2025 AHIP FINAL ACTUAL EXAM
PAPER 2026 QUESTIONS WITH
ANSWERS GRADED A+
◍ Mr. Ford enrolled in an MA-only plan in mid-November during the Annual
Election Period (AEP). On December 1, he calls you up and says that he has
changed his mind and would like to enroll in a MA-PD plan. What
enrollment rules would apply in this case?.
Answer: He can make as many enrollment changes as he likes during the
Annual Election Period and the last choice made before the end of the
period will be the effective one as of January 1.He can make as many
enrollment changes as he likes during the Annual Election Period and the
last choice made before the end of the period will be the effective one as of
January 1.
◍ Mrs. Schmidt is moving and a friend told her she might qualify for a
"special election period" to enroll in a new Medicare Advantage plan. She
contacted you to ask what a special election period is. What could you tell
her?.
Answer: It is a single period from January 1 - March 31, created by statute,
when any Medicare beneficiary who has moved out of the area of their
Medicare Advantage or Part D plan can add, drop, or change their Medicare
prescription drug coverage.
◍ Ms. Galindo will turn 65 on June 10th. She has never previously qualified
for Medicare. She is entitled to Medicare Part A and intends to enroll in Part
B. She wants to know if she is eligible to enroll in a Medicare Advantage
plan that includes prescription drug coverage. What do you tell her?.
Answer: a. Ms. Galindo can enroll in an MA-PD plan now since her initial
election period (IEP) for Part D prescription drug coverage and initial
, coverage election period (ICEP) are occurring together beginning March 1st
and ending September 30th.
◍ Mr. Moreno invited his neighbor, Agent Tom Smith, to discuss Medicare
Advantage (MA) and Part D plans that Agent Smith sells at the regular
Tuesday brunch the neighbors have for senior citizens. What should Agent
Tom Smith tell Mr. Moreno about the kinds of food that can be provided to
potential enrollees who attend the sales presentation?.
Answer: A meal cannot be provided, but light snacks would be permitted.
◍ 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?.
Answer: 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?.
Answer: 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?.
Answer: 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?.
, Answer: 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.
◍ 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?.
Answer: 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?.
Answer: 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
PAPER 2026 QUESTIONS WITH
ANSWERS GRADED A+
◍ Mr. Ford enrolled in an MA-only plan in mid-November during the Annual
Election Period (AEP). On December 1, he calls you up and says that he has
changed his mind and would like to enroll in a MA-PD plan. What
enrollment rules would apply in this case?.
Answer: He can make as many enrollment changes as he likes during the
Annual Election Period and the last choice made before the end of the
period will be the effective one as of January 1.He can make as many
enrollment changes as he likes during the Annual Election Period and the
last choice made before the end of the period will be the effective one as of
January 1.
◍ Mrs. Schmidt is moving and a friend told her she might qualify for a
"special election period" to enroll in a new Medicare Advantage plan. She
contacted you to ask what a special election period is. What could you tell
her?.
Answer: It is a single period from January 1 - March 31, created by statute,
when any Medicare beneficiary who has moved out of the area of their
Medicare Advantage or Part D plan can add, drop, or change their Medicare
prescription drug coverage.
◍ Ms. Galindo will turn 65 on June 10th. She has never previously qualified
for Medicare. She is entitled to Medicare Part A and intends to enroll in Part
B. She wants to know if she is eligible to enroll in a Medicare Advantage
plan that includes prescription drug coverage. What do you tell her?.
Answer: a. Ms. Galindo can enroll in an MA-PD plan now since her initial
election period (IEP) for Part D prescription drug coverage and initial
, coverage election period (ICEP) are occurring together beginning March 1st
and ending September 30th.
◍ Mr. Moreno invited his neighbor, Agent Tom Smith, to discuss Medicare
Advantage (MA) and Part D plans that Agent Smith sells at the regular
Tuesday brunch the neighbors have for senior citizens. What should Agent
Tom Smith tell Mr. Moreno about the kinds of food that can be provided to
potential enrollees who attend the sales presentation?.
Answer: A meal cannot be provided, but light snacks would be permitted.
◍ 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?.
Answer: 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?.
Answer: 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?.
Answer: 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?.
, Answer: 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.
◍ 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?.
Answer: 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?.
Answer: 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
