AHIP 2026 Final Assessment Study Guide
Mr. Capadona would like to purchase a Medicare Advantage (MA) plan and a Medigap plan to pick up costs not
X X X X X X X X X X X X X X X X X X X
covered by that plan. What should you tell him? - correct answers It is illegal for you to sell Mr. Capadona a
X X X X X X X X X X X X X X X X X X X X X X X
Medigap plan if he is enrolled in an MA plan, and besides, Medigap only works with Original Medicare.
X X X X X X X X X X X X X X X X X
Agent John Miller is meeting with Jerry Smith, a new prospect. Jerry is currently enrolled in Medicare Parts A
X X X X X X X X X X X X X X X X X X X
and B. Jerry has also purchased a Medicare Supplement (Medigap) plan which he has had for several years.
X X X X X X X X X X X X X X X X X X
However, the plan does not provide drug benefits. How would you advise Agent John Miller to proceed? -
X X X X X X X X X X X X X X X X X X
correct answers Tell prospect Jerry Smith that he should consider adding a standalone Part D prescription
X X X X X X X X X X X X X X X X
drug coverage policy to his present coverage.
X X X X X X
Mr. Wu is eligible for Medicare. He has limited financial resources but failed to qualify for the Part D low-
X X X X X X X X X X X X X X X X X X X
income subsidy. Where might he turn for help with his prescription drug costs? - correct answers Mr. Wu may
X X X X X X X X X X X X X X X X X X X
still qualify for help in paying Part D costs through his State Pharmaceutical Assistance Program (SPAP).
X X X X X X X X X X X X X X X
Mr. Vasquez is in good health and is preparing a budget in anticipation of his retirement when he turns 66. He
X X X X X X X X X X X X X X X X X X X X X
wants to understand the health care costs he might be exposed to under Medicare if he were to require
X X X X X X X X X X X X X X X X X X X
hospitalization because of an illness. In general terms, what could you tell him about his costs for inpatient X X X X X X X X X X X X X X X X X X
hospital services under Original Medicare? - correct answers Under Original Medicare, there is a single
X X X X X X X X X X X X X X X
deductible amount due for the first 60 days of any inpatient hospital stay, after which it converts into a per-day
X X X X X X X X X X X X X X X X X X X X
coinsurance amount through day 90. After day 90, he would pay a daily amount up to 60 days over his lifetime,
X X X X X X X X X X X X X X X X X X X X X
after which he would be responsible for all costs.
X X X X X X X X
Mr. Moy will soon turn age 65. He is slightly younger than his wife. Mr. Moy's wife has a Medicare Advantage
X X X X X X X X X X X X X X X X X X X X X
plan, but he wants to understand what coverage Medicare Supplemental Insurance provides since his health
X X X X X X X X X X X X X X X
care needs are different from his wife's needs. What could you tell Mr. Moy? - correct answers Medicare
X X X X X X X X X X X X X X X X X X
,Supplemental Insurance would help cover his Part A deductible and Part B coinsurance or copayments in X X X X X X X X X X X X X X X X
Original Fee-for-Service (FFS) Medicare as well as possibly some services that Medicare does not cover.
X X X X X X X X X X X X X X
Juan Perez, who is turning age 65 next month, intends to work for several more years at Smallcap,
X X X X X X X X X X X X X X X X X X
Incorporated. Smallcap has a workforce of 15 employees and offers employer-sponsored healthcare X X X X X X X X X X X X
coverage. Juan is a naturalized citizen and has contributed to the Medicare system for over 20 years. Juan asks
X X X X X X X X X X X X X X X X X X X
you if he will be entitled to Medicare and if he enrolls how that will impact his employer- sponsored healthcare
X X X X X X X X X X X X X X X X X X X X
coverage. How would you respond? - correct answers Juan is likely to be eligible for Medicare once he turns
X X X X X X X X X X X X X X X X X X X
age 65 and if he enrolls, Medicare would become the primary payor of his healthcare claims and Smallcap
X X X X X X X X X X X X X X X X X X
does not have to continue to offer him coverage comparable to those under age 65 under its employer-
X X X X X X X X X X X X X X X X X
sponsored group health plan. Juan is likely to be eligible for Medicare once he turns age 65 and if he enrolls,
X X X X X X X X X X X X X X X X X X X X X
Medicare would become the primary payor of his healthcare claims but Smallcap must continue to offer him
X X X X X X X X X X X X X X X X X
coverage under its employer-sponsored group health plan and would become a secondary payor.
