AHIP 2026
AHIP 2026
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1. Mr. Schmidt would like to plan for retirement Part A, which covers hospital, skilled
and has asked you what is covered under Orig- nursing facility, hospice, and home
inal Fee-for-Service (FFS) Medicare. What could health services and Part B, which
you tell him? covers professional services such
as those provided by a doctor are
covered under Original Medicare.
2. Mrs. Cook is an elderly retiree. Mrs. Cook has a She should contact her state Med-
low fixed income. What could you tell Mrs. Cook icaid agency to see if she qualifies
that might be of assistance? for one of the several programs that
can help with Medicare costs for
which she is responsible.
3. Mr. Moy will soon turn age 65. He is slight- Medicare supplemental insurance
ly younger than his wife. Mr. Moy's wife has would help cover his Part A
a Medicare Advantage plan, but he wants to deductible and Part B coinsur-
understand what coverage Medicare Supple- ance or copayments in Original
mental insurance provides since his health care Fee-for-Service (FFS) Medicare as
needs are different from his wife's needs. What well as possibly some services that
could you tell Mr. Moy? Medicare does not cover
4. Mr. Vasquez is in good health and is prepar- Under Original Medicare, there is a
ing a budget in anticipation of his retirement single deductible amount due for
when he turns 66. He wants to understand the the first 60 days of any inpatient
health care costs he might be exposed to under hospital stay, after which it converts
Medicare is he were to require hospitalization into a per-day coinsurance amount
because of an illness. In general terms, what through day 90. After day 90, he
could you tell him about his costs for inpatient would pay a daily amount up to 60
hospital services under Original Medicare? days over his lifetime, after which
he would be responsible for all
costs
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AHIP 2026
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5. Mr. Wu is eligible for Medicare. He has limited Mr. Wu may still qualify for help
financial resources but failed to qualify for the in paying Part D costs through
Part D low-income subsidy. Where might he turn his State Pharmaceutical Assistance
for help with his prescription drug costs? program (SPAP)
6. Ms. Henderson believes that she will qualify for To obtain Part B coverage, she must
Medicare Coverage when she turns 65, without pay a standard monthly premium,
paying any premiums, because she has been though it is higher for individuals
working for 40 years and paying Medicare taxes. with higher income
What should you tell her?
7. Agent John Miller is meeting with Jerry Smith, Tell prospect Jerry Smith that he
a new prospect. Jerry is currently enrolled in should consider adding a stand-
Medicare Parts A and B. Jerry has also purchased alone Part D prescription drug cov-
a Medicare Supplement (Medigap) plan which erage policy to his present cover-
he has had for several years. However, the plan age
does not provide drug benefits. How would you
advise Agent John Miller to proceed?
8. Madeline Martinez was widowed several years You should tell Madeline that she
ago. Her husband worked for many years and will be able to enroll in Medicare
contributed into the Medicare system. He also Part A without paying monthly pre-
left a substantial estate which provides Made- miums due to her husband's long
line with an annual income of approximate- work record and participation in
ly $130,000. Madeline, who has only worked the Medicare system. You should
part-time for the last three years, will soon turn also tell Madeline that she will pay
age 65 and hopes to enroll in Original Medicare. Part B premiums at more than the
She comes to you for advice. What should you standard lowest rate but less than
tell her? the highest rate due her substantial
income
9. Ms. Kumar plans to retire when she turns 65 Medicare is a program for peo-
in a few months. She is in excellent health and ple age 65 or older and those un-
, AHIP 2026
AHIP 2026
Study online at https://quizlet.com/_hi0io6
will have considerable income when she retires. der age 65 with certain disabilities,
She is concerned that her income will make it end-stage renal disease, and Lou
impossible for her to qualify for Medicare. What Gehrig's disease so she will be eli-
could you tell her to address her concern? gible for Medicare
10. Edward suffered from serious kidney disease. As Individuals eligible for Medicare
a result. Edward became eligible for Medicare based on ESRD generally lose eligi-
coverage due to end-stage renal disease (ESRD). bility 36 months after the month in
A close relative donated their kidney and Ed- which the individual receives a kid-
ward successfully underwent transplant surgery ney transplant unless they are eligi-
12 months ago. Edward is now age 50 and asks ble for Medicare on another basis
you if his Medicare coverage will continue, what such as age or disability. Edward
should you say? may, however, remain enrolled in
Part B but solely for coverage of im-
munosuppressive drugs if he has
no other health care coverage that
would cover the drugs.
11. Mrs. Thomas is 66 years old, has coverage under She may enroll at any time while
an employer plan, and will retire next year. She she is covered under her employer
heard she must enroll in Part B at the beginning plan, but she will have a special
of the year to ensure no gap in coverage. What eight-month enrollment period af-
can you tell her? ter the last month on her employer
plan that differs from the standard
general enrollment period, during
which she may enroll in Medicare
Part B.
12. Ms. Lewis has aggressive cancer and would like Medicare covers hospice services,
to know if Medicare will cover hospice services in and they will be available for her
case she needs them. What should you tell her?
13.
