AHIP 2026 - GENERAL COMPLIANCE FINAL EXAM WITH 100% CORRECT
ANSWERS
Section 1: Medicare Basics & Eligibility (Questions 1–30)
1. Ms. Kumar plans to retire when she turns 65. She is in excellent health and will
have considerable income. She is concerned her income will make her ineligible
for Medicare. What should you tell her?
a) Her high income will disqualify her from Medicare coverage
b) Medicare is a program for people age 65+ and those under 65 with certain
disabilities, ESRD, and ALS, so she will be eligible
c) Only those with low income are eligible for Medicare
d) She needs to apply for Medicaid instead
Answer: b) Medicare is a program for people age 65+ and those under 65 with
certain disabilities, ESRD, and ALS, so she will be eligible
,Rationale: Medicare eligibility is based on age (65+) and certain medical
conditions, NOT income. While higher income may affect Part B and Part D
premiums (IRMAA), it does not prevent eligibility.
2. 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?
a) You can sell him a Medigap plan to help with costs not covered by MA
b) It is illegal to sell a Medigap plan if he is enrolled in an MA plan, and Medigap
only works with Original Medicare
c) Medigap plans are designed to work alongside Medicare Advantage plans
d) He must disenroll from his MA plan before buying a Medigap plan
Answer: b) It is illegal to sell a Medigap plan if he is enrolled in an MA plan, and
Medigap only works with Original Medicare
Rationale: Federal law prohibits issuing a Medigap policy to anyone enrolled in a
Medicare Advantage plan. Medigap supplements only Original Medicare (Parts A
and B), not MA plans.
,3. Mrs. Ellis received a letter that she was automatically enrolled in Medicare Part
B after retirement. She wants to understand what this means. What should you
tell her?
a) Medicare Part B covers only hospital services
b) Part B primarily covers physician services; she will pay a monthly premium, and
except for many preventive screenings, generally has a deductible and
coinsurance
c) Part B covers all healthcare costs with no out-of-pocket expenses
d) Part B is optional and she can decline without penalty at any time
Answer: b) Part B primarily covers physician services; she will pay a monthly
premium, and except for many preventive screenings, generally has a deductible
and coinsurance
Rationale: Part B covers physician services, outpatient care, and preventive
services. Beneficiaries pay a monthly premium, an annual deductible, and
typically 20% coinsurance.
4. What is the coverage structure for inpatient hospital services under Original
Medicare Part A?
a) No deductible for first 60 days
, b) Single deductible for days 1–60, daily coinsurance for days 61–90, lifetime
reserve days after day 90 with daily coinsurance, then all costs beneficiary
responsibility
c) Flat daily rate for all hospital days
d) 100% coverage with no out-of-pocket costs
Answer: b) Single deductible for days 1–60, daily coinsurance for days 61–90,
lifetime reserve days after day 90 with daily coinsurance, then all costs beneficiary
responsibility
Rationale: Part A covers inpatient stays with a deductible per benefit period, daily
coinsurance for days 61–90, and lifetime reserve days (up to 60) with
coinsurance. After reserve days, all costs are the beneficiary's responsibility.
5. Mr. Moy will soon turn 65. He wants to understand what coverage Medicare
Supplemental Insurance (Medigap) provides. What could you tell him?
a) It covers everything Original Medicare does not
b) It provides prescription drug coverage
c) Medigap helps cover Part A deductible and Part B coinsurance/copayments in
Original Medicare, as well as possibly some services Medicare does not cover
d) It is only available for Medicare Advantage enrollees
ANSWERS
Section 1: Medicare Basics & Eligibility (Questions 1–30)
1. Ms. Kumar plans to retire when she turns 65. She is in excellent health and will
have considerable income. She is concerned her income will make her ineligible
for Medicare. What should you tell her?
a) Her high income will disqualify her from Medicare coverage
b) Medicare is a program for people age 65+ and those under 65 with certain
disabilities, ESRD, and ALS, so she will be eligible
c) Only those with low income are eligible for Medicare
d) She needs to apply for Medicaid instead
Answer: b) Medicare is a program for people age 65+ and those under 65 with
certain disabilities, ESRD, and ALS, so she will be eligible
,Rationale: Medicare eligibility is based on age (65+) and certain medical
conditions, NOT income. While higher income may affect Part B and Part D
premiums (IRMAA), it does not prevent eligibility.
2. 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?
a) You can sell him a Medigap plan to help with costs not covered by MA
b) It is illegal to sell a Medigap plan if he is enrolled in an MA plan, and Medigap
only works with Original Medicare
c) Medigap plans are designed to work alongside Medicare Advantage plans
d) He must disenroll from his MA plan before buying a Medigap plan
Answer: b) It is illegal to sell a Medigap plan if he is enrolled in an MA plan, and
Medigap only works with Original Medicare
Rationale: Federal law prohibits issuing a Medigap policy to anyone enrolled in a
Medicare Advantage plan. Medigap supplements only Original Medicare (Parts A
and B), not MA plans.
,3. Mrs. Ellis received a letter that she was automatically enrolled in Medicare Part
B after retirement. She wants to understand what this means. What should you
tell her?
a) Medicare Part B covers only hospital services
b) Part B primarily covers physician services; she will pay a monthly premium, and
except for many preventive screenings, generally has a deductible and
coinsurance
c) Part B covers all healthcare costs with no out-of-pocket expenses
d) Part B is optional and she can decline without penalty at any time
Answer: b) Part B primarily covers physician services; she will pay a monthly
premium, and except for many preventive screenings, generally has a deductible
and coinsurance
Rationale: Part B covers physician services, outpatient care, and preventive
services. Beneficiaries pay a monthly premium, an annual deductible, and
typically 20% coinsurance.
4. What is the coverage structure for inpatient hospital services under Original
Medicare Part A?
a) No deductible for first 60 days
, b) Single deductible for days 1–60, daily coinsurance for days 61–90, lifetime
reserve days after day 90 with daily coinsurance, then all costs beneficiary
responsibility
c) Flat daily rate for all hospital days
d) 100% coverage with no out-of-pocket costs
Answer: b) Single deductible for days 1–60, daily coinsurance for days 61–90,
lifetime reserve days after day 90 with daily coinsurance, then all costs beneficiary
responsibility
Rationale: Part A covers inpatient stays with a deductible per benefit period, daily
coinsurance for days 61–90, and lifetime reserve days (up to 60) with
coinsurance. After reserve days, all costs are the beneficiary's responsibility.
5. Mr. Moy will soon turn 65. He wants to understand what coverage Medicare
Supplemental Insurance (Medigap) provides. What could you tell him?
a) It covers everything Original Medicare does not
b) It provides prescription drug coverage
c) Medigap helps cover Part A deductible and Part B coinsurance/copayments in
Original Medicare, as well as possibly some services Medicare does not cover
d) It is only available for Medicare Advantage enrollees