X X X X X X X X X X X X
Ms. Kumar plans to retire when she turns 65 in a few months. She is in excellent health and will have
X X X X X X X X X X X X X X X X X X X X X
considerable income when she retires. She is concerned that her income will make it impossible for her to X X X X X X X X X X X X X X X X X X
qualify for Medicare. What could you tell her to address her concern? - correct answers Medicare is a program
X X X X X X X X X X X X X X X X X X X
for people age 65 or older and those under age 65 with certain disabilities, end-stage renal disease, and Lou
X X X X X X X X X X X X X X X X X X X
Gehrig's disease so she will be eligible for Medicare. X X X X X X X X
Mrs. Ellis recently turned 66 and decided after many years of work to retire and begin receiving Social Security
X X X X X X X X X X X X X X X X X X X
benefits. Shortly thereafter Mrs. Ellis received a letter informing her that she had been automatically enrolled
X X X X X X X X X X X X X X X X
in Medicare Part B. She wants to understand what this means. What should you tell Mrs. Ellis? - correct
X X X X X X X X X X X X X X X X X X X
answers Part B primarily covers physician services. She will be paying a monthly premium and, except for
X X X X X X X X X X X X X X X X X
many preventive and screening tests, generally will have 20% co-payments for these services, in addition to
X X X X X X X X X X X X X X X X
an annual deductible.
X X
Mr. Singh would like drug coverage but does not want to be enrolled in a Medicare Advantage plan. What
X X X X X X X X X X X X X X X X X X X
should you tell him? - correct answers Mr. Singh can enroll in a stand-alone prescription drug plan and
X X X X X X X X X X X X X X X X X X
continue to be covered for Part A and Part B services through Original Fee-for-Service Medicare.
X X X X X X X X X X X X X X
Mrs. Cook is an elderly retiree. Mrs. Cook has a low fixed income. What could you tell Mrs. Cook that might be
X X X X X X X X X X X X X X X X X X X X X X
of assistance? - correct answers She should contact her state Medicaid agency to see if she qualifies for one of
X X X X X X X X X X X X X X X X X X X X
several programs that can help with Medicare costs for which she is responsible.
X X X X X X X X X X X X
Ms. Henderson believes that she will qualify for Medicare Coverage when she turns 65, without paying any
X X X X X X X X X X X X X X X X X
premiums, because she has been working for 40 years and paying Medicare taxes. What should you tell her? - X X X X X X X X X X X X X X X X X X X
, correct answers To obtain Part B coverage, she must pay a standard monthly premium, though it is higher for
X X X X X X X X X X X X X X X X X X X
individuals with higher incomes. X X X
Mr. Bauer is 49 years old, but eighteen months ago he was declared disabled by the Social Security
X X X X X X X X X X X X X X X X X X
Administration and has been receiving disability payments. He is wondering whether he can obtain coverage X X X X X X X X X X X X X X X
under Medicare. What should you tell him? - correct answers After receiving such disability payments for 24
X X X X X X X X X X X X X X X X X
months, he will be automatically enrolled in Medicare, regardless of age.
X X X X X X X X X X
Mr. Schmidt would like to plan for retirement and has asked you what is covered under Original Fee-for-
X X X X X X X X X X X X X X X X X
Service (FFS) Medicare. What could you tell him? - correct answers Part A, which covers hospital, skilled
X X X X X X X X X X X X X X X X X
nursing facility, hospice, and home health services and Part B, which covers professional services such as
X X X X X X X X X X X X X X X X
those provided by a doctor are covered under Original Medicare.
X X X X X X X X X
Anthony Boniface turned 65 in 2024. He was not receiving Social Security or Railroad Retirement Benefits on
X X X X X X X X X X X X X X X X X
his 65th birthday. He was interested in obtaining Medicare coverage and is eligible for premium-free Part A.
