2026 AHIP Final Exam – Verified Edition with
Complete Rationales
Mr. Capadonawouldlike to purchasea MedicareAdvantage(MA) plan and a Medigapplan to pi ck up costs not
p
covered by that plan. What should you tell him?
-
CORRECT ANSWERSIt is illegal for you to sell Mr. Capadonaa Medigapplan if he is enrolledin an MA plan,
and besides, Medigap only works with Original Medicare.
Agent John Miller is meetingwith Jerry Smith, a new prospect.Jerry is currentlyenrolledin Med icareParts
A and B. Jerry has also purchaseda MedicareSupplement(Medigap)plan which he h as had for severalyears.
p
However,theplan doesnot providedrug benefits.How wouldyou advi se Agent John Miller to proceed?
-
CORRECT ANSWERSTell prospectJerry Smith thathe shouldconsideraddinga standalonePart D prescription
drug coverage policy to his present coverage.
Mr. Wu is eligible for Medicare.He has limited financial resourcesbut failed to qualify for the Pa rt D low-
income subsidy. Where might he turn for help with his prescription drug costs?
-
CORRECT ANSWERSMr. Wu maystill qualifyfor helpin payingPart D coststhroughhis StatePha rmaceutical
Assistance Program (SPAP).
Mr. Vasquezis in goodhealthand is preparinga budgetin anticipationof his retirementwhenh e turns 66. He
wants to understandthe health care costs he might be exposedto under Medicar e if he were to require
hospitalizationbecauseof an illness. In generalterms, what could you tell him about his costs for inpatient
hospital services under Original Medicare?
-
CORRECT ANSWERSUnder Original Medicare,thereis a singledeductibleamountduefor thefir st 60 days of
any inpatient hospital stay, after which it converts into-a per
day coinsuranceamountthrough day 90. After day 90, he wouldpay a daily amountup to 60 da ys over his
lifetime, after which he would be responsible for all costs.
Mr. Moy will soon turn age65. He is slightly youngerthan his wife.Mr. Moy'swifehas a Medicar eAdvantage
plan,but he wantsto understandwhatcoverageMedicareSupplementalInsurance providessincehis healthcare
needs are different from his wife's needs. What could you tell Mr.roy
,CORRECT ANSWERSMedicareSupplementalInsurancewould help cover his Part A deductiblea nd Part B
coinsurance or copayments in Original Fee
-for-
Service(FFS) Medicareas wellas possiblysomeservicesthatMedicaredoesnot cover.
Juan Perez,whois turning age65 nextmonth,intendsto workfor severalmoreyearsat Smallca p, Incorporated.
Smallcap has a workforce of 15 employees and offers employer
-
sponsoredhealthcarecoverage.Juan is a naturalizedcitizenand hascontributedto theMedicar esystemfor over
20 years.Juan asks you if he will be entitledto Medicareand if he enrolls how that will impact his employer
-
sponsored healthcare coverage. How would you respond?
-
CORRECT ANSWERSJuan is likely to beeligiblefor Medicareoncehe turnsage65 and if he enrol ls,Medicare
wouldbecometheprimarypayorof his healthcareclaimsand Smallcapdoesnot ha ve to continue to offer him
coverage comparable to those under age 65 under its employer
- sponsoredgrouphealthplan.Juan is likelyto be
eligiblefor Medicareonceheturns age65 and i f he enrolls,Medicarewouldbecometheprimarypayor ofhis
healthcareclaimsbut Smallcap m ust continue to offer him coverage under its employer
-
sponsoredgrouphealthplan and wouldbecomea secondarypayor.
Ms. Kumar plans to retire when she turns
65 in afew months. She is in excellent health and will have
considerableincomewhensheretires.Sheis concernedthather incomewill makeit impos sible for her to qualify
for Medicare. What could you tell her to address her concern?
-
CORRECT ANSWERSMedicareis a programfor peopleage65 or olderandthoseunderage65 wi th certain
disabilities, end
-
stagerenaldisease,andLou Gehrig'sdiseaseso shewill beeligiblefor Medicare.
Mrs. Ellis recentlyturned66 and decided aftermany yearsof work to retireand beginreceiving SocialSecurity
benefits.ShortlythereafterMrs. Ellis receiveda letterinformingher thatshehad beenautomaticallyenrolledin
MedicarePart B. Shewantsto understandwhatthis means.Wha t should you tell Mrs. Ellis?
p -
CORRECT ANSWERSPart B primarilycoversphysicianservices.Shewill bepayinga monthlypre mium and,
except for many preventive and screening tests, generally will have-20%
payments
co for these services, in
addition to an annual deductible.
