AHIP - 2026 - MODULES 1-5 Q AND A

AHIP - 2026 - MODULES 1-5 Q AND A

Mr.nkCapadonankwouldnklikenktonkpurchasenkankMedicarenkAdvantagenk(MA)nkplannkandnkan
kMedigapnkplannktonkpicknkupnkcostsnknotnkcoverednkbynkthatnkplan.nkWhatnkshouldnkyounktell

nkhim?nk-nkanswer--

ItnkisnkillegalnkfornkyounktonksellnkMr.nkCapadonankankMedigapnkplannkifnkhenkisnkenrollednkinnka
nnkMAnkplan,nkandnkbesides,nkMedigapnkonlynkworksnkwithnkOriginalnkMedicare.

AgentnkJohnnkMillernkisnkmeetingnkwithnkJerrynkSmith,nkanknewnkprospect.nkJerrynkisnkcurren
tlynkenrollednkinnkMedicarenkPartsnkAnkandnkB.nkJerrynkhasnkalsonkpurchasednkankMedicarenk
Supplementnk(Medigap)nkplannkwhichnkhenkhasnkhadnkfornkseveralnkyears.nkHowever,nkthen
kplannkdoesnknotnkprovidenkdrugnkbenefits.nkHownkwouldnkyounkadvisenkAgentnkJohnnkMiller

nktonkproceed?nk-nkanswer--

TellnkprospectnkJerrynkSmithnkthatnkhenkshouldnkconsidernkaddingnkankstandalonenkPartnkDn
kprescriptionnkdrugnkcoveragenkpolicynktonkhisnkpresentnkcoverage.



Mr.nkWunkisnkeligiblenkfornkMedicare.nkHenkhasnklimitednkfinancialnkresourcesnkbutnkfailednkt
onkqualifynkfornkthenkPartnkDnklow-
incomenksubsidy.nkWherenkmightnkhenkturnnkfornkhelpnkwithnkhisnkprescriptionnkdrugnkcosts
?nk-nkanswer--
Mr.nkWunkmaynkstillnkqualifynkfornkhelpnkinnkpayingnkPartnkDnkcostsnkthroughnkhisnkStatenkPha
rmaceuticalnkAssistancenkProgramnk(SPAP).

Mr.nkVasqueznkisnkinnkgoodnkhealthnkandnkisnkpreparingnkankbudgetnkinnkanticipationnkofnkhis
nkretirementnkwhennkhenkturnsnk66.nkHenkwantsnktonkunderstandnkthenkhealthnkcarenkcostsnk

henkmightnkbenkexposednktonkundernkMedicarenkifnkhenkwerenktonkrequirenkhospitalizationnkb
ecausenkofnkannkillness.nkInnkgeneralnkterms,nkwhatnkcouldnkyounktellnkhimnkaboutnkhisnkcost
snkfornkinpatientnkhospitalnkservicesnkundernkOriginalnkMedicare?nk-nkanswer--
UndernkOriginalnkMedicare,nktherenkisnkanksinglenkdeductiblenkamountnkduenkfornkthenkfirstnk
60nkdaysnkofnkanynkinpatientnkhospitalnkstay,nkafternkwhichnkitnkconvertsnkintonkankper-
daynkcoinsurancenkamountnkthroughnkdaynk90.nkAfternkdaynk90,nkhenkwouldnkpaynkankdailynk
amountnkupnktonk60nkdaysnkovernkhisnklifetime,nkafternkwhichnkhenkwouldnkbenkresponsiblenkf
ornkallnkcosts.