X X X X X X X X X X X X X X X X X
Before he could enroll in Medicare, his entire area was impacted by a hurricane causing massive flooding and
X X X X X X X X X X X X X X X X X X
severe wind damage. The Federal government declared this to be a natural disaster which has recently ended.
X X X X X X X X X X X X X X X X
During this period Anthony's initial enrollment period expired. Anthony asks you how he can now obtain
X X X X X X X X X X X X X X X X X
Medicare coverage. What should you say? - correct answers Anthony is eligible for a special enrollment
X X X X X X X X X X X X X X X X
period (SEP) because he missed an enrollment period due to the impact of the Federally declared disaster.
X X X X X X X X X X X X X X X X X
This SEP will allow Anthony to enroll in Part B up to six months after the end of the emergency declaration.
X X X X X X X X X X X X X X X X X X X X X
Anthony may enroll in premium-free Part A at any time and his Part A coverage will be retroactive for up to 6
X X X X X X X X X X X X X X X X X X X X X X
months.
Ms. Lewis has aggressive cancer and would like to know if Medicare will cover hospice services in case she
X X X X X X X X X X X X X X X X X X X
needs them. What should you tell her? - correct answers Medicare covers hospice services, and they will be
X X X X X X X X X X X X X X X X X X
available for her. X X
Edward suffered from serious kidney disease. As a result, Edward became eligible for Medicare coverage due
X X X X X X X X X X X X X X X X
to end-stage renal disease (ESRD). A close relative donated their kidney and Edward successfully underwent
X X X X X X X X X X X X X X X
transplant surgery 12 months ago. Edward is now age 50 and asks you if his Medicare coverage will continue,
X X X X X X X X X X X X X X X X X X X
what should you say? - correct answers Individuals eligible for Medicare based on ESRD generally lose
X X X X X X X X X X X X X X X X
eligibility 36 months after the month in which the individual receives a kidney transplant unless they are
X X X X X X X X X X X X X X X X X
eligible for Medicare on another basis such as age or disability. Edward may, however, remain enrolled in Part
X X X X X X X X X X X X X X X X X X
B but solely for coverage of immunosuppressive drugs if he has no other health care coverage that would
X X X X X X X X X X X X X X X X X X
cover the drugs. X X
Mr. Capadona would like to purchase a Medicare Advantage (MA) plan and a Medigap plan to pick up costs not
X X X X X X X X X X X X X X X X X X X
covered by that plan. What should you tell him? - correct answers It is illegal for you to sell Mr. Capadona a
X X X X X X X X X X X X X X X X X X X X X X X
Medigap plan if he is enrolled in an MA plan, and besides, Medigap only works with Original Medicare.
X X X X X X X X X X X X X X X X X
Agent John Miller is meeting with Jerry Smith, a new prospect. Jerry is currently enrolled in Medicare Parts A
X X X X X X X X X X X X X X X X X X X
and B. Jerry has also purchased a Medicare Supplement (Medigap) plan which he has had for several years.
X X X X X X X X X X X X X X X X X X
However, the plan does not provide drug benefits. How would you advise Agent John Miller to proceed? -
X X X X X X X X X X X X X X X X X X
correct answers Tell prospect Jerry Smith that he should consider adding a standalone Part D prescription
X X X X X X X X X X X X X X X X
drug coverage policy to his present coverage.
X X X X X X
Mr. Wu is eligible for Medicare. He has limited financial resources but failed to qualify for the Part D low-
X X X X X X X X X X X X X X X X X X X
income subsidy. Where might he turn for help with his prescription drug costs? - correct answers Mr. Wu may
X X X X X X X X X X X X X X X X X X X
still qualify for help in paying Part D costs through his State Pharmaceutical Assistance Program (SPAP).
X X X X X X X X X X X X X X X
Mr. Vasquez is in good health and is preparing a budget in anticipation of his retirement when he turns 66. He
X X X X X X X X X X X X X X X X X X X X X
wants to understand the health care costs he might be exposed to under Medicare if he were to require
X X X X X X X X X X X X X X X X X X X
hospitalization because of an illness. In general terms, what could you tell him about his costs for inpatient X X X X X X X X X X X X X X X X X X
hospital services under Original Medicare? - correct answers Under Original Medicare, there is a single
X X X X X X X X X X X X X X X
deductible amount due for the first 60 days of any inpatient hospital stay, after which it converts into a per-day
X X X X X X X X X X X X X X X X X X X X
coinsurance amount through day 90. After day 90, he would pay a daily amount up to 60 days over his lifetime,
X X X X X X X X X X X X X X X X X X X X X
after which he would be responsible for all costs.
