AHIP 2026 Certification study guide
1.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?:
2.Ms. Henderson believes that she will qualify for Medicare Coverage when
she turns 65, without paying any premiums, because she has been working
for 40 years and paying Medicare taxes. What should you tell her?: To
obtain Part B coverage, she must pay a standard monthly premium,
though it is higher for individuals with higher incomes.
3.Ms. Lewis has aggressive cancer and would like to know if Medicare will
cover hospice services in case she needs them. What should you tell her?:
- Medicare covers hospice services under Part A.
4.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?: 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.
5.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?: 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 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
6.Mrs. Foster is covered by Original Medicare. She sustained a hip
fracture and is being successfully treated for that 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?:
Medicare
will cover Mrs. Foster's skilled nursing services provided during the first
20 days of her stay, after which she would have a copay until she has
, AHIP 2026 Certification study guide
been in the facility for 100 days.
7.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?: Mr. Wu may still qualify for help in
paying Part D costs through his State Pharmaceutical Assistance
Program (SPAP).
, AHIP 2026 Certification study guide
8.Mr. Singh would like drug coverage but does not want to be enrolled in a
Medicare Advantage plan. What should you tell him?: 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.
9.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?: 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.
10.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 and is eligible for 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?:
Anthony is eligible for
a SEP of six months after the end of the disaster declaration. Use of the
SEP will allow Anthony to sign up for Part B without being subject to a
Part B late penalty. Anthony may enroll in premium-free Part A at any
time and his Part A coverage will be retroactive for up to 6 months.
11.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?:
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.
12.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 employ- ees 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?: 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
, AHIP 2026 Certification study guide
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.
1.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?:
2.Ms. Henderson believes that she will qualify for Medicare Coverage when
she turns 65, without paying any premiums, because she has been working
for 40 years and paying Medicare taxes. What should you tell her?: To
obtain Part B coverage, she must pay a standard monthly premium,
though it is higher for individuals with higher incomes.
3.Ms. Lewis has aggressive cancer and would like to know if Medicare will
cover hospice services in case she needs them. What should you tell her?:
- Medicare covers hospice services under Part A.
4.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?: 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.
5.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?: 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 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
6.Mrs. Foster is covered by Original Medicare. She sustained a hip
fracture and is being successfully treated for that 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?:
Medicare
will cover Mrs. Foster's skilled nursing services provided during the first
20 days of her stay, after which she would have a copay until she has
, AHIP 2026 Certification study guide
been in the facility for 100 days.
7.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?: Mr. Wu may still qualify for help in
paying Part D costs through his State Pharmaceutical Assistance
Program (SPAP).
, AHIP 2026 Certification study guide
8.Mr. Singh would like drug coverage but does not want to be enrolled in a
Medicare Advantage plan. What should you tell him?: 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.
9.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?: 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.
10.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 and is eligible for 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?:
Anthony is eligible for
a SEP of six months after the end of the disaster declaration. Use of the
SEP will allow Anthony to sign up for Part B without being subject to a
Part B late penalty. Anthony may enroll in premium-free Part A at any
time and his Part A coverage will be retroactive for up to 6 months.
11.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?:
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.
12.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 employ- ees 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?: 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
, AHIP 2026 Certification study guide
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.
