AHIP 2026 FINAL EXAM WITH
QUESTIONS AND CORRECT
ANSWERS
Ms. Galindo will turn 65 on June 10th. She has never previously qualified for Medicare. She is
entitled to Medicare Part A and intends to enroll in Part B. She wants to know if she is eligible
to enroll in a Medicare Advantage plan that includes prescription drug coverage. What do you
tell her? - correct answer<✔✔💖💖a. Ms. Galindo can enroll in an MA-PD plan now since
her initial election period (IEP) for Part D prescription drug coverage and initial coverage
election period (ICEP) are occurring together beginning March 1st and ending September 30th.
Mr. Moreno invited his neighbor, Agent Tom Smith, to discuss Medicare Advantage (MA) and
Part D plans that Agent Smith sells at the regular Tuesday brunch the neighbors have for senior
citizens. What should Agent Tom Smith tell Mr. Moreno about the kinds of food that can be
provided to potential enrollees who attend the sales presentation? - correct
answer<✔✔💖💖A meal cannot be provided, but light snacks would be permitted.
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? - correct
answer<✔✔💖💖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.
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? - correct answer<✔✔💖💖Tell prospect Jerry Smith
that he should consider adding a standalone Part D prescription drug coverage policy to his
present coverage.
Mr. Wu is eligible for Medicare. He has limited financial resources but failed to qualify for the
Part D low-income subsidy. Where might he turn for help with his prescription drug costs? -
,correct answer<✔✔💖💖Mr. Wu may still qualify for help in paying Part D costs through his
State Pharmaceutical Assistance Program (SPAP).
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? -
correct answer<✔✔💖💖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.
Mr. Moy will soon turn age 65. He is slightly younger than his wife. Mr. Moy's wife has a
Medicare Advantage plan, but he wants to understand what coverage Medicare Supplemental
Insurance provides since his health care needs are different from his wife's needs. What could
you tell Mr. Moy? - correct answer<✔✔💖💖Medicare Supplemental Insurance would help
cover his Part A deductible and Part B coinsurance or copayments in Original Fee-for-Service
(FFS) Medicare as well as possibly some services that Medicare does not cover.
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? - correct answer<✔✔💖💖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. 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 but Smallcap must continue to offer him coverage under its employer-
sponsored group health plan and would become a secondary payor.
Ms. Kumar plans to retire when she turns 65 in a few months. She is in excellent health and will
have considerable income when she 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? -
correct answer<✔✔💖💖Medicare is a program for people age 65 or older and those under
, age 65 with certain disabilities, end-stage renal disease, and Lou Gehrig's disease so she will be
eligible for Medicare.
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? - correct answer<✔✔💖💖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.
Mr. Singh would like drug coverage but does not want to be enrolled in a Medicare Advantage
plan. What should you tell him? - correct answer<✔✔💖💖Mr. Singh can enroll in a stand-
alone prescription drug plan and continue to be covered for Part A and Part B services through
Original Fee-for-Service Medicare.
Mrs. Cook is an elderly retiree. Mrs. Cook has a low fixed income. What could you tell Mrs. Cook
that might be of assistance? - correct answer<✔✔💖💖To obtain Part B coverage, she
must pay a standard monthly premium, though it is higher for individuals with higher incomes.
Mr. Bauer is 49 years old, but eighteen months ago he was declared disabled by the Social
Security Administration and has been receiving disability payments. He is wondering whether
he can obtain coverage under Medicare. What should you tell him? - correct
answer<✔✔💖💖After receiving such disability payments for 24 months, he will be
automatically enrolled in Medicare, regardless of age.
Mr. Schmidt would like to plan for retirement and has asked you what is covered under Original
Fee-for-Service (FFS) Medicare. What could you tell him? - correct answer<✔✔💖💖Part A,
which covers hospital, skilled nursing facility, hospice, and home health services and Part B,
which covers professional services such as those provided by a doctor are covered under
Original Medicare.