X X X X X X X X
Mr. Moy will soon turn age 65. He is slightly younger than his wife. Mr. Moy's wife has a Medicare Advantage
X X X X X X X X X X X X X X X X X X X X X
plan, but he wants to understand what coverage Medicare Supplemental Insurance provides since his health
X X X X X X X X X X X X X X X
care needs are different from his wife's needs. What could you tell Mr. Moy? - correct answers Medicare
X X X X X X X X X X X X X X X X X X
,Supplemental Insurance would help cover his Part A deductible and Part B coinsurance or copayments in X X X X X X X X X X X X X X X X
Original Fee-for-Service (FFS) Medicare as well as possibly some services that Medicare does not cover.
X X X X X X X X X X X X X X
Juan Perez, who is turning age 65 next month, intends to work for several more years at Smallcap,
X X X X X X X X X X X X X X X X X X
Incorporated. Smallcap has a workforce of 15 employees and offers employer-sponsored healthcare X X X X X X X X X X X X
coverage. Juan is a naturalized citizen and has contributed to the Medicare system for over 20 years. Juan asks
X X X X X X X X X X X X X X X X X X X
you if he will be entitled to Medicare and if he enrolls how that will impact his employer- sponsored healthcare
X X X X X X X X X X X X X X X X X X X X
coverage. How would you respond? - correct answers Juan is likely to be eligible for Medicare once he turns
X X X X X X X X X X X X X X X X X X X
age 65 and if he enrolls, Medicare would become the primary payor of his healthcare claims and Smallcap
X X X X X X X X X X X X X X X X X X
does not have to continue to offer him coverage comparable to those under age 65 under its employer-
X X X X X X X X X X X X X X X X X
sponsored group health plan. Juan is likely to be eligible for Medicare once he turns age 65 and if he enrolls,
X X X X X X X X X X X X X X X X X X X X X
Medicare would become the primary payor of his healthcare claims but Smallcap must continue to offer him
X X X X X X X X X X X X X X X X X
coverage under its employer-sponsored group health plan and would become a secondary payor.
X X X X X X X X X X X X
Ms. Kumar plans to retire when she turns 65 in a few months. She is in excellent health and will have
X X X X X X X X X X X X X X X X X X X X X
considerable income when she retires. She is concerned that her income will make it impossible for her to X X X X X X X X X X X X X X X X X X
qualify for Medicare. What could you tell her to address her concern? - correct answers Medicare is a program
X X X X X X X X X X X X X X X X X X X
for people age 65 or older and those under age 65 with certain disabilities, end-stage renal disease, and Lou
X X X X X X X X X X X X X X X X X X X
Gehrig's disease so she will be eligible for Medicare. X X X X X X X X
Mrs. Ellis recently turned 66 and decided after many years of work to retire and begin receiving Social Security
X X X X X X X X X X X X X X X X X X X
benefits. Shortly thereafter Mrs. Ellis received a letter informing her that she had been automatically enrolled
X X X X X X X X X X X X X X X X
in Medicare Part B. She wants to understand what this means. What should you tell Mrs. Ellis? - correct
X X X X X X X X X X X X X X X X X X X
answers Part B primarily covers physician services. She will be paying a monthly premium and, except for
X X X X X X X X X X X X X X X X X
many preventive and screening tests, generally will have 20% co-payments for these services, in addition to
X X X X X X X X X X X X X X X X
an annual deductible.
X X
Mr. Singh would like drug coverage but does not want to be enrolled in a Medicare Advantage plan. What
X X X X X X X X X X X X X X X X X X X
should you tell him? - correct answers Mr. Singh can enroll in a stand-alone prescription drug plan and
X X X X X X X X X X X X X X X X X X
continue to be covered for Part A and Part B services through Original Fee-for-Service Medicare.
