AHIP FINAL EXAM 2026 - MODULES 1-5| 100+ VERIFIED
QUESTIONS AND CORRECT ANSWERS |GRADED A+
Mod ! - review - mrs. Ellis recently turned 66 and decided after many years of work to retire and
begin receiving social security benefits. Shortly thereafter mrs. Ellis received a letter informing
her that she had been automatically enrolled in medicare part b. She wants to understand what
this means.
What should you tell mrs. Ellis?
A.she should disenroll if she does not want to pay the monthly premiums. There is no
disadvantage in doing so.
B.she will need to pay no premiums for part b as she qualifies for premium-free coverage due to
the number of quarters she has worked.
C.part b primarily covers physician services. She will be paying a monthly premium and, except
for many preventive and screening tests, generally will have 20% co-payments for these
services, in addition to an annual deductible.
D.part b will cover her routine dental and vision needs.
Correct Answer: c
Mod 1 - review - 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?
A.tell prospect jerry smith that he should consider adding a standalone part d prescription drug
coverage policy to his present coverage.
B.tell prospect jerry smith that he should drop his medigap coverage and put those premium
dollars toward the purchase of a standalone part d prescription drug plan because he can
always reactivate his medigap policy on a guaranteed issue basis. Furthermore, because he has
had medigap jerry will not incur a part d late enrollment penalty.
,C.tell prospect jerry smith that medigap is simply a variation of a medicare advantage plan and
the companies john r
A.tell prospect jerry smith that he should consider adding a standalone part d prescription drug
coverage policy to his present coverage.
Mod 1 - review - mildred savage enrolled in allcare medicare advantage plan several years ago.
Mildred recently learned that she is suffering from inoperable cancer and has just a few months
to live. She would like to spend these final months in hospice care. Mildred's family asks you
whether hospice benefits will be paid for under the allcare medicare advantage plan. What
should you say?
A.hospice benefits will be available to mildred but they will be paid for by original medicare
under part b.
B.hospice benefits will be paid for under mildred's allcare medicare advantage plan which must
cover all medicare part a and part b benefits.
C.mildred may remain enrolled in allcare and make a hospice election. Hospice benefits will be
paid for by original medicare under part a and allcare will continue to pay for any non-hospice
services
.d.hospice benefits are not covered under medicare and must be paid for using private f
Correct Answer: c.
Mod 1 - review - mr. Vasquez is in good health and is preparing a budget in anticipation of his
retirement when he turns 66. He wants to understand the health care costs he might be
exposed to under medicare if he were to require hospitalization because of an illness. In general
terms, what could you tell him about his costs for inpatient hospital services under original
medicare?
A.under original medicare, if the inpatient hospital service is provided by a participating
medicare provider, the co-payment is waived. Co-payments are only charged when a beneficiary
opts to receive care from a non-participating provider.
B.under original medicare, the inpatient hospital co-payment is a percentage of allowed
charges. The percentage increases after 60 days and again after 90 days.
C.under original medicare, there is a single deductible amount due for the first 60 days of any
inpatient hospital stay, after which it converts
Correct Answer: c.
,Mod 1. - review - edward suffered from serious kidney disease. As a result, edward became
eligible for medicare coverage due to end-stage renal disease (esrd). A close relative donated
their kidney and edward successfully underwent transplant surgery 12 months ago. Edward is
now age 50 and asks you if his medicare coverage will continue, what should you say?
A.individuals eligible for medicare based on esrd generally lose eligibility 36 months after the
month in which the individual receives a kidney transplant unless they are eligible for medicare
on another basis such as age or disability. Edward may, however, remain enrolled in part b but
solely for coverage of immunosuppressive drugs if he has no other health care coverage that
would cover the drugs.
B.individuals eligible for medicare based on esrd generally lose eligibility 24 months after the
month in which the individual receives a kidney transplant unless t
Correct Answer: a.
Mod 1 - review - mr. Capadona would like to purchase a medicare advantage (ma) plan and a
medigap plan to pick up costs not covered by that plan. What should you tell him?
A.you will help mr. Capadona to select a medigap plan that is designed to cover gaps in
medicare advantage
B.medigap policies designed to cover costs not paid for by an ma plan can be purchased, but
only if the ma plan's design is considered to be the "defined standard benefit."
C.medigap plans that cover costs not paid for by an ma plan are available only in massachusetts,
minnesota, and wisconsin.
D.it is illegal for you to sell mr. Capadona a medigap plan if he is enrolled in an ma plan, and
besides, medigap only works with original medicare.
Correct Answer: d.
Mod 1 - review - 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?
, A.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.
B.you should tell madeline that she will need to pay premiums for part a because of her short
work history. You should also tell madeline that s
Correct Answer: a.
Mod 1 - review - mrs. Cook is an elderly retiree. Mrs. Cook has a low fixed income. What could
you tell mrs. Cook that might be of assistance?
A.she should contact her state medicaid agency to see if she qualifies for one of several
programs that can help with medicare costs for which she is responsible.
B.she can apply to the medicare agency for lower premiums and cost-sharing
.c.she should only seek help from private organizations to cover her medicare costs.d.she should
not sign up for a medicare advantage plan.
Correct Answer: a.
