AHIP - 2026 - Modules 1-5 With complete solu on
Newest RATED A+ 2025/2026 NEW!!
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 Answers 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 mee%ng 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 Answers Tell prospect Jerry Smith that he
should consider adding a standalone Part D prescrip%on 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 prescrip%on drug costs? -
Correct Answers Mr. Wu may s%ll qualify for help in paying Part D costs through his State
Pharmaceu%cal Assistance Program (SPAP).
Mr. Vasquez is in good health and is preparing a budget in an%cipa%on of his re%rement when
he turns 66. He wants to understand the health care costs he might be exposed to under
Medicare if he were to require hospitaliza%on because of an illness. In general terms, what
could you tell him about his costs for inpa%ent hospital services under Original Medicare? -
Correct Answers Under Original Medicare, there is a single deduc%ble amount due for the first
60 days of any inpa%ent hospital stay, a4er which it converts into a per-day coinsurance amount
through day 90. A4er day 90, he would pay a daily amount up to 60 days over his life%me, a4er
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 Answers Medicare Supplemental Insurance would help cover his
,Part A deduc%ble 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 ci%zen and has contributed to the
Medicare system for over 20 years. Juan asks you if he will be en%tled to Medicare and if he
enrolls how that will impact his employer- sponsored healthcare coverage. How would you
respond? - Correct Answers 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 con%nue 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 con%nue to offer him coverage under its employer-sponsored group health plan
and would become a secondary payor.
Ms. Kumar plans to re%re when she turns 65 in a few months. She is in excellent health and will
have considerable income when she re%res. 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 Answers Medicare is a program for people age 65 or older and those under age 65
with certain disabili%es, end-stage renal disease, and Lou Gehrig's disease so she will be eligible
for Medicare.
Mrs. Ellis recently turned 66 and decided a4er many years of work to re%re and begin receiving
Social Security benefits. Shortly therea4er Mrs. Ellis received a le@er informing her that she had
been automa%cally enrolled in Medicare Part B. She wants to understand what this means.
What should you tell Mrs. Ellis? - Correct Answers Part B primarily covers physician services.
She will be paying a monthly premium and, except for many preven%ve and screening tests,
generally will have 20% co-payments for these services, in addi%on to an annual deduc%ble.
Mr. Singh would like drug coverage but does not want to be enrolled in a Medicare Advantage
plan. What should you tell him? - Correct Answers Mr. Singh can enroll in a stand-alone
prescrip%on drug plan and con%nue to be covered for Part A and Part B services through
Original Fee-for-Service Medicare.
, Mrs. Cook is an elderly re%ree. Mrs. Cook has a low fixed income. What could you tell Mrs.
Cook that might be of assistance? - Correct Answers She should contact her state Medicaid
agency to see if she qualifies for one of several programs that can help with Medicare costs for
which she is responsible.
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? - Correct Answers 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 Administra%on and has been receiving disability payments. He is wondering whether
he can obtain coverage under Medicare. What should you tell him? - Correct Answers A4er
receiving such disability payments for 24 months, he will be automa%cally enrolled in Medicare,
regardless of age.
Mr. Schmidt would like to plan for re%rement and has asked you what is covered under Original
Fee-for-Service (FFS) Medicare. What could you tell him? - Correct Answers 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
Re%rement 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 en%re 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 ini%al enrollment period expired. Anthony asks you how he can now obtain Medicare
coverage. What should you say? - Correct Answers Anthony is eligible for a special enrollment
period (SEP) because he missed an enrollment period due to the impact of the Federally
declared disaster. This SEP will allow Anthony to enroll in Part B up to six months a4er the end
of the emergency declara%on. Anthony may enroll in premium-free Part A at any %me and his
Part A coverage will be retroac%ve for up to 6 months.
Newest RATED A+ 2025/2026 NEW!!
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 Answers 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 mee%ng 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 Answers Tell prospect Jerry Smith that he
should consider adding a standalone Part D prescrip%on 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 prescrip%on drug costs? -
Correct Answers Mr. Wu may s%ll qualify for help in paying Part D costs through his State
Pharmaceu%cal Assistance Program (SPAP).
Mr. Vasquez is in good health and is preparing a budget in an%cipa%on of his re%rement when
he turns 66. He wants to understand the health care costs he might be exposed to under
Medicare if he were to require hospitaliza%on because of an illness. In general terms, what
could you tell him about his costs for inpa%ent hospital services under Original Medicare? -
Correct Answers Under Original Medicare, there is a single deduc%ble amount due for the first
60 days of any inpa%ent hospital stay, a4er which it converts into a per-day coinsurance amount
through day 90. A4er day 90, he would pay a daily amount up to 60 days over his life%me, a4er
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 Answers Medicare Supplemental Insurance would help cover his
,Part A deduc%ble 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 ci%zen and has contributed to the
Medicare system for over 20 years. Juan asks you if he will be en%tled to Medicare and if he
enrolls how that will impact his employer- sponsored healthcare coverage. How would you
respond? - Correct Answers 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 con%nue 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 con%nue to offer him coverage under its employer-sponsored group health plan
and would become a secondary payor.
Ms. Kumar plans to re%re when she turns 65 in a few months. She is in excellent health and will
have considerable income when she re%res. 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 Answers Medicare is a program for people age 65 or older and those under age 65
with certain disabili%es, end-stage renal disease, and Lou Gehrig's disease so she will be eligible
for Medicare.
Mrs. Ellis recently turned 66 and decided a4er many years of work to re%re and begin receiving
Social Security benefits. Shortly therea4er Mrs. Ellis received a le@er informing her that she had
been automa%cally enrolled in Medicare Part B. She wants to understand what this means.
What should you tell Mrs. Ellis? - Correct Answers Part B primarily covers physician services.
She will be paying a monthly premium and, except for many preven%ve and screening tests,
generally will have 20% co-payments for these services, in addi%on to an annual deduc%ble.
Mr. Singh would like drug coverage but does not want to be enrolled in a Medicare Advantage
plan. What should you tell him? - Correct Answers Mr. Singh can enroll in a stand-alone
prescrip%on drug plan and con%nue to be covered for Part A and Part B services through
Original Fee-for-Service Medicare.
, Mrs. Cook is an elderly re%ree. Mrs. Cook has a low fixed income. What could you tell Mrs.
Cook that might be of assistance? - Correct Answers She should contact her state Medicaid
agency to see if she qualifies for one of several programs that can help with Medicare costs for
which she is responsible.
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? - Correct Answers 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 Administra%on and has been receiving disability payments. He is wondering whether
he can obtain coverage under Medicare. What should you tell him? - Correct Answers A4er
receiving such disability payments for 24 months, he will be automa%cally enrolled in Medicare,
regardless of age.
Mr. Schmidt would like to plan for re%rement and has asked you what is covered under Original
Fee-for-Service (FFS) Medicare. What could you tell him? - Correct Answers 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
Re%rement 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 en%re 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 ini%al enrollment period expired. Anthony asks you how he can now obtain Medicare
coverage. What should you say? - Correct Answers Anthony is eligible for a special enrollment
period (SEP) because he missed an enrollment period due to the impact of the Federally
declared disaster. This SEP will allow Anthony to enroll in Part B up to six months a4er the end
of the emergency declara%on. Anthony may enroll in premium-free Part A at any %me and his
Part A coverage will be retroac%ve for up to 6 months.