Mr.nkMoynkwillnksoonnkturnnkagenk65.nkHenkisnkslightlynkyoungernkthannkhisnkwife.nkMr.nkMoy's
nkwifenkhasnkankMedicarenkAdvantagenkplan,nkbutnkhenkwantsnktonkunderstandnkwhatnkcover

agenkMedicarenkSupplementalnkInsurancenkprovidesnksincenkhisnkhealthnkcarenkneedsnkar
enkdifferentnkfromnkhisnkwife'snkneeds.nkWhatnkcouldnkyounktellnkMr.nkMoy?nk-nkanswer--
MedicarenkSupplementalnkInsurancenkwouldnkhelpnkcovernkhisnkPartnkAnkdeductiblenkandnk
PartnkBnkcoinsurancenkornkcopaymentsnkinnkOriginalnkFee-for-
Servicenk(FFS)nkMedicarenkasnkwellnkasnkpossiblynksomenkservicesnkthatnkMedicarenkdoes
nknotnkcover.



JuannkPerez,nkwhonkisnkturningnkagenk65nknextnkmonth,nkintendsnktonkworknkfornkseveralnkm
orenkyearsnkatnkSmallcap,nkIncorporated.nkSmallcapnkhasnkankworkforcenkofnk15nkemploye
esnkandnkoffersnkemployer-

,sponsorednkhealthcarenkcoverage.nkJuannkisnkanknaturalizednkcitizennkandnkhasnkcontribut
ednktonkthenkMedicarenksystemnkfornkovernk20nkyears.nkJuannkasksnkyounkifnkhenkwillnkbenkenti
tlednktonkMedicarenkandnkifnkhenkenrollsnkhownkthatnkwillnkimpactnkhisnkemployer-
nksponsorednkhealthcarenkcoverage.nkHownkwouldnkyounkrespond?nk-nkanswer--

JuannkisnklikelynktonkbenkeligiblenkfornkMedicarenkoncenkhenkturnsnkagenk65nkandnkifnkhenkenro
lls,nkMedicarenkwouldnkbecomenkthenkprimarynkpayornkofnkhisnkhealthcarenkclaimsnkandnkS
mallcapnkdoesnknotnkhavenktonkcontinuenktonkoffernkhimnkcoveragenkcomparablenktonkthosen
kundernkagenk65nkundernkitsnkemployer-

sponsorednkgroupnkhealthnkplan.nkJuannkisnklikelynktonkbenkeligiblenkfornkMedicarenkoncenkh
enkturnsnkagenk65nkandnkifnkhenkenrolls,nkMedicarenkwouldnkbecomenkthenkprimarynkpayornko
fnkhisnkhealthcarenkclaimsnkbutnkSmallcapnkmustnkcontinuenktonkoffernkhimnkcoveragenkund
ernkitsnkemployer-
sponsorednkgroupnkhealthnkplannkandnkwouldnkbecomenkanksecondarynkpayor.

Ms.nkKumarnkplansnktonkretirenkwhennkshenkturnsnk65nkinnkankfewnkmonths.nkShenkisnkinnkexc
ellentnkhealthnkandnkwillnkhavenkconsiderablenkincomenkwhennkshenkretires.nkShenkisnkconc
ernednkthatnkhernkincomenkwillnkmakenkitnkimpossiblenkfornkhernktonkqualifynkfornkMedicare.nk
Whatnkcouldnkyounktellnkhernktonkaddressnkhernkconcern?nk-nkanswer--
Medicarenkisnkankprogramnkfornkpeoplenkagenk65nkornkoldernkandnkthosenkundernkagenk65nkwi
thnkcertainnkdisabilities,nkend-
stagenkrenalnkdisease,nkandnkLounkGehrig'snkdiseasenksonkshenkwillnkbenkeligiblenkfornkMedi
care.

