2026 AHIP Final Exam – Verified Edition with Rationales

,2026 ahip final exam verified edition with r 8l 8l 8l 8l 8l 8l 8l




ationales
Mr. Capadona would like to purchase a Medicare Advantage (MA) plan and a Medigap plan to pi ckpup
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costs not covered by that plan. What should you tell him? -
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CORRECT ANSWERSIt is illegal for you to sell Mr. Capadona a Medigap plan if he is enrolled in an MA
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plan, and besides, Medigap only works with Original Medicare.
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Agent John Miller is meeting with Jerry Smith, a new prospect. Jerry is currently enrolled in Med icare
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Parts Apand B. Jerry has also purchased a Medicare Supplement (Medigap) plan which he h as had for
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several years. However, the plan does not provide drug benefits. How would you advi se Agent John
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Miller to proceed? -
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CORRECT ANSWERSTell prospect Jerry Smith that he should consider adding a standalone Part D l
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prescription drug coverage policy to his present coverage.
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Mr.WuiseligibleforMedicare.Hehaslimited financialresourcesbutfailedtoqualifyforthePa rt D low-
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income subsidy. Where might he turn for help with his prescription drug costs? -
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CORRECT ANSWERSMr. Wu may still qualify for help in paying Part D costs through his State Pha
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rmaceutical Assistance Program (SPAP).
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Mr. Vasquez is in good health and is preparing a budget in anticipation of his retirement when h e turns
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66. He wants to understand the health care costs he might be exposed to under Medicar e if he were to
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require hospitalization because of an illness. In general terms, what could you tell him about his costs
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for inpatient hospital services under Original Medicare? -
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CORRECT ANSWERSUnder Original Medicare, there is a single deductible amount due for the fir st 60
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days of any inpatient hospital stay, after which it converts into a per-
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day coinsurance amountthrough day 90. After day 90, he would pay a daily amount up to 60 da ys over
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his lifetime, after which he would be responsible for all costs.
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Mr. Moy will soon turn age 65. He is slightly younger than his wife. Mr. Moy's wife has a Medicar e
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Advantage plan, but he wants to understand what coverage Medicare Supplemental Insurance
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provides sincehishealthcare needsare differentfrom hiswife's needs.Whatcould you tell Mr. Moy? -
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, CORRECT ANSWERSMedicare Supplemental Insurance would help cover his Part A deductible a nd l
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Part B coinsurance or copayments in Original Fee-for-
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Service(FFS)MedicareaswellaspossiblysomeservicesthatMedicaredoesnotcover.
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Juan Perez, who is turning age 65 next month, intends to work for several more years at Smallca p,
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Incorporated. Smallcap has a workforce of 15 employees and offers employer-
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sponsored healthcare coverage. Juan is a naturalized citizen and has contributed to the Medicar e l
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system for over 20 years. Juan asks you if he will be entitled to Medicare and if he enrolls how that will
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impact his employer- sponsored healthcare coverage. How would you respond? -
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CORRECTANSWERSJuanislikelytobeeligible forMedicareonceheturnsage 65andifheenrol ls, 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l 8l




Medicarewouldbecometheprimarypayorofhishealthcareclaims andSmallcap doesnotha ve to
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continue to offer him coverage comparable to those under age 65 under its employer- sponsored
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grouphealth plan. Juanis likelyto beeligiblefor Medicare oncehe turnsage 65and i f heenrolls,
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Medicare would become theprimarypayor of his healthcareclaims butSmallcap m ust continue to
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offer him coverage under its employer-
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sponsoredgrouphealthplan andwouldbecomeasecondarypayor. 8l 8l 8l 8l l
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Ms. Kumar plans to retire when she turns 65 in a few months. She is in excellent health and will have
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considerableincomewhensheretires.Sheisconcernedthatherincomewillmakeitimpos sible for her
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to qualify for Medicare. What could you tell her to address her concern? -
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CORRECTANSWERSMedicareisaprogramforpeopleage65orolderandthoseunderage65wi th 8l 8l 8l l
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certain disabilities, end-
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stagerenaldisease,andLou Gehrig'sdiseasesoshewillbeeligiblefor Medicare.
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Mrs. Ellis recently turned 66 and decided after many years of work to retire and begin receiving Social
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Security benefits. Shortly thereafter Mrs. Ellis received a letter informing her that she had been
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automatically enrolled in Medicare Part B. She wants to understand whatpthis means. Wha t should
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you tell Mrs. Ellis? -
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CORRECTANSWERSPartBprimarilycoversphysicianservices.Shewillbepayingamonthlypre mium 8l l
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and, except for many preventive and screening tests, generally will have 20% co- payments for these
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services, in addition to an annual deductible.
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Mr.SinghwouldlikedrugpcoveragebutdoesnotwanttobeenrolledinaMedicareAdvantagepl an.
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What should you tell him? - CORRECT ANSWERSMr. Singh can enroll in a stand-
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