Mod 1 - review - mrs. Foster is covered by original medicare. She sustained a hip fracture and is
being successfully treated for that condition. However, she and her physicians feel that after her
QUESTIONS AND CORRECT ANSWERS |GRADED A+
Mod ! - review - mrs. Ellis recently turned 66 and decided after many years of work to retire and
begin receiving social security benefits. Shortly thereafter mrs. Ellis received a letter informing
her that she had been automatically enrolled in medicare part b. She wants to understand what
this means.
What should you tell mrs. Ellis?
A.she should disenroll if she does not want to pay the monthly premiums. There is no
disadvantage in doing so.
B.she will need to pay no premiums for part b as she qualifies for premium-free coverage due to
the number of quarters she has worked.
C.part b primarily covers physician services. She will be paying a monthly premium and, except
for many preventive and screening tests, generally will have 20% co-payments for these
services, in addition to an annual deductible.
D.part b will cover her routine dental and vision needs.
Correct Answer: c
Mod 1 - review - 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?
A.tell prospect jerry smith that he should consider adding a standalone part d prescription drug
coverage policy to his present coverage.
B.tell prospect jerry smith that he should drop his medigap coverage and put those premium
dollars toward the purchase of a standalone part d prescription drug plan because he can
always reactivate his medigap policy on a guaranteed issue basis. Furthermore, because he has
had medigap jerry will not incur a part d late enrollment penalty.
,C.tell prospect jerry smith that medigap is simply a variation of a medicare advantage plan and
the companies john r
A.tell prospect jerry smith that he should consider adding a standalone part d prescription drug
coverage policy to his present coverage.
Mod 1 - review - mildred savage enrolled in allcare medicare advantage plan several years ago.
Mildred recently learned that she is suffering from inoperable cancer and has just a few months
to live. She would like to spend these final months in hospice care. Mildred's family asks you
whether hospice benefits will be paid for under the allcare medicare advantage plan. What
should you say?
A.hospice benefits will be available to mildred but they will be paid for by original medicare
under part b.
B.hospice benefits will be paid for under mildred's allcare medicare advantage plan which must
cover all medicare part a and part b benefits.
C.mildred may remain enrolled in allcare and make a hospice election. Hospice benefits will be
paid for by original medicare under part a and allcare will continue to pay for any non-hospice
services
.d.hospice benefits are not covered under medicare and must be paid for using private f
Correct Answer: c.
Mod 1 - review - mr. Vasquez is in good health and is preparing a budget in anticipation of his
retirement when he turns 66. He wants to understand the health care costs he might be
exposed to under medicare if he were to require hospitalization because of an illness. In general
terms, what could you tell him about his costs for inpatient hospital services under original
medicare?
A.under original medicare, if the inpatient hospital service is provided by a participating
medicare provider, the co-payment is waived. Co-payments are only charged when a beneficiary
opts to receive care from a non-participating provider.
B.under original medicare, the inpatient hospital co-payment is a percentage of allowed
charges. The percentage increases after 60 days and again after 90 days.
C.under original medicare, there is a single deductible amount due for the first 60 days of any
inpatient hospital stay, after which it converts
Correct Answer: c.
,Mod 1. - review - edward suffered from serious kidney disease. As a result, edward became
eligible for medicare coverage due to end-stage renal disease (esrd). A close relative donated
their kidney and edward successfully underwent transplant surgery 12 months ago. Edward is
now age 50 and asks you if his medicare coverage will continue, what should you say?
A.individuals eligible for medicare based on esrd generally lose eligibility 36 months after the
month in which the individual receives a kidney transplant unless they are eligible for medicare
on another basis such as age or disability. Edward may, however, remain enrolled in part b but
solely for coverage of immunosuppressive drugs if he has no other health care coverage that
would cover the drugs.
B.individuals eligible for medicare based on esrd generally lose eligibility 24 months after the
month in which the individual receives a kidney transplant unless t
Correct Answer: a.
Mod 1 - review - mr. Capadona would like to purchase a medicare advantage (ma) plan and a
medigap plan to pick up costs not covered by that plan. What should you tell him?
A.you will help mr. Capadona to select a medigap plan that is designed to cover gaps in
medicare advantage
B.medigap policies designed to cover costs not paid for by an ma plan can be purchased, but
only if the ma plan's design is considered to be the "defined standard benefit."
C.medigap plans that cover costs not paid for by an ma plan are available only in massachusetts,
minnesota, and wisconsin.
D.it is illegal for you to sell mr. Capadona a medigap plan if he is enrolled in an ma plan, and
besides, medigap only works with original medicare.
Correct Answer: d.
Mod 1 - review - 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?
, A.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.
B.you should tell madeline that she will need to pay premiums for part a because of her short
work history. You should also tell madeline that s
Correct Answer: a.
Mod 1 - review - mrs. Cook is an elderly retiree. Mrs. Cook has a low fixed income. What could
you tell mrs. Cook that might be of assistance?
A.she should contact her state medicaid agency to see if she qualifies for one of several
programs that can help with medicare costs for which she is responsible.
B.she can apply to the medicare agency for lower premiums and cost-sharing
.c.she should only seek help from private organizations to cover her medicare costs.d.she should
not sign up for a medicare advantage plan.
Correct Answer: a.
Mod 1 - review - mrs. Foster is covered by original medicare. She sustained a hip fracture and is
being successfully treated for that condition. However, she and her physicians feel that after her