Mrs.nkEllisnkrecentlynkturnednk66nkandnkdecidednkafternkmanynkyearsnkofnkworknktonkretirenka
ndnkbeginnkreceivingnkSocialnkSecuritynkbenefits.nkShortlynkthereafternkMrs.nkEllisnkreceive
dnkankletternkinformingnkhernkthatnkshenkhadnkbeennkautomaticallynkenrollednkinnkMedicarenk
PartnkB.nkShenkwantsnktonkunderstandnkwhatnkthisnkmeans.nkWhatnkshouldnkyounktellnkMrs.nk
Ellis?nk-nkanswer--
PartnkBnkprimarilynkcoversnkphysiciannkservices.nkShenkwillnkbenkpayingnkankmonthlynkpremi
umnkand,nkexceptnkfornkmanynkpreventivenkandnkscreeningnktests,nkgenerallynkwillnkhavenk2
0%nkco-paymentsnkfornkthesenkservices,nkinnkadditionnktonkannkannualnkdeductible.

Mr.nkSinghnkwouldnklikenkdrugnkcoveragenkbutnkdoesnknotnkwantnktonkbenkenrollednkinnkankMe
dicarenkAdvantagenkplan.nkWhatnkshouldnkyounktellnkhim?nk-nkanswer--
Mr.nkSinghnkcannkenrollnkinnkankstand-
alonenkprescriptionnkdrugnkplannkandnkcontinuenktonkbenkcoverednkfornkPartnkAnkandnkPartnk
BnkservicesnkthroughnkOriginalnkFee-for-ServicenkMedicare.

Mrs.nkCooknkisnkannkelderlynkretiree.nkMrs.nkCooknkhasnkanklownkfixednkincome.nkWhatnkcoul
dnkyounktellnkMrs.nkCooknkthatnkmightnkbenkofnkassistance?nk-nkanswer--
ShenkshouldnkcontactnkhernkstatenkMedicaidnkagencynktonkseenkifnkshenkqualifiesnkfornkonenk
ofnkseveralnkprogramsnkthatnkcannkhelpnkwithnkMedicarenkcostsnkfornkwhichnkshenkisnkrespo
nsible.

Ms.nkHendersonnkbelievesnkthatnkshenkwillnkqualifynkfornkMedicarenkCoveragenkwhennkshen
kturnsnk65,nkwithoutnkpayingnkanynkpremiums,nkbecausenkshenkhasnkbeennkworkingnkfornk40

nkyearsnkandnkpayingnkMedicarenktaxes.nkWhatnkshouldnkyounktellnkher?nk-nkanswer--

TonkobtainnkPartnkBnkcoverage,nkshenkmustnkpaynkankstandardnkmonthlynkpremium,nkthoug
hnkitnkisnkhighernkfornkindividualsnkwithnkhighernkincomes.

, Mr.nkBauernkisnk49nkyearsnkold,nkbutnkeighteennkmonthsnkagonkhenkwasnkdeclarednkdisabled
nkbynkthenkSocialnkSecuritynkAdministrationnkandnkhasnkbeennkreceivingnkdisabilitynkpayme

nts.nkHenkisnkwonderingnkwhethernkhenkcannkobtainnkcoveragenkundernkMedicare.nkWhatnks
houldnkyounktellnkhim?nk-nkanswer--
Afternkreceivingnksuchnkdisabilitynkpaymentsnkfornk24nkmonths,nkhenkwillnkbenkautomatically
nkenrollednkinnkMedicare,nkregardlessnkofnkage.



Mr.nkSchmidtnkwouldnklikenktonkplannkfornkretirementnkandnkhasnkaskednkyounkwhatnkisnkcove
rednkundernkOriginalnkFee-for-Servicenk(FFS)nkMedicare.nkWhatnkcouldnkyounktellnkhim?nk-
nkanswer--

PartnkA,nkwhichnkcoversnkhospital,nkskillednknursingnkfacility,nkhospice,nkandnkhomenkhealth
nkservicesnkandnkPartnkB,nkwhichnkcoversnkprofessionalnkservicesnksuchnkasnkthosenkprovid

ednkbynkankdoctornkarenkcoverednkundernkOriginalnkMedicare.

