AHIP 2026 MODULES 1-5 STUDY GUIDE 2026
EXAM QUESTIONS AND CORRECT ANSWERS
GRADED A+
◉ MOD 1 - Review -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 be entitled to Medicare and if he enrolls how that will impact his
employer- sponsored healthcare coverage. How would you respond?
a.Juan is likely to be ineligible for Medicare since he was born outside
the United States and has only contributed to the Medicare system for 20
years.
b.Juan is likely to be eligible for Medicare once he turns age 65 and if he
enrolls his employer-sponsored coverage would continue to be the
primary payor while Medicare would be considered a secondary payor
of his healthcare claims.
c.Juan is likely to be eligible for Medicare once he turns age 65 and if h.
Answer: d.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 and would become a secondary payor.
,◉ 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. Answer: 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. Answer: 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
◉ 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.
, Answer: 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 into a per-day coinsurance amount through day 90. After day
90, he would pay a daily amount up to 60 days over his lifetime, after
which he would be responsible for all costs.
◉ 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. Answer: 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.
EXAM QUESTIONS AND CORRECT ANSWERS
GRADED A+
◉ MOD 1 - Review -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 be entitled to Medicare and if he enrolls how that will impact his
employer- sponsored healthcare coverage. How would you respond?
a.Juan is likely to be ineligible for Medicare since he was born outside
the United States and has only contributed to the Medicare system for 20
years.
b.Juan is likely to be eligible for Medicare once he turns age 65 and if he
enrolls his employer-sponsored coverage would continue to be the
primary payor while Medicare would be considered a secondary payor
of his healthcare claims.
c.Juan is likely to be eligible for Medicare once he turns age 65 and if h.
Answer: d.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 and would become a secondary payor.
,◉ 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. Answer: 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. Answer: 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
◉ 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.
, Answer: 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 into a per-day coinsurance amount through day 90. After day
90, he would pay a daily amount up to 60 days over his lifetime, after
which he would be responsible for all costs.
◉ 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. Answer: 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.
