AHIP 2025-2026 Final Exam
Actual Questions and Verified Answers
1) 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.
2) 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.
3) Mildred Savage enrolled in Allcare Medicare Advantage plan several years ago. Mildred
recently learned that she is suffering from inoperable cancer
, and has just a few months to live. She would like to spend these final months in
hospice care. Mildred's family asks you whether hospice benefits will be paid for under
the Allcare Medicare Advantage plan. What should you say?
- Ans>> Mildred may remain enrolled in Allcare and make a hospice election. Hospice
benefits will be paid for by Original Medicare under Part A and Allcare will continue to
pay for any non-hospice services.
4) 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.
5) 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.
6) 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?
- Ans>> He may sign-up for Medicare at any time however coverage
, usually begins on the fourth month after dialysis treatments start.
7) Mr. Diaz continued working with his company and was insured under his employer's
group plan until he reached age 68. He has heard that there is a premium penalty for
those who did not sign up for Part B when first eligible and wants to know how much
he will have to pay. What should you tell him?
- Ans>> Mr. Diaz will not pay any penalty because he had continuous coverage
under his employer's plan.
8) Madeline Martinez was widowed several years ago. Her husband worked for many
years and contributed into the Medicare system. He also left a substantial estate
which provides Madeline with an annual income of approximately $130,000. Madeline,
who has only worked part-time for the last three years, will soon turn age 65 and
hopes to enroll in Original Medicare. She comes to you for advice. What should you
tell her?
- Ans>> You should tell Madeline that she will be able to enroll in Medicare Part A
without paying monthly premiums due to her husband's long work record and
participation in the Medicare system. You should also tell Madeline that she will pay
Part B premiums at more than the standard lowest rate but less than the highest rate
due her substantial income.
9) Edward IP suffered from serious kidney disease. As a result. Edward became
eligible for Medicare coverage due to end-stage renal disease (ESRD). A close
relative donated their kidney and Edward successfully underwent transplant
surgery 12 months ago. Edward is now age 50 and asks you if his Medicare
coverage will continue, what should you say?
, - Ans>> Individuals eligible for Medicare based on ESRD generally lose eligibility 36
months after the month in which the individual receives a kidney transplant unless
they are eligible for Medicare on another basis such as age or disability. Edward may,
however, remain enrolled in Part B but solely for coverage of immunosuppressive
drugs if he has no other health care coverage that would cover the drugs.
10) 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 ensure no gap
in coverage. What can you tell her?
- Ans>> 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.
11) 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.
12) 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.
Actual Questions and Verified Answers
1) 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.
2) 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.
3) Mildred Savage enrolled in Allcare Medicare Advantage plan several years ago. Mildred
recently learned that she is suffering from inoperable cancer
, and has just a few months to live. She would like to spend these final months in
hospice care. Mildred's family asks you whether hospice benefits will be paid for under
the Allcare Medicare Advantage plan. What should you say?
- Ans>> Mildred may remain enrolled in Allcare and make a hospice election. Hospice
benefits will be paid for by Original Medicare under Part A and Allcare will continue to
pay for any non-hospice services.
4) 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.
5) 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.
6) 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?
- Ans>> He may sign-up for Medicare at any time however coverage
, usually begins on the fourth month after dialysis treatments start.
7) Mr. Diaz continued working with his company and was insured under his employer's
group plan until he reached age 68. He has heard that there is a premium penalty for
those who did not sign up for Part B when first eligible and wants to know how much
he will have to pay. What should you tell him?
- Ans>> Mr. Diaz will not pay any penalty because he had continuous coverage
under his employer's plan.
8) Madeline Martinez was widowed several years ago. Her husband worked for many
years and contributed into the Medicare system. He also left a substantial estate
which provides Madeline with an annual income of approximately $130,000. Madeline,
who has only worked part-time for the last three years, will soon turn age 65 and
hopes to enroll in Original Medicare. She comes to you for advice. What should you
tell her?
- Ans>> You should tell Madeline that she will be able to enroll in Medicare Part A
without paying monthly premiums due to her husband's long work record and
participation in the Medicare system. You should also tell Madeline that she will pay
Part B premiums at more than the standard lowest rate but less than the highest rate
due her substantial income.
9) Edward IP suffered from serious kidney disease. As a result. Edward became
eligible for Medicare coverage due to end-stage renal disease (ESRD). A close
relative donated their kidney and Edward successfully underwent transplant
surgery 12 months ago. Edward is now age 50 and asks you if his Medicare
coverage will continue, what should you say?
, - Ans>> Individuals eligible for Medicare based on ESRD generally lose eligibility 36
months after the month in which the individual receives a kidney transplant unless
they are eligible for Medicare on another basis such as age or disability. Edward may,
however, remain enrolled in Part B but solely for coverage of immunosuppressive
drugs if he has no other health care coverage that would cover the drugs.
10) 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 ensure no gap
in coverage. What can you tell her?
- Ans>> 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.
11) 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.
12) 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.