Mr. Singh wouldlike drug coveragebutdoesnotwantto beenrolledin a MedicareAdvantagepl an. What should
p
you tell him?- CORRECT ANSWERSMr. Singh can enroll in a stand
-
, aloneprescriptiondrug plan and continueto becoveredfor Part A and Part B servicesthroughO riginal Fee-for-
p
Service Medicare.
Mrs. Cook is an elderlyretiree.Mrs. Cook has a low fixed income.What could you tell Mrs. Cook that might be
of assistance?-
CORRECT ANSWERSShe should contacther stateMedicaidagencyto seeif she qualifiesfor one of several
programs that can help with Medicare costs for which she is responsible.
Ms. Hendersonbelievesthat she will qualify for MedicareCoveragewhen she turns 65, without payingany
premiums,becauseshehasbeenworkingfor 40 yearsandpayingMedicaretaxes.W hat should you tell her?
-
CORRECT ANSWERSTo obtain Part B coverage,she must pay a standardmonthly premium,thou gh it is
higher for individuals with higher incomes.
Mr. Bauer is 49 years old, but eighteen months ago he was declared disabled by the Social Securi ty
Administrationand has beenreceivingdisabilitypayments.He is wonderingwhetherhe can o btain coverage
under Medicare. What should you tell him?
-
CORRECT ANSWERSAfter receivingsuch disabilitypaymentsfor 24 months,he will beautomatic ally enrolled
in Medicare, regardless of age.
Mr. Schmidtwouldlike to planfor retirementand hasaskedyou whatis coveredunderOriginal Fee-for-Service
(FFS) Medicare. What could you tell him?
-
CORRECT ANSWERSPart A, whichcovershospital,skillednursing facility,hospice,and homehea lthservices
and Part B, which coversprofessionalservicessuch as thoseprovided bya doctorar e covered under Original
Medicare.
AnthonyBonifaceturned65 in 2024.He wasnot receivingSocial Securityor RailroadRetirement Benefits
on his
65thbirthday.He wasinterested inobtainingMedicarecoverageand is eligiblef or premium-
free Part A. Beforehe could enroll in Medicare,his entire area was impactedby a hurricanecaus ing massive
flooding and severewind damage.The Federal governmentdeclaredthis to be a nat ural disasterwhich has
recentlyended.During this periodAnthony'sinitial enrollmentperiodex pired. Anthony asks youhow he can
now obtain Medicare coverage. What should you -say?
Complete Rationales
Mr. Capadonawouldlike to purchasea MedicareAdvantage(MA) plan and a Medigapplan to pi ck up costs not
p
covered by that plan. What should you tell him?
-
CORRECT ANSWERSIt is illegal for you to sell Mr. Capadonaa Medigapplan if he is enrolledin an MA plan,
and besides, Medigap only works with Original Medicare.
Agent John Miller is meetingwith Jerry Smith, a new prospect.Jerry is currentlyenrolledin Med icareParts
A and B. Jerry has also purchaseda MedicareSupplement(Medigap)plan which he h as had for severalyears.
p
However,theplan doesnot providedrug benefits.How wouldyou advi se Agent John Miller to proceed?
-
CORRECT ANSWERSTell prospectJerry Smith thathe shouldconsideraddinga standalonePart D prescription
drug coverage policy to his present coverage.
Mr. Wu is eligible for Medicare.He has limited financial resourcesbut failed to qualify for the Pa rt D low-
income subsidy. Where might he turn for help with his prescription drug costs?
-
CORRECT ANSWERSMr. Wu maystill qualifyfor helpin payingPart D coststhroughhis StatePha rmaceutical
Assistance Program (SPAP).
Mr. Vasquezis in goodhealthand is preparinga budgetin anticipationof his retirementwhenh e turns 66. He
wants to understandthe health care costs he might be exposedto under Medicar e if he were to require
hospitalizationbecauseof an illness. In generalterms, what could you tell him about his costs for inpatient
hospital services under Original Medicare?
-
CORRECT ANSWERSUnder Original Medicare,thereis a singledeductibleamountduefor thefir st 60 days of
any inpatient hospital stay, after which it converts into-a per
day coinsuranceamountthrough day 90. After day 90, he wouldpay a daily amountup to 60 da ys over his
lifetime, after which he would be responsible for all costs.
Mr. Moy will soon turn age65. He is slightly youngerthan his wife.Mr. Moy'swifehas a Medicar eAdvantage
plan,but he wantsto understandwhatcoverageMedicareSupplementalInsurance providessincehis healthcare
needs are different from his wife's needs. What could you tell Mr.roy
,CORRECT ANSWERSMedicareSupplementalInsurancewould help cover his Part A deductiblea nd Part B
coinsurance or copayments in Original Fee
-for-
Service(FFS) Medicareas wellas possiblysomeservicesthatMedicaredoesnot cover.
