medicare,
regardless of age.
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? - ANS 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.
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? - ANS 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.
@2026/2027 ALLRIGHTS RESERVED.