AnthonynkBonifacenkturnednk65nkinnk2024.nkHenkwasnknotnkreceivingnkSocialnkSecuritynkornk
RailroadnkRetirementnkBenefitsnkonnkhisnk65thnkbirthday.nkHenkwasnkinterestednkinnkobtaini
ngnkMedicarenkcoveragenkandnkisnkeligiblenkfornkpremium-
freenkPartnkA.nkBeforenkhenkcouldnkenrollnkinnkMedicare,nkhisnkentirenkareankwasnkimpactednk
bynkankhurricanenkcausingnkmassivenkfloodingnkandnkseverenkwindnkdamage.nkThenkFeder
alnkgovernmentnkdeclarednkthisnktonkbenkanknaturalnkdisasternkwhichnkhasnkrecentlynkended
.nkDuringnkthisnkperiodnkAnthony'snkinitialnkenrollmentnkperiodnkexpired.nkAnthonynkasksnky
ounkhownkhenkcannknownkobtainnkMedicarenkcoverage.nkWhatnkshouldnkyounksay?nk-
nkanswer--

Anthonynkisnkeligiblenkfornkankspecialnkenrollmentnkperiodnk(SEP)nkbecausenkhenkmissednka
nnkenrollmentnkperiodnkduenktonkthenkimpactnkofnkthenkFederallynkdeclarednkdisaster.nkThisnk
SEPnkwillnkallownkAnthonynktonkenrollnkinnkPartnkBnkupnktonksixnkmonthsnkafternkthenkendnkofnkt
henkemergencynkdeclaration.nkAnthonynkmaynkenrollnkinnkpremium-
freenkPartnkAnkatnkanynktimenkandnkhisnkPartnkAnkcoveragenkwillnkbenkretroactivenkfornkupnktonk
6nkmonths.

Ms.nkLewisnkhasnkaggressivenkcancernkandnkwouldnklikenktonkknownkifnkMedicarenkwillnkcove
rnkhospicenkservicesnkinnkcasenkshenkneedsnkthem.nkWhatnkshouldnkyounktellnkher?nk-
nkanswer--Medicarenkcoversnkhospicenkservices,nkandnktheynkwillnkbenkavailablenkfornkher.



Edwardnksufferednkfromnkseriousnkkidneynkdisease.nkAsnkankresult,nkEdwardnkbecamenkeli
giblenkfornkMedicarenkcoveragenkduenktonkend-
stagenkrenalnkdiseasenk(ESRD).nkAnkclosenkrelativenkdonatednktheirnkkidneynkandnkEdward
nksuccessfullynkunderwentnktransplantnksurgerynk12nkmonthsnkago.nkEdwardnkisnknownkage

nk50nkandnkasksnkyounkifnkhisnkMedicarenkcoveragenkwillnkcontinue,nkwhatnkshouldnkyounksay

?nk-nkanswer--
IndividualsnkeligiblenkfornkMedicarenkbasednkonnkESRDnkgenerallynklosenkeligibilitynk36nkm
onthsnkafternkthenkmonthnkinnkwhichnkthenkindividualnkreceivesnkankkidneynktransplantnkunle
ssnktheynkarenkeligiblenkfornkMedicarenkonnkanothernkbasisnksuchnkasnkagenkornkdisability.nkE
dwardnkmay,nkhowever,nkremainnkenrollednkinnkPartnkBnkbutnksolelynkfornkcoveragenkofnkim
munosuppressivenkdrugsnkifnkhenkhasnknonkothernkhealthnkcarenkcoveragenkthatnkwouldnkco
vernkthenkdrugs.

Mrs.nkFosternkisnkcoverednkbynkOriginalnkMedicare.nkShenksustainednkankhipnkfracturenkandn
kisnkbeingnksuccessfullynktreatednkfornkthatnkcondition.nkHowever,nkshenkandnkhernkphysicia

nsnkfeelnkthatnkafternkhernklengthynkhospitalnkstay,nkshenkwillnkneednkankmonthnkornktwonkofnkn