AHIP - 2026 - MODULES 1-5 / COMPREHENSIVE STUDY GUIDE
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QUESTIONS BANK
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1. Mr. Capadona would like to purchase a Medicare Advantage (MA) plan and a Medigap plan to pick up
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costs not covered by that plan. What should you tell him?
vv vv vv vv vv vv vv vv vv vv vv
..ANS>> It is illegal for you to sell Mr. Capadona a Medigap plan if he is enrolled in an MA plan, and
vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv
vv besides, Medigap only works with Original Medicare.
vv vv vv vv vv vv
2. Agent John Miller is meeting with Jerry Smith, a new prospect. Jerry is cur-
vv vv vv vv vv vv vv vv vv vv vv vv vv vv rently enrolled in Medicare vv vv vv
Parts A and B. Jerry has also purchased a Medicare Supplement (Medigap) plan which he has had for several
vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv
vv years. However, the plan does not provide drug benefits. How would you advise Agent John Miller to
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proceed?
vv
vv ..ANS>> Tell prospect Jerry Smith that he should consider adding a standalone Part D prescription drug
vvvv vv vv vv vv vv vv vv vv vv vv vv vv vv vv
vv coverage policy to his present coverage.
vv vv vv vv vv
3. Mr.Wu is eligible for Medicare. He has limited financial resources but failed to qualify for the Part D low-
v vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv
income subsidy.Where might he turn for help with his prescription drug costs?
vv v vv vv vv vv vv vv vv vv vv vv
vv ..ANS>> Mr. Wu may still qualify for help in paying Part D costs through his State Pharmaceutical
vvvv v vv vv vv vv vv vv vv vv vv vv vv vv vv vv
vv Assistance Program (SPAP). vv vv
,4. Mr.Vasquez is in good health and is preparing a budget in anticipation of his retirement when he
v vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv
turns 66.He wants to understand the health care costs he might be exposed to under Medicare if he were to
vv vv v vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv
vv require hospitalization because of an illness. In general terms, what could you tell him about his costs
vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv
vv for inpatient hospital services under Original Medicare?
vv vv vv vv vv vv
vv ..ANS>> Under Original Medicare, there is a single deductible amount due for the first 60 days of any inpatient
vvvv vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv
vv hospital stay, after which it converts into a per-day coinsurance amount through day
vv vv vv vv vv vv vv vv vv vv vv vv
90. After day 90, he would pay a daily amount up to 60 days over his lifetime, after which he would be
vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv
vv responsible for all costs. vv vv vv
5. Mr. Moy will soon turn age 65. He is slightly younger than his wife. Mr. Moy's wife has a Medicare
vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv
vv Advantage plan, but he wants to understand what coverage Medicare Supplemental Insurance provides
vv vv vv vv vv vv vv vv vv vv vv vv
vv since his health care needs are different from his wife's needs.What could you tell Mr. Moy?
vv vv vv vv vv vv vv vv vv vv v vv vv vv vv vv
vv ..ANS>> - Medicare Supplemental Insurance would help cover his Part A deductible and Part B
vvvv vv vv vv vv vv vv vv vv vv vv vv vv vv
coinsurance or copayments in Original Fee-for-Service (FFS) Medicare as well as possibly some services that
vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv
vv Medicare does not cover. vv vv vv
6. Juan Perez, who is turning age 65 next month, intends to work for several more years at Smallcap,
vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv
Incorporated.Smallcap has a workforce of 15 employ- ees and offers employer-sponsored healthcare coverage.
v v vv vv vv vv vv vv vv vv vv vv vv vv
Juan is a naturalized citizen and has contributed to the Medicare system for over 20 years. Juan asks you
v vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv
if he will be entitled to Medicare and if he enrolls how that will impact his employer- sponsored healthcare
vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv
coverage.How would you respond?