AHIP 2026
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1. Mr. Schmidt would like to plan for retirement Part A, which covers hospital, skilled
and has asked you what is covered under Orig- nursing facility, hospice, and home
inal Fee-for-Service (FFS) Medicare. What could health services and Part B, which
you tell him? covers professional services such
as those provided by a doctor are
covered under Original Medicare.
2. Mrs. Cook is an elderly retiree. Mrs. Cook has a She should contact her state Med-
low fixed income. What could you tell Mrs. Cook icaid agency to see if she qualifies
that might be of assistance? for one of the several programs that
can help with Medicare costs for
which she is responsible.
3. Mr. Moy will soon turn age 65. He is slight- Medicare supplemental insurance
ly younger than his wife. Mr. Moy's wife has would help cover his Part A
a Medicare Advantage plan, but he wants to deductible and Part B coinsur-
understand what coverage Medicare Supple- ance or copayments in Original
mental insurance provides since his health care Fee-for-Service (FFS) Medicare as
needs are different from his wife's needs. What well as possibly some services that
could you tell Mr. Moy? Medicare does not cover
4. Mr. Vasquez is in good health and is prepar- Under Original Medicare, there is a
ing a budget in anticipation of his retirement single deductible amount due for
when he turns 66. He wants to understand the the first 60 days of any inpatient
health care costs he might be exposed to under hospital stay, after which it converts
Medicare is he were to require hospitalization into a per-day coinsurance amount
because of an illness. In general terms, what through day 90. After day 90, he
could you tell him about his costs for inpatient would pay a daily amount up to 60
hospital services under Original Medicare? days over his lifetime, after which
he would be responsible for all
costs
, AHIP 2026
AHIP 2026
Study online at https://quizlet.com/_hi0io6
5. Mr. Wu is eligible for Medicare. He has limited Mr. Wu may still qualify for help
financial resources but failed to qualify for the in paying Part D costs through
Part D low-income subsidy. Where might he turn his State Pharmaceutical Assistance
for help with his prescription drug costs? program (SPAP)
6. Ms. Henderson believes that she will qualify for To obtain Part B coverage, she must
Medicare Coverage when she turns 65, without pay a standard monthly premium,
paying any premiums, because she has been though it is higher for individuals
working for 40 years and paying Medicare taxes. with higher income
What should you tell her?
7. Agent John Miller is meeting with Jerry Smith, Tell prospect Jerry Smith that he
a new prospect. Jerry is currently enrolled in should consider adding a stand-
Medicare Parts A and B. Jerry has also purchased alone Part D prescription drug cov-
a Medicare Supplement (Medigap) plan which erage policy to his present cover-
he has had for several years. However, the plan age
does not provide drug benefits. How would you
advise Agent John Miller to proceed?
8. Madeline Martinez was widowed several years You should tell Madeline that she
ago. Her husband worked for many years and will be able to enroll in Medicare
contributed into the Medicare system. He also Part A without paying monthly pre-
left a substantial estate which provides Made- miums due to her husband's long
line with an annual income of approximate- work record and participation in
ly $130,000. Madeline, who has only worked the Medicare system. You should
part-time for the last three years, will soon turn also tell Madeline that she will pay
age 65 and hopes to enroll in Original Medicare. Part B premiums at more than the
She comes to you for advice. What should you standard lowest rate but less than
tell her? the highest rate due her substantial
income
9. Ms. Kumar plans to retire when she turns 65 Medicare is a program for peo-
in a few months. She is in excellent health and ple age 65 or older and those un-
, AHIP 2026
AHIP 2026
Study online at https://quizlet.com/_hi0io6
will have considerable income when she retires. der age 65 with certain disabilities,
She is concerned that her income will make it end-stage renal disease, and Lou
impossible for her to qualify for Medicare. What Gehrig's disease so she will be eli-
could you tell her to address her concern? gible for Medicare
10. Edward suffered from serious kidney disease. As Individuals eligible for Medicare
a result. Edward became eligible for Medicare based on ESRD generally lose eligi-
coverage due to end-stage renal disease (ESRD). bility 36 months after the month in
A close relative donated their kidney and Ed- which the individual receives a kid-
ward successfully underwent transplant surgery ney transplant unless they are eligi-
12 months ago. Edward is now age 50 and asks ble for Medicare on another basis
you if his Medicare coverage will continue, what such as age or disability. Edward
should you say? may, however, remain enrolled in
Part B but solely for coverage of im-
munosuppressive drugs if he has
no other health care coverage that
would cover the drugs.
11. Mrs. Thomas is 66 years old, has coverage under She may enroll at any time while
an employer plan, and will retire next year. She she is covered under her employer
heard she must enroll in Part B at the beginning plan, but she will have a special
of the year to ensure no gap in coverage. What eight-month enrollment period af-
can you tell her? ter the last month on her employer
plan that differs from the standard
general enrollment period, during
which she may enroll in Medicare
Part B.
12. Ms. Lewis has aggressive cancer and would like Medicare covers hospice services,
to know if Medicare will cover hospice services in and they will be available for her
case she needs them. What should you tell her?
13.
