AHIP - 2026 - Modules 1-5
Mr. Capadona would like to purchase a It is illegal for you to sell Mr. Capadona a Medigap plan if he is enrolled in an MA
Medicare Advantage (MA) plan and a plan, and besides, Medigap only works with Original Medicare.
Medigap plan to pick up costs not
covered by that plan. What should you
tell him?
Agent John Miller is meeting with Jerry Tell prospect Jerry Smith that he should consider adding a standalone Part D
Smith, a new prospect. Jerry is currently prescription drug coverage policy to his present coverage.
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?
Mr. Wu is eligible for Medicare. He has Mr. Wu may still qualify for help in paying Part D costs through his State
limited financial resources but failed to Pharmaceutical Assistance Program (SPAP).
qualify for the Part D low-income subsidy.
Where might he turn for help with his
prescription drug costs?
Mr. Vasquez is in good health and is Under Original Medicare, there is a single deductible amount due for the first 60
preparing a budget in anticipation of his days of any inpatient hospital stay, after which it converts into a per-day
retirement when he turns 66. He wants to coinsurance amount through day 90. After day 90, he would pay a daily amount up
understand the health care costs he might to 60 days over his lifetime, after which he would be responsible for all costs.
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?
Mr. Moy will soon turn age 65. He is Medicare Supplemental Insurance would help cover his Part A deductible and
slightly younger than his wife. Mr. Moy's Part B coinsurance or copayments in Original Fee-for-Service (FFS) Medicare as
wife has a Medicare Advantage plan, but well as possibly some services that Medicare does not cover.
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?
,Juan Perez, who is turning age 65 next Juan is likely to be eligible for Medicare once he turns age 65 and if he enrolls,
month, intends to work for several more Medicare would become the primary payor of his healthcare claims and Smallcap
years at Smallcap, Incorporated. does not have to continue to offer him coverage comparable to those under age
Smallcap has a workforce of 15 65 under its employer-sponsored group health plan. Juan is likely to be eligible
employees and offers employer- for Medicare once he turns age 65 and if he enrolls, Medicare would become the
sponsored healthcare coverage. Juan is a primary payor of his healthcare claims but Smallcap must continue to offer him
naturalized citizen and has contributed to coverage under its employer-sponsored group health plan and would become a
the Medicare system for over 20 years. secondary payor.
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?
Ms. Kumar plans to retire when she turns Medicare is a program for people age 65 or older and those under age 65 with
65 in a few months. She is in excellent certain disabilities, end-stage renal disease, and Lou Gehrig's disease so she will
health and will have considerable income be eligible for Medicare.
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?
Mrs. Ellis recently turned 66 and decided Part B primarily covers physician services. She will be paying a monthly premium
after many years of work to retire and and, except for many preventive and screening tests, generally will have 20% co-
begin receiving Social Security benefits. payments for these services, in addition to an annual deductible.
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?
Mr. Singh would like drug coverage but Mr. Singh can enroll in a stand-alone prescription drug plan and continue to be
does not want to be enrolled in a covered for Part A and Part B services through Original Fee-for-Service Medicare.
Medicare Advantage plan. What should
you tell him?
Mrs. Cook is an elderly retiree. Mrs. Cook She should contact her state Medicaid agency to see if she qualifies for one of
has a low fixed income. What could you several programs that can help with Medicare costs for which she is responsible.
tell Mrs. Cook that might be of
assistance?
Ms. Henderson believes that she will To obtain Part B coverage, she must pay a standard monthly premium, though it is
qualify for Medicare Coverage when she higher for individuals with higher incomes.
turns 65, without paying any premiums,
because she has been working for 40
years and paying Medicare taxes. What
should you tell her?
Mr. Bauer is 49 years old, but eighteen After receiving such disability payments for 24 months, he will be automatically
months ago he was declared disabled by enrolled in Medicare, regardless of age.
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?
, Mr. Schmidt would like to plan for Part A, which covers hospital, skilled nursing facility, hospice, and home health
retirement and has asked you what is services and Part B, which covers professional services such as those provided by
covered under Original Fee-for-Service a doctor are covered under Original Medicare.
(FFS) Medicare. What could you tell him?