vv v vv vv vv
,vv ..ANS>> Juan is likely to be eligible for Medicare once he turns age 65 and if he enrolls, Medicare would
vvvv vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv
become the primary payor of his healthcare claims and Smallcap does not have to continue to offer him
vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv
coverage comparable to those under age 65 under
vv vv vv vv vv vv vv vv
, its employer-sponsored group health plan. Juan is likely to be eligible for Medicare once he turns age 65
vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv
vv and if he enrolls, Medicare would become the primary payor of his healthcare claims but Smallcap must
vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv
vv continue to offer him coverage under its employer-sponsored group health plan and would become a
vv vv vv vv vv vv vv vv vv vv vv vv vv vv
vv secondary payor. vv
7. Ms. Kumar vv vv plans to retire when she turns 65 in a few months. She is in excellent health and
vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv
vv will have considerable income when she retires. She is concerned that her income will make it
vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv
vv impossible for her to qualify for Medicare.What could you tell her to address her concern?
vv vv vv vv vv vv v vv vv vv vv vv vv vv vv
vv ..ANS>> Medicare is a vvvv vv vv
program for people age 65 or older and those under age 65 with certain disabilities, end-stage renal disease,
vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv
vv and Lou Gehrig's disease so she will be eligible for Medicare.
vv vv vv vv vv vv vv vv vv vv
8. Mrs. Ellis recently turned 66 and decided after many years of work to retire and begin receiving
vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv
vv Social Security benefits. Shortly thereafter Mrs. Ellis received a letter informing her that she had been
vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv
vv automatically enrolled in Medicare Part B. She wants to understand what this means.What should you
vv vv vv vv vv vv vv vv vv vv vv vv v vv vv
vv tell Mrs. Ellis?
vv vv
vv ..ANS>> Part B primarily covers physician services. She will be paying a monthly premium and, except
vvvv vv vv vv vv vv vv vv vv vv vv vv vv vv vv
vv for many preventive and screening tests, generally will have 20% co-payments for these services, in
vv vv vv vv vv vv vv vv vv vv vv vv vv vv
vv addition to an annual deductible. vv vv vv vv
v v v v v v v v v
QUESTIONS BANK
v v
1. Mr. Capadona would like to purchase a Medicare Advantage (MA) plan and a Medigap plan to pick up
vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv
costs not covered by that plan. What should you tell him?
vv vv vv vv vv vv vv vv vv vv vv
..ANS>> It is illegal for you to sell Mr. Capadona a Medigap plan if he is enrolled in an MA plan, and
vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv
vv besides, Medigap only works with Original Medicare.
vv vv vv vv vv vv
2. Agent John Miller is meeting with Jerry Smith, a new prospect. Jerry is cur-
vv vv vv vv vv vv vv vv vv vv vv vv vv vv rently enrolled in Medicare vv vv vv
Parts A and B. Jerry has also purchased a Medicare Supplement (Medigap) plan which he has had for several
vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv
vv years. However, the plan does not provide drug benefits. How would you advise Agent John Miller to
vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv
proceed?
vv
vv ..ANS>> Tell prospect Jerry Smith that he should consider adding a standalone Part D prescription drug
vvvv vv vv vv vv vv vv vv vv vv vv vv vv vv vv
vv coverage policy to his present coverage.
vv vv vv vv vv
3. Mr.Wu is eligible for Medicare. He has limited financial resources but failed to qualify for the Part D low-
v vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv
income subsidy.Where might he turn for help with his prescription drug costs?
vv v vv vv vv vv vv vv vv vv vv vv
vv ..ANS>> Mr. Wu may still qualify for help in paying Part D costs through his State Pharmaceutical
vvvv v vv vv vv vv vv vv vv vv vv vv vv vv vv vv
vv Assistance Program (SPAP). vv vv
,4. Mr.Vasquez is in good health and is preparing a budget in anticipation of his retirement when he
v vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv
turns 66.He wants to understand the health care costs he might be exposed to under Medicare if he were to
vv vv v vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv
vv require hospitalization because of an illness. In general terms, what could you tell him about his costs
vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv
vv for inpatient hospital services under Original Medicare?
