AHIP MEDICARE CERTIFICATION EXAM TOTAL QUESTIONS AND
SOLUTIONS
1. 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 can sell him a Medigap plan to help with costs not covered under Medicare
Advantage.
B) 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.
C) Medigap plans are designed to work alongside Medicare Advantage plans.
D) He must disenroll from his MA plan before buying a Medigap plan.
ANSWER: B
Rationale: Medigap plans supplement Original Medicare benefits only. Federal law
prohibits the sale of a Medigap policy to an individual enrolled in a Medicare Advantage
plan. Medigap cannot pay MA plan cost-sharing .
,2. 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) Inform Jerry he is all set with his current coverage.
B) Tell Jerry he must switch to a Medicare Advantage plan to get drug coverage.
C) Tell Jerry he should consider adding a standalone Part D prescription drug coverage
policy to his present coverage.
D) Tell Jerry to cancel his Medigap plan and enroll in a different plan that offers drug
coverage.
ANSWER: C
Rationale: Individuals in Original Medicare with a Medigap plan who need drug coverage
can enroll in a standalone Part D Prescription Drug Plan (PDP) to add that benefit. They do
not need to give up their Medigap policy .
3. 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?
A) Apply for Medicaid to cover prescription costs.
B) Seek assistance from pharmaceutical company discount programs.
C) Mr. Wu may still qualify for help in paying Part D costs through his State Pharmaceutical
Assistance Program (SPAP).
D) Try to enroll in a Medigap plan with drug coverage.
ANSWER: C
Rationale: State Pharmaceutical Assistance Programs (SPAPs) are state-run programs
designed to help residents with limited resources pay for prescription drugs. They can be a
resource for individuals who do not qualify for the federal Low Income Subsidy (LIS) .
,4. Mr. Vasquez is in good health and wants to understand the health care costs for
inpatient hospital services under Original Medicare. What could you tell him?
A) He pays no deductible if admitted to a hospital.
B) He is responsible for a copayment every day in the hospital.
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.
D) Medicare covers 100% of inpatient hospitalization with no out-of-pocket expense.
ANSWER: C
Rationale: Medicare Part A has a defined cost-sharing structure: a deductible for the first
60 days, daily coinsurance for days 61-90, and the use of "lifetime reserve days" with their
own daily coinsurance after day 90. Beyond that, the beneficiary is responsible for all
costs .
5. Mr. Moy will soon turn age 65. He wants to understand what coverage Medicare
Supplemental Insurance provides. What could you tell Mr. Moy?
A) It covers everything Original Medicare does not.
B) It provides prescription drug coverage.
C) 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.
D) It is only available for Medicare Advantage enrollees.
ANSWER: C
Rationale: Medigap policies help pay certain out-of-pocket costs not covered by Original
Medicare, such as deductibles, coinsurance, and copayments. Some plans cover foreign
travel emergency care. They do not cover everything, and they do not provide prescription
drug coverage .
, 6. 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 asks about his Medicare eligibility and
the impact on his employer coverage. How would you respond?
A) Juan is likely to be eligible for Medicare once he turns 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.
B) Juan is not eligible for Medicare.
C) Juan is likely to be eligible for Medicare once he turns 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.
D) He must drop employer insurance if he enrolls in Medicare.
ANSWER: A
Rationale: For employers with fewer than 20 employees, Medicare becomes the primary
payer for Medicare-eligible employees. The employer is not required to provide coverage
comparable to that offered to younger employees .
7. Ms. Kumar is concerned that her income will make her ineligible for Medicare at age
65. What could you tell her?
A) High income makes one ineligible for Medicare.
B) Only low-income individuals qualify for Medicare.
C) Medicare is a program for people age 65 or older and those under age 65 with certain
disabilities, ESRD, and ALS, so she will be eligible for Medicare.
D) She should apply for Medicaid instead.
