AHIP NONDISCRIMINATION
COMPREHENSIVE EXAMINATION TEST
2026 FULL QUESTIONS AND CORRECT
ANSWERS
◉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.
◉Madeline Martinez was widowed several years ago. Her husband
worked for many years and contributed into the Medicare system.
He also left a substantial estate which provides Madeline with an
annual income of approximately $130,000. Madeline, who has only
worked part-time for the last three years, will soon turn age 65 and
hopes to enroll in Original Medicare. She comes to you for advice.
What should you tell her? Answer: You should tell Madeline that she
will be able to enroll in Medicare Part A without paying monthly
premiums due to her husband's long work record and participation
in the Medicare system. You should also tell Madeline that she will
pay Part B premiums at more than the standard lowest rate but less
than the highest rate due her substantial income.
,◉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.
◉Mrs. Paterson is concerned about the deductibles and co-
payments associated with Original Medicare. What can you tell her
about Medigap as an option to address this concern? Answer:
Medigap plans help beneficiaries cover coinsurance, co-payments,
and/or deductibles for medically necessary services
◉Mr. Davis is 52 years old and has recently been diagnosed with
end-stage renal disease (ESRD) and will soon begin dialysis. He is
wondering if he can obtain coverage under Medicare. What should
you tell him? Answer: He may sign-up for Medicare at any time
however coverage usually begins on the fourth month after dialysis
treatments start.
◉Mrs. Chen will be 65 soon, has been a citizen for twelve years, has
been employed full time, and paid taxes during that entire period.
She is concerned that she will not qualify for coverage under part A
because she was not born in the United States. What should you tell
her? Answer: Most individuals who are citizens and age 65 or over
are covered under Part A by virtue of having paid Medicare taxes
,while working, though some may be covered as a result of paying
monthly premiums.
◉Mr. Singh would like drug coverage but does not want to be
enrolled in a Medicare Advantage plan. What should you tell him?
Answer: 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.
◉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 beentitled 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.
◉Mrs. Radford asks whether there are any special eligibility
requirements for Medicare Advantage. What should you tell her?
Answer: Mrs. Radford must be entitled to Part A and enrolled in Part
B to enroll in Medicare Advantage.
, ◉Mr. Castillo, a naturalized citizen, previously enrolled in Medicare
Part B but has recently stopped paying his Part B premium. Mr.
Castillo is still covered by Part A. He would like to enroll in a
Medicare Advantage (MA) plan and is still covered by Part A. What
should you tell him? Answer: He is not eligible to enroll in a
Medicare Advantage plan until he reenrolls in Medicare Part B.
◉Mr. Kumar is considering a Medicare Advantage HMO and has
questions about his ability to access providers. What should you tell
him? Answer: In most Medicare Advantage HMOs, Mr. Kumar must
generally obtain his services only from providers who have a
contractual relationship with the plan (except in an emergency or
where care is unavailable within the network).
◉Mr. Lopez has heard that he can sign up for a product called
"Medicare Advantage" but is not sure about what type of plan
designs are available through this program. What should you tell
him about the types of health plans that are available through the
Medicare Advantage program? Answer: They are Medicare health
plans such as HMOs, PPOs, PFFS, and MSAs.
◉Mr. Greco is in excellent health, lives in his own home, and has a
sizeable income from his investments. He has a friend enrolled in a
Medicare Advantage Special Needs Plan (SNP). His friend has
mentioned that the SNP charges very low cost-sharing amounts and
Mr. Greco would like to join that plan. What should you tell him?
Answer: SNPs limit enrollment to certain subpopulations of
COMPREHENSIVE EXAMINATION TEST
2026 FULL QUESTIONS AND CORRECT
ANSWERS
◉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.
◉Madeline Martinez was widowed several years ago. Her husband
worked for many years and contributed into the Medicare system.
He also left a substantial estate which provides Madeline with an
annual income of approximately $130,000. Madeline, who has only
worked part-time for the last three years, will soon turn age 65 and
hopes to enroll in Original Medicare. She comes to you for advice.
What should you tell her? Answer: You should tell Madeline that she
will be able to enroll in Medicare Part A without paying monthly
premiums due to her husband's long work record and participation
in the Medicare system. You should also tell Madeline that she will
pay Part B premiums at more than the standard lowest rate but less
than the highest rate due her substantial income.
,◉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.
◉Mrs. Paterson is concerned about the deductibles and co-
payments associated with Original Medicare. What can you tell her
about Medigap as an option to address this concern? Answer:
Medigap plans help beneficiaries cover coinsurance, co-payments,
and/or deductibles for medically necessary services
◉Mr. Davis is 52 years old and has recently been diagnosed with
end-stage renal disease (ESRD) and will soon begin dialysis. He is
wondering if he can obtain coverage under Medicare. What should
you tell him? Answer: He may sign-up for Medicare at any time
however coverage usually begins on the fourth month after dialysis
treatments start.
◉Mrs. Chen will be 65 soon, has been a citizen for twelve years, has
been employed full time, and paid taxes during that entire period.
She is concerned that she will not qualify for coverage under part A
because she was not born in the United States. What should you tell
her? Answer: Most individuals who are citizens and age 65 or over
are covered under Part A by virtue of having paid Medicare taxes
,while working, though some may be covered as a result of paying
monthly premiums.
◉Mr. Singh would like drug coverage but does not want to be
enrolled in a Medicare Advantage plan. What should you tell him?
Answer: 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.
◉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 beentitled 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.
◉Mrs. Radford asks whether there are any special eligibility
requirements for Medicare Advantage. What should you tell her?
Answer: Mrs. Radford must be entitled to Part A and enrolled in Part
B to enroll in Medicare Advantage.
, ◉Mr. Castillo, a naturalized citizen, previously enrolled in Medicare
Part B but has recently stopped paying his Part B premium. Mr.
Castillo is still covered by Part A. He would like to enroll in a
Medicare Advantage (MA) plan and is still covered by Part A. What
should you tell him? Answer: He is not eligible to enroll in a
Medicare Advantage plan until he reenrolls in Medicare Part B.
◉Mr. Kumar is considering a Medicare Advantage HMO and has
questions about his ability to access providers. What should you tell
him? Answer: In most Medicare Advantage HMOs, Mr. Kumar must
generally obtain his services only from providers who have a
contractual relationship with the plan (except in an emergency or
where care is unavailable within the network).
◉Mr. Lopez has heard that he can sign up for a product called
"Medicare Advantage" but is not sure about what type of plan
designs are available through this program. What should you tell
him about the types of health plans that are available through the
Medicare Advantage program? Answer: They are Medicare health
plans such as HMOs, PPOs, PFFS, and MSAs.
◉Mr. Greco is in excellent health, lives in his own home, and has a
sizeable income from his investments. He has a friend enrolled in a
Medicare Advantage Special Needs Plan (SNP). His friend has
mentioned that the SNP charges very low cost-sharing amounts and
Mr. Greco would like to join that plan. What should you tell him?
Answer: SNPs limit enrollment to certain subpopulations of