Anthony Boniface turned 65 in 2024. He Anthony is eligible for a special enrollment period (SEP) because he missed an
was not receiving Social Security or enrollment period due to the impact of the Federally declared disaster. This SEP
Railroad Retirement Benefits on his 65th will allow Anthony to enroll in Part B up to six months after the end of the
birthday. He was interested in obtaining emergency declaration. Anthony may enroll in premium-free Part A at any time
Medicare coverage and is eligible for and his Part A coverage will be retroactive for up to 6 months.
premium-free Part A. Before he could
enroll in Medicare, his entire area was
impacted by a hurricane causing massive
flooding and severe wind damage. The
Federal government declared this to be a
natural disaster which has recently ended.
During this period Anthony's initial
enrollment period expired. Anthony asks
you how he can now obtain Medicare
coverage. What should you say?
Ms. Lewis has aggressive cancer and Medicare covers hospice services, and they will be available for her.
would like to know if Medicare will cover
hospice services in case she needs them.
What should you tell her?
Edward suffered from serious kidney Individuals eligible for Medicare based on ESRD generally lose eligibility 36
disease. As a result, Edward became months after the month in which the individual receives a kidney transplant unless
eligible for Medicare coverage due to they are eligible for Medicare on another basis such as age or disability. Edward
end-stage renal disease (ESRD). A close may, however, remain enrolled in Part B but solely for coverage of
relative donated their kidney and Edward immunosuppressive drugs if he has no other health care coverage that would
successfully underwent transplant surgery cover the drugs.
12 months ago. Edward is now age 50 and
asks you if his Medicare coverage will
continue, what should you say?
Mrs. Foster is covered by Original Medicare will cover Mrs. Foster's skilled nursing services provided during the first
Medicare. She sustained a hip fracture 20 days of her stay, after which she would have a copay until she has been in the
and is being successfully treated for that facility for 100 days.
condition. However, she and her
physicians feel that after her lengthy
hospital stay, she will need a month or
two of nursing and rehabilitative care.
What should you tell them about Original
Medicare's coverage of care in a skilled
nursing facility?
Mr. Capadona would like to purchase a It is illegal for you to sell Mr. Capadona a Medigap plan if he is enrolled in an MA
Medicare Advantage (MA) plan and a plan, and besides, Medigap only works with Original Medicare.
Medigap plan to pick up costs not
covered by that plan. What should you
tell him?
Agent John Miller is meeting with Jerry Tell prospect Jerry Smith that he should consider adding a standalone Part D
Smith, a new prospect. Jerry is currently prescription drug coverage policy to his present coverage.
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?
Mr. Wu is eligible for Medicare. He has Mr. Wu may still qualify for help in paying Part D costs through his State
limited financial resources but failed to Pharmaceutical Assistance Program (SPAP).
qualify for the Part D low-income subsidy.
Where might he turn for help with his
prescription drug costs?
Mr. Vasquez is in good health and is Under Original Medicare, there is a single deductible amount due for the first 60
preparing a budget in anticipation of his days of any inpatient hospital stay, after which it converts into a per-day
retirement when he turns 66. He wants to coinsurance amount through day 90. After day 90, he would pay a daily amount up
understand the health care costs he might to 60 days over his lifetime, after which he would be responsible for all costs.
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?
Mr. Moy will soon turn age 65. He is Medicare Supplemental Insurance would help cover his Part A deductible and
slightly younger than his wife. Mr. Moy's Part B coinsurance or copayments in Original Fee-for-Service (FFS) Medicare as
wife has a Medicare Advantage plan, but well as possibly some services that Medicare does not cover.
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?
,Juan Perez, who is turning age 65 next Juan is likely to be eligible for Medicare once he turns age 65 and if he enrolls,
month, intends to work for several more Medicare would become the primary payor of his healthcare claims and Smallcap
years at Smallcap, Incorporated. does not have to continue to offer him coverage comparable to those under age
Smallcap has a workforce of 15 65 under its employer-sponsored group health plan. Juan is likely to be eligible
employees and offers employer- for Medicare once he turns age 65 and if he enrolls, Medicare would become the
sponsored healthcare coverage. Juan is a primary payor of his healthcare claims but Smallcap must continue to offer him
naturalized citizen and has contributed to coverage under its employer-sponsored group health plan and would become a
the Medicare system for over 20 years. secondary payor.
