AHIP - 2026 - MODULES 1-5 ACTUAL EXAM |
REAL AND 100% AUTHENTIC QUESTIONS
AND VERIFIED ANSWERS | GRADED A+
(ALL TIME STUDY GUIDE)
1. 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?
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.
2. 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?
Tell prospect Jerry Smith that he should consider adding a standalone Part D
prescription drug coverage policy to his present coverage.
3. 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?
Mr. Wu may still qualify for help in paying Part D costs through his State
Pharmaceutical Assistance Program (SPAP).
4. 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?
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.
5. 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?
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.
6. 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?
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.
7. 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?
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.
8. 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?
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.
9. Mr. Singh would like drug coverage but does not want to be enrolled in a
Medicare Advantage plan. What should you tell him?
Mr. Singh can enroll in a stand-alone prescription drug plan and continue to
be covered for Part A and Part B services through Original Fee-for-Service
Medicare.
10. Mrs. Cook is an elderly retiree. Mrs. Cook has a low fixed income. What could
you tell Mrs. Cook that might be of assistance?
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.
11. Mr. Chen is eligible for Medicare and is currently enrolled in Original
Medicare (Parts A and B). He has a limited income and is applying for the low-
income subsidy (LIS) for his Part D prescription drug coverage. If approved, what
impact will the LIS have?
The LIS will lower or eliminate his Part D premium, reduce or eliminate his
deductible, and lower his cost-sharing for covered drugs.
12. Mrs. Garcia is enrolled in a Medicare Advantage (MA) plan that includes
prescription drug coverage (MA-PD). She is moving to a different state and wants
to know her options. What should you tell her?
She can use her special election period (SEP) to switch to a new MA-PD plan
in her new state or return to Original Medicare and enroll in a stand-alone
PDP, and the SEP lasts for 2 months after the month she moves.
, 13. Mr. Patel has Original Medicare and a Medigap plan. He is considering
switching to a Medicare Advantage plan. What must he understand about
Medigap?
If he enrolls in an MA plan, he cannot keep his Medigap plan, and he may not
be able to get his Medigap policy back if he later leaves the MA plan unless he
has a guaranteed issue right.
14. Ms. Johnson is 64 and plans to retire at 66. She asks when she should apply for
Medicare. What is the correct guidance?
She should apply during her Initial Enrollment Period (IEP), which begins 3
months before the month she turns 65 and ends 3 months after that month, to
avoid late enrollment penalties.
15. Mr. Davis has been enrolled in a Medicare Advantage plan for 3 years. He is
diagnosed with end-stage renal disease (ESRD). What happens to his MA plan?
He can remain in his MA plan, but he also has the right to switch to Original
Medicare with a SEP; MA plans cannot disenroll him solely because of ESRD.
16. Mrs. Thompson has a Medicare Part D plan and takes several expensive
medications. She is notified that her plan will no longer cover one of her drugs
starting next year. What rights does she have?
She has the right to request a formulary exception (coverage determination)
from the plan, and she may also switch to another Part D plan during the
Annual Enrollment Period (AEP).
17. Mr. Lee is turning 65 and is still working for an employer with 100+
employees. He has health insurance through his employer. Should he enroll in
Medicare Part B immediately?
He can delay Part B without penalty because the employer group health plan
is primary due to the employer size, as long as he enrolls within 8 months of
losing that coverage or stopping work.
REAL AND 100% AUTHENTIC QUESTIONS
AND VERIFIED ANSWERS | GRADED A+
(ALL TIME STUDY GUIDE)
1. 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?
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.
2. 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?
Tell prospect Jerry Smith that he should consider adding a standalone Part D
prescription drug coverage policy to his present coverage.
3. 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?
Mr. Wu may still qualify for help in paying Part D costs through his State
Pharmaceutical Assistance Program (SPAP).
4. 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?
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.
5. 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?
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.
6. 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?
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.
7. 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?
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.
8. 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?
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.
9. Mr. Singh would like drug coverage but does not want to be enrolled in a
Medicare Advantage plan. What should you tell him?
Mr. Singh can enroll in a stand-alone prescription drug plan and continue to
be covered for Part A and Part B services through Original Fee-for-Service
Medicare.
10. Mrs. Cook is an elderly retiree. Mrs. Cook has a low fixed income. What could
you tell Mrs. Cook that might be of assistance?
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.
11. Mr. Chen is eligible for Medicare and is currently enrolled in Original
Medicare (Parts A and B). He has a limited income and is applying for the low-
income subsidy (LIS) for his Part D prescription drug coverage. If approved, what
impact will the LIS have?
The LIS will lower or eliminate his Part D premium, reduce or eliminate his
deductible, and lower his cost-sharing for covered drugs.
12. Mrs. Garcia is enrolled in a Medicare Advantage (MA) plan that includes
prescription drug coverage (MA-PD). She is moving to a different state and wants
to know her options. What should you tell her?
She can use her special election period (SEP) to switch to a new MA-PD plan
in her new state or return to Original Medicare and enroll in a stand-alone
PDP, and the SEP lasts for 2 months after the month she moves.
, 13. Mr. Patel has Original Medicare and a Medigap plan. He is considering
switching to a Medicare Advantage plan. What must he understand about
Medigap?
If he enrolls in an MA plan, he cannot keep his Medigap plan, and he may not
be able to get his Medigap policy back if he later leaves the MA plan unless he
has a guaranteed issue right.
14. Ms. Johnson is 64 and plans to retire at 66. She asks when she should apply for
Medicare. What is the correct guidance?
She should apply during her Initial Enrollment Period (IEP), which begins 3
months before the month she turns 65 and ends 3 months after that month, to
avoid late enrollment penalties.
15. Mr. Davis has been enrolled in a Medicare Advantage plan for 3 years. He is
diagnosed with end-stage renal disease (ESRD). What happens to his MA plan?
He can remain in his MA plan, but he also has the right to switch to Original
Medicare with a SEP; MA plans cannot disenroll him solely because of ESRD.
16. Mrs. Thompson has a Medicare Part D plan and takes several expensive
medications. She is notified that her plan will no longer cover one of her drugs
starting next year. What rights does she have?
She has the right to request a formulary exception (coverage determination)
from the plan, and she may also switch to another Part D plan during the
Annual Enrollment Period (AEP).
17. Mr. Lee is turning 65 and is still working for an employer with 100+
employees. He has health insurance through his employer. Should he enroll in
Medicare Part B immediately?
He can delay Part B without penalty because the employer group health plan
is primary due to the employer size, as long as he enrolls within 8 months of
losing that coverage or stopping work.