Juan Perez,whois turning age65 nextmonth,intendsto workfor severalmoreyearsat Smallca p, Incorporated.
Smallcap has a workforce of 15 employees and offers employer
-
sponsoredhealthcarecoverage.Juan is a naturalizedcitizenand hascontributedto theMedicar esystemfor over
20 years.Juan asks you if he will be entitledto Medicareand if he enrolls how that will impact his employer
-
sponsored healthcare coverage. How would you respond?
-
CORRECT ANSWERSJuan is likely to beeligiblefor Medicareoncehe turnsage65 and if he enrol ls,Medicare
wouldbecometheprimarypayorof his healthcareclaimsand Smallcapdoesnot ha ve to continue to offer him
coverage comparable to those under age 65 under its employer
- sponsoredgrouphealthplan.Juan is likelyto be
eligiblefor Medicareonceheturns age65 and i f he enrolls,Medicarewouldbecometheprimarypayor ofhis
healthcareclaimsbut Smallcap m ust continue to offer him coverage under its employer
-
sponsoredgrouphealthplan and wouldbecomea secondarypayor.
Ms. Kumar plans to retire when she turns
65 in afew months. She is in excellent health and will have
considerableincomewhensheretires.Sheis concernedthather incomewill makeit impos sible for her to qualify
for Medicare. What could you tell her to address her concern?
-
CORRECT ANSWERSMedicareis a programfor peopleage65 or olderandthoseunderage65 wi th certain
disabilities, end
-
stagerenaldisease,andLou Gehrig'sdiseaseso shewill beeligiblefor Medicare.
Mrs. Ellis recentlyturned66 and decided aftermany yearsof work to retireand beginreceiving SocialSecurity
benefits.ShortlythereafterMrs. Ellis receiveda letterinformingher thatshehad beenautomaticallyenrolledin
MedicarePart B. Shewantsto understandwhatthis means.Wha t should you tell Mrs. Ellis?
p -
CORRECT ANSWERSPart B primarilycoversphysicianservices.Shewill bepayinga monthlypre mium and,
except for many preventive and screening tests, generally will have-20%
payments
co for these services, in
addition to an annual deductible.
Mr. Singh wouldlike drug coveragebutdoesnotwantto beenrolledin a MedicareAdvantagepl an. What should
p
you tell him?- CORRECT ANSWERSMr. Singh can enroll in a stand
-
, aloneprescriptiondrug plan and continueto becoveredfor Part A and Part B servicesthroughO riginal Fee-for-
p
Service Medicare.
Mrs. Cook is an elderlyretiree.Mrs. Cook has a low fixed income.What could you tell Mrs. Cook that might be
of assistance?-
CORRECT ANSWERSShe should contacther stateMedicaidagencyto seeif she qualifiesfor one of several
programs that can help with Medicare costs for which she is responsible.
Ms. Hendersonbelievesthat she will qualify for MedicareCoveragewhen she turns 65, without payingany
premiums,becauseshehasbeenworkingfor 40 yearsandpayingMedicaretaxes.W hat should you tell her?
-
CORRECT ANSWERSTo obtain Part B coverage,she must pay a standardmonthly premium,thou gh it is
higher for individuals with higher incomes.
Mr. Bauer is 49 years old, but eighteen months ago he was declared disabled by the Social Securi ty
Administrationand has beenreceivingdisabilitypayments.He is wonderingwhetherhe can o btain coverage
under Medicare. What should you tell him?
-
CORRECT ANSWERSAfter receivingsuch disabilitypaymentsfor 24 months,he will beautomatic ally enrolled
in Medicare, regardless of age.
Mr. Schmidtwouldlike to planfor retirementand hasaskedyou whatis coveredunderOriginal Fee-for-Service
(FFS) Medicare. What could you tell him?
-
CORRECT ANSWERSPart A, whichcovershospital,skillednursing facility,hospice,and homehea lthservices
and Part B, which coversprofessionalservicessuch as thoseprovided bya doctorar e covered under Original
Medicare.
AnthonyBonifaceturned65 in 2024.He wasnot receivingSocial Securityor RailroadRetirement Benefits
on his
65thbirthday.He wasinterested inobtainingMedicarecoverageand is eligiblef or premium-
free Part A. Beforehe could enroll in Medicare,his entire area was impactedby a hurricanecaus ing massive
flooding and severewind damage.The Federal governmentdeclaredthis to be a nat ural disasterwhich has
recentlyended.During this periodAnthony'sinitial enrollmentperiodex pired. Anthony asks youhow he can
now obtain Medicare coverage. What should you -say?
