AHIP - 2026 - Modules 1-5 Exam comprehensive
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Mr. Capadona would like to It is illegal for you to sell Mr. Capadona a Medigap
purchase a Medicare Advantage plan if he is enrolled in an MA plan, and besides,
(MA) plan and a Medigap plan to Medigap only works with Original Medicare.
pick up costs not covered by that
plan. What should you tell him?
Agent John Miller is meeting with Tell prospect Jerry Smith that he should consider
Jerry Smith, a new prospect. Jerry is adding a standalone Part D prescription drug
currently enrolled in Medicare Parts coverage policy to his present coverage.
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?
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Mr. Wu is eligible for Medicare. He Mr. Wu may still qualify for help in paying Part D
has limited financial resources but costs through his State Pharmaceutical Assistance
failed to qualify for the Part D low- Program (SPAP).
income subsidy. Where might he turn
for help with his prescription drug
costs?
Mr. Vasquez is in good health and is Under Original Medicare, there is a single
preparing a budget in anticipation of deductible amount due for the first 60 days of any
his retirement when he turns 66. He inpatient hospital stay, after which it converts into a
wants to understand the health care per-day coinsurance amount through day 90. After
costs he might be exposed to under day 90, he would pay a daily amount up to 60 days
Medicare if he were to require over his lifetime, after which he would be
hospitalization because of an illness. responsible for all costs.
In general terms, what could you tell
him about his costs for inpatient
hospital services under Original
Medicare?
Mr. Moy will soon turn age 65. He is Medicare Supplemental Insurance would help
slightly younger than his wife. Mr. cover his Part A deductible and Part B coinsurance
Moy's wife has a Medicare or copayments in Original Fee-for-Service (FFS)
Advantage plan, but he wants to Medicare as well as possibly some services that
understand what coverage Medicare Medicare does not cover.
Supplemental Insurance provides
since his health care needs are
different from his wife's needs. What
could you tell Mr. Moy?
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Juan Perez, who is turning age 65 Juan is likely to be eligible for Medicare once he
next month, intends to work for turns age 65 and if he enrolls, Medicare would
several more years at Smallcap, become the primary payor of his healthcare claims
Incorporated. Smallcap has a and Smallcap does not have to continue to offer
workforce of 15 employees and him coverage comparable to those under age 65
offers employer-sponsored under its employer-sponsored group health plan.
healthcare coverage. Juan is a Juan is likely to be eligible for Medicare once he
naturalized citizen and has turns age 65 and if he enrolls, Medicare would
contributed to the Medicare system become the primary payor of his healthcare claims
for over 20 years. Juan asks you if he but Smallcap must continue to offer him coverage
will be entitled to Medicare and if he under its employer-sponsored group health plan
enrolls how that will impact his and would become a secondary payor.
employer- sponsored healthcare
coverage. How would you respond?
Ms. Kumar plans to retire when she Medicare is a program for people age 65 or older
turns 65 in a few months. She is in and those under age 65 with certain disabilities,
excellent health and will have end-stage renal disease, and Lou Gehrig's disease
considerable income when she so she will be eligible for Medicare.
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?
Mrs. Ellis recently turned 66 and Part B primarily covers physician services. She will
decided after many years of work to be paying a monthly premium and, except for many
retire and begin receiving Social preventive and screening tests, generally will have
Security benefits. Shortly thereafter 20% co-payments for these services, in addition to
Mrs. Ellis received a letter informing an annual deductible.
her that she had been automatically
enrolled in Medicare Part B. She
wants to understand what this means.
What should you tell Mrs. Ellis?
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Mr. Singh would like drug coverage Mr. Singh can enroll in a stand-alone prescription
but does not want to be enrolled in a drug plan and continue to be covered for Part A
Medicare Advantage plan. What and Part B services through Original Fee-for-
should you tell him? Service Medicare.
Mrs. Cook is an elderly retiree. Mrs. She should contact her state Medicaid agency to
Cook has a low fixed income. What see if she qualifies for one of several programs that
could you tell Mrs. Cook that might can help with Medicare costs for which she is
be of assistance? responsible.
Ms. Henderson believes that she will To obtain Part B coverage, she must pay a standard
qualify for Medicare Coverage when monthly premium, though it is higher for individuals
she turns 65, without paying any with higher incomes.
premiums, because she has been
working for 40 years and paying
Medicare taxes. What should you tell
her?
Mr. Bauer is 49 years old, but After receiving such disability payments for 24
eighteen months ago he was months, he will be automatically enrolled in
declared disabled by the Social Medicare, regardless of age.
Security Administration and has been
receiving disability payments. He is
wondering whether he can obtain
coverage under Medicare. What
should you tell him?
Mr. Schmidt would like to plan for Part A, which covers hospital, skilled nursing facility,
retirement and has asked you what is hospice, and home health services and Part B,
covered under Original Fee-for- which covers professional services such as those
Service (FFS) Medicare. What could provided by a doctor are covered under Original
you tell him? Medicare.
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