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?
Ms. Kumar plans to retire when she turns Medicare is a program for people age 65 or older and those under age 65 with
65 in a few months. She is in excellent certain disabilities, end-stage renal disease, and Lou Gehrig's disease so she will
health and will have considerable income be eligible for Medicare.
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?
Mrs. Ellis recently turned 66 and decided Part B primarily covers physician services. She will be paying a monthly premium
after many years of work to retire and and, except for many preventive and screening tests, generally will have 20% co-
begin receiving Social Security benefits. payments for these services, in addition to an annual deductible.
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?
Mr. Singh would like drug coverage but Mr. Singh can enroll in a stand-alone prescription drug plan and continue to be
does not want to be enrolled in a covered for Part A and Part B services through Original Fee-for-Service Medicare.
Medicare Advantage plan. What should
you tell him?
Mrs. Cook is an elderly retiree. Mrs. Cook She should contact her state Medicaid agency to see if she qualifies for one of
has a low fixed income. What could you several programs that can help with Medicare costs for which she is responsible.
tell Mrs. Cook that might be of
assistance?
Ms. Henderson believes that she will To obtain Part B coverage, she must pay a standard monthly premium, though it is
qualify for Medicare Coverage when she higher for individuals with higher incomes.
turns 65, without paying any premiums,
because she has been working for 40
years and paying Medicare taxes. What
should you tell her?
Mr. Bauer is 49 years old, but eighteen After receiving such disability payments for 24 months, he will be automatically
months ago he was declared disabled by enrolled in Medicare, regardless of age.
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?
, Mr. Schmidt would like to plan for Part A, which covers hospital, skilled nursing facility, hospice, and home health
retirement and has asked you what is services and Part B, which covers professional services such as those provided by
covered under Original Fee-for-Service a doctor are covered under Original Medicare.
(FFS) Medicare. What could you tell him?
Anthony Boniface turned 65 in 2024. He Anthony is eligible for a special enrollment period (SEP) because he missed an
was not receiving Social Security or enrollment period due to the impact of the Federally declared disaster. This SEP
Railroad Retirement Benefits on his 65th will allow Anthony to enroll in Part B up to six months after the end of the
birthday. He was interested in obtaining emergency declaration. Anthony may enroll in premium-free Part A at any time
Medicare coverage and is eligible for and his Part A coverage will be retroactive for up to 6 months.
premium-free Part A. Before he could
enroll in Medicare, his entire area was
impacted by a hurricane causing massive
flooding and severe wind damage. The
Federal government declared this to be a
natural disaster which has recently ended.
During this period Anthony's initial
enrollment period expired. Anthony asks
you how he can now obtain Medicare
coverage. What should you say?
Ms. Lewis has aggressive cancer and Medicare covers hospice services, and they will be available for her.
would like to know if Medicare will cover
hospice services in case she needs them.
What should you tell her?
Edward suffered from serious kidney Individuals eligible for Medicare based on ESRD generally lose eligibility 36
disease. As a result, Edward became months after the month in which the individual receives a kidney transplant unless
eligible for Medicare coverage due to they are eligible for Medicare on another basis such as age or disability. Edward
end-stage renal disease (ESRD). A close may, however, remain enrolled in Part B but solely for coverage of
relative donated their kidney and Edward immunosuppressive drugs if he has no other health care coverage that would
successfully underwent transplant surgery cover the drugs.
12 months ago. Edward is now age 50 and
asks you if his Medicare coverage will
continue, what should you say?
Mrs. Foster is covered by Original Medicare will cover Mrs. Foster's skilled nursing services provided during the first
Medicare. She sustained a hip fracture 20 days of her stay, after which she would have a copay until she has been in the
and is being successfully treated for that facility for 100 days.
condition. However, she and her
physicians feel that after her lengthy
hospital stay, she will need a month or
two of nursing and rehabilitative care.
What should you tell them about Original
Medicare's coverage of care in a skilled
nursing facility?