Anthony Boniface turned 65 in 2024. He was not receiving Social Security or Railroad
Retirement Benefits on his 65th birthday. He was interested in obtaining Medicare coverage
QUESTIONS AND CORRECT
ANSWERS
Ms. Galindo will turn 65 on June 10th. She has never previously qualified for Medicare. She is
entitled to Medicare Part A and intends to enroll in Part B. She wants to know if she is eligible
to enroll in a Medicare Advantage plan that includes prescription drug coverage. What do you
tell her? - correct answer<✔✔💖💖a. Ms. Galindo can enroll in an MA-PD plan now since
her initial election period (IEP) for Part D prescription drug coverage and initial coverage
election period (ICEP) are occurring together beginning March 1st and ending September 30th.
Mr. Moreno invited his neighbor, Agent Tom Smith, to discuss Medicare Advantage (MA) and
Part D plans that Agent Smith sells at the regular Tuesday brunch the neighbors have for senior
citizens. What should Agent Tom Smith tell Mr. Moreno about the kinds of food that can be
provided to potential enrollees who attend the sales presentation? - correct
answer<✔✔💖💖A meal cannot be provided, but light snacks would be permitted.
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? - correct
answer<✔✔💖💖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.
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? - correct answer<✔✔💖💖Tell prospect Jerry Smith
that he should consider adding a standalone Part D prescription drug coverage policy to his
present coverage.
Mr. Wu is eligible for Medicare. He has limited financial resources but failed to qualify for the
Part D low-income subsidy. Where might he turn for help with his prescription drug costs? -
,correct answer<✔✔💖💖Mr. Wu may still qualify for help in paying Part D costs through his
State Pharmaceutical Assistance Program (SPAP).
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? -
correct answer<✔✔💖💖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.
Mr. Moy will soon turn age 65. He is slightly younger than his wife. Mr. Moy's wife has a
Medicare Advantage plan, but he wants to understand what coverage Medicare Supplemental
Insurance provides since his health care needs are different from his wife's needs. What could
you tell Mr. Moy? - correct answer<✔✔💖💖Medicare Supplemental Insurance would help
cover his Part A deductible and Part B coinsurance or copayments in Original Fee-for-Service
(FFS) Medicare as well as possibly some services that Medicare does not cover.
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? - correct answer<✔✔💖💖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. 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 but Smallcap must continue to offer him coverage under its employer-
sponsored group health plan and would become a secondary payor.
Ms. Kumar plans to retire when she turns 65 in a few months. She is in excellent health and will
have considerable income when she 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? -
correct answer<✔✔💖💖Medicare is a program for people age 65 or older and those under
, age 65 with certain disabilities, end-stage renal disease, and Lou Gehrig's disease so she will be
eligible for Medicare.
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? - correct answer<✔✔💖💖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.
Mr. Singh would like drug coverage but does not want to be enrolled in a Medicare Advantage
plan. What should you tell him? - correct answer<✔✔💖💖Mr. Singh can enroll in a stand-
alone prescription drug plan and continue to be covered for Part A and Part B services through
Original Fee-for-Service Medicare.
Mrs. Cook is an elderly retiree. Mrs. Cook has a low fixed income. What could you tell Mrs. Cook
that might be of assistance? - correct answer<✔✔💖💖To obtain Part B coverage, she
must pay a standard monthly premium, though it is higher for individuals with higher incomes.
Mr. Bauer is 49 years old, but eighteen months ago he was declared disabled by the Social
Security Administration and has been receiving disability payments. He is wondering whether
he can obtain coverage under Medicare. What should you tell him? - correct
answer<✔✔💖💖After receiving such disability payments for 24 months, he will be
automatically enrolled in Medicare, regardless of age.
Mr. Schmidt would like to plan for retirement and has asked you what is covered under Original
Fee-for-Service (FFS) Medicare. What could you tell him? - correct answer<✔✔💖💖Part A,
which covers hospital, skilled nursing facility, hospice, and home health services and Part B,
which covers professional services such as those provided by a doctor are covered under
Original Medicare.
Anthony Boniface turned 65 in 2024. He was not receiving Social Security or Railroad
Retirement Benefits on his 65th birthday. He was interested in obtaining Medicare coverage