ANSWER: C
Rationale: Eligibility for Medicare is based on age (65+) or qualifying disabilities/diseases,
SOLUTIONS
1. 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 can sell him a Medigap plan to help with costs not covered under Medicare
Advantage.
B) 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.
C) Medigap plans are designed to work alongside Medicare Advantage plans.
D) He must disenroll from his MA plan before buying a Medigap plan.
ANSWER: B
Rationale: Medigap plans supplement Original Medicare benefits only. Federal law
prohibits the sale of a Medigap policy to an individual enrolled in a Medicare Advantage
plan. Medigap cannot pay MA plan cost-sharing .
,2. 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) Inform Jerry he is all set with his current coverage.
B) Tell Jerry he must switch to a Medicare Advantage plan to get drug coverage.
C) Tell Jerry he should consider adding a standalone Part D prescription drug coverage
policy to his present coverage.
D) Tell Jerry to cancel his Medigap plan and enroll in a different plan that offers drug
coverage.
ANSWER: C
Rationale: Individuals in Original Medicare with a Medigap plan who need drug coverage
can enroll in a standalone Part D Prescription Drug Plan (PDP) to add that benefit. They do
not need to give up their Medigap policy .
3. 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?
A) Apply for Medicaid to cover prescription costs.
B) Seek assistance from pharmaceutical company discount programs.
C) Mr. Wu may still qualify for help in paying Part D costs through his State Pharmaceutical
Assistance Program (SPAP).
D) Try to enroll in a Medigap plan with drug coverage.
ANSWER: C
Rationale: State Pharmaceutical Assistance Programs (SPAPs) are state-run programs
designed to help residents with limited resources pay for prescription drugs. They can be a
resource for individuals who do not qualify for the federal Low Income Subsidy (LIS) .
,4. Mr. Vasquez is in good health and wants to understand the health care costs for
inpatient hospital services under Original Medicare. What could you tell him?
A) He pays no deductible if admitted to a hospital.
B) He is responsible for a copayment every day in the hospital.
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.
D) Medicare covers 100% of inpatient hospitalization with no out-of-pocket expense.
ANSWER: C
Rationale: Medicare Part A has a defined cost-sharing structure: a deductible for the first
60 days, daily coinsurance for days 61-90, and the use of "lifetime reserve days" with their
own daily coinsurance after day 90. Beyond that, the beneficiary is responsible for all
costs .
5. Mr. Moy will soon turn age 65. He wants to understand what coverage Medicare
Supplemental Insurance provides. What could you tell Mr. Moy?
A) It covers everything Original Medicare does not.
B) It provides prescription drug coverage.
C) 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.
D) It is only available for Medicare Advantage enrollees.
ANSWER: C
Rationale: Medigap policies help pay certain out-of-pocket costs not covered by Original
Medicare, such as deductibles, coinsurance, and copayments. Some plans cover foreign
travel emergency care. They do not cover everything, and they do not provide prescription
drug coverage .
, 6. 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 asks about his Medicare eligibility and
the impact on his employer coverage. How would you respond?
A) Juan is likely to be eligible for Medicare once he turns 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.
B) Juan is not eligible for Medicare.
C) Juan is likely to be eligible for Medicare once he turns 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.
D) He must drop employer insurance if he enrolls in Medicare.
ANSWER: A
Rationale: For employers with fewer than 20 employees, Medicare becomes the primary
payer for Medicare-eligible employees. The employer is not required to provide coverage
comparable to that offered to younger employees .
7. Ms. Kumar is concerned that her income will make her ineligible for Medicare at age
65. What could you tell her?
A) High income makes one ineligible for Medicare.
B) Only low-income individuals qualify for Medicare.
C) Medicare is a program for people age 65 or older and those under age 65 with certain
disabilities, ESRD, and ALS, so she will be eligible for Medicare.
D) She should apply for Medicaid instead.
ANSWER: C
Rationale: Eligibility for Medicare is based on age (65+) or qualifying disabilities/diseases,