X X X X X X X X X X X X X X
Mrs. Cook is an elderly retiree. Mrs. Cook has a low fixed income. What could you tell Mrs. Cook that might be
X X X X X X X X X X X X X X X X X X X X X X
of assistance? - correct answers She should contact her state Medicaid agency to see if she qualifies for one of
X X X X X X X X X X X X X X X X X X X X
several programs that can help with Medicare costs for which she is responsible.
X X X X X X X X X X X X
Ms. Henderson believes that she will qualify for Medicare Coverage when she turns 65, without paying any
X X X X X X X X X X X X X X X X X
premiums, because she has been working for 40 years and paying Medicare taxes. What should you tell her? - X X X X X X X X X X X X X X X X X X X
, correct answers To obtain Part B coverage, she must pay a standard monthly premium, though it is higher for
X X X X X X X X X X X X X X X X X X X
individuals with higher incomes. X X X
Mr. Bauer is 49 years old, but eighteen months ago he was declared disabled by the Social Security
X X X X X X X X X X X X X X X X X X
Administration and has been receiving disability payments. He is wondering whether he can obtain coverage X X X X X X X X X X X X X X X
under Medicare. What should you tell him? - correct answers After receiving such disability payments for 24
X X X X X X X X X X X X X X X X X
months, he will be automatically enrolled in Medicare, regardless of age.
X X X X X X X X X X
Mr. Schmidt would like to plan for retirement and has asked you what is covered under Original Fee-for-
X X X X X X X X X X X X X X X X X
Service (FFS) Medicare. What could you tell him? - correct answers Part A, which covers hospital, skilled
X X X X X X X X X X X X X X X X X
nursing facility, hospice, and home health services and Part B, which covers professional services such as
X X X X X X X X X X X X X X X X
those provided by a doctor are covered under Original Medicare.
X X X X X X X X X
Anthony Boniface turned 65 in 2024. He was not receiving Social Security or Railroad Retirement Benefits on
X X X X X X X X X X X X X X X X X
his 65th birthday. He was interested in obtaining Medicare coverage and is eligible for premium-free Part A.
X X X X X X X X X X X X X X X X X
Before he could enroll in Medicare, his entire area was impacted by a hurricane causing massive flooding and
X X X X X X X X X X X X X X X X X X
severe wind damage. The Federal government declared this to be a natural disaster which has recently ended.
X X X X X X X X X X X X X X X X
During this period Anthony's initial enrollment period expired. Anthony asks you how he can now obtain
X X X X X X X X X X X X X X X X X
Medicare coverage. What should you say? - correct answers Anthony is eligible for a special enrollment
X X X X X X X X X X X X X X X X
period (SEP) because he missed an enrollment period due to the impact of the Federally declared disaster.
X X X X X X X X X X X X X X X X X
This SEP will allow Anthony to enroll in Part B up to six months after the end of the emergency declaration.
X X X X X X X X X X X X X X X X X X X X X
Anthony may enroll in premium-free Part A at any time and his Part A coverage will be retroactive for up to 6
X X X X X X X X X X X X X X X X X X X X X X
months.
Ms. Lewis has aggressive cancer and would like to know if Medicare will cover hospice services in case she
X X X X X X X X X X X X X X X X X X X
needs them. What should you tell her? - correct answers Medicare covers hospice services, and they will be
X X X X X X X X X X X X X X X X X X
available for her. X X
Edward suffered from serious kidney disease. As a result, Edward became eligible for Medicare coverage due
X X X X X X X X X X X X X X X X
to end-stage renal disease (ESRD). A close relative donated their kidney and Edward successfully underwent
X X X X X X X X X X X X X X X
transplant surgery 12 months ago. Edward is now age 50 and asks you if his Medicare coverage will continue,
X X X X X X X X X X X X X X X X X X X
what should you say? - correct answers Individuals eligible for Medicare based on ESRD generally lose
X X X X X X X X X X X X X X X X
eligibility 36 months after the month in which the individual receives a kidney transplant unless they are
X X X X X X X X X X X X X X X X X
eligible for Medicare on another basis such as age or disability. Edward may, however, remain enrolled in Part
X X X X X X X X X X X X X X X X X X
B but solely for coverage of immunosuppressive drugs if he has no other health care coverage that would
X X X X X X X X X X X X X X X X X X
cover the drugs. X X