vv vv vv vv vv vv
vv ..ANS>> Under Original Medicare, there is a single deductible amount due for the first 60 days of any inpatient
vvvv vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv
vv hospital stay, after which it converts into a per-day coinsurance amount through day
vv vv vv vv vv vv vv vv vv vv vv vv
90. After day 90, he would pay a daily amount up to 60 days over his lifetime, after which he would be
vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv
vv responsible for all costs. vv vv vv
5. Mr. Moy will soon turn age 65. He is slightly younger than his wife. Mr. Moy's wife has a Medicare
vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv
vv Advantage plan, but he wants to understand what coverage Medicare Supplemental Insurance provides
vv vv vv vv vv vv vv vv vv vv vv vv
vv since his health care needs are different from his wife's needs.What could you tell Mr. Moy?
vv vv vv vv vv vv vv vv vv vv v vv vv vv vv vv
vv ..ANS>> - Medicare Supplemental Insurance would help cover his Part A deductible and Part B
vvvv vv vv vv vv vv vv vv vv vv vv vv vv vv
coinsurance or copayments in Original Fee-for-Service (FFS) Medicare as well as possibly some services that
vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv
vv Medicare does not cover. vv vv vv
6. Juan Perez, who is turning age 65 next month, intends to work for several more years at Smallcap,
vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv
Incorporated.Smallcap has a workforce of 15 employ- ees and offers employer-sponsored healthcare coverage.
v v vv vv vv vv vv vv vv vv vv vv vv vv
Juan is a naturalized citizen and has contributed to the Medicare system for over 20 years. Juan asks you
v vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv
if he will be entitled to Medicare and if he enrolls how that will impact his employer- sponsored healthcare
vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv
coverage.How would you respond?
vv v vv vv vv
,vv ..ANS>> Juan is likely to be eligible for Medicare once he turns age 65 and if he enrolls, Medicare would
vvvv vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv
become the primary payor of his healthcare claims and Smallcap does not have to continue to offer him
vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv
coverage comparable to those under age 65 under
vv vv vv vv vv vv vv vv
, its employer-sponsored group health plan. Juan is likely to be eligible for Medicare once he turns age 65
vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv
vv and if he enrolls, Medicare would become the primary payor of his healthcare claims but Smallcap must
vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv
vv continue to offer him coverage under its employer-sponsored group health plan and would become a
vv vv vv vv vv vv vv vv vv vv vv vv vv vv
vv secondary payor. vv
7. Ms. Kumar vv vv plans to retire when she turns 65 in a few months. She is in excellent health and
vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv
vv will have considerable income when she retires. She is concerned that her income will make it
vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv
vv impossible for her to qualify for Medicare.What could you tell her to address her concern?
vv vv vv vv vv vv v vv vv vv vv vv vv vv vv
vv ..ANS>> Medicare is a vvvv vv vv
program for people age 65 or older and those under age 65 with certain disabilities, end-stage renal disease,
vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv
vv and Lou Gehrig's disease so she will be eligible for Medicare.
vv vv vv vv vv vv vv vv vv vv
8. Mrs. Ellis recently turned 66 and decided after many years of work to retire and begin receiving
vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv
vv Social Security benefits. Shortly thereafter Mrs. Ellis received a letter informing her that she had been
vv vv vv vv vv vv vv vv vv vv vv vv vv vv vv
vv automatically enrolled in Medicare Part B. She wants to understand what this means.What should you
vv vv vv vv vv vv vv vv vv vv vv vv v vv vv
vv tell Mrs. Ellis?
vv vv
vv ..ANS>> Part B primarily covers physician services. She will be paying a monthly premium and, except
vvvv vv vv vv vv vv vv vv vv vv vv vv vv vv vv
vv for many preventive and screening tests, generally will have 20% co-payments for these services, in
vv vv vv vv vv vv vv vv vv vv vv vv vv vv
vv addition to an annual deductible. vv vv vv vv
