,2027 AHIP FINAL EXAM – MEDICARE
CERTIFICATION (QUESTIONS 1-200)
SECTION 1: MEDICARE BASICS & ELIGIBILITY
1. 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?
A) You can sell him a Medigap plan to help with costs not covered under
Medicare Advantage.
B) 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.
C) Medigap plans are designed to work alongside Medicare Advantage
plans.
D) He must disenroll from his MA plan before buying a Medigap plan.
*B) 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. *
Rationale: Medigap plans are supplemental policies that fill gaps in Original
Medicare (Parts A and B) coverage. Federal law prohibits issuance of a
Medigap policy to anyone currently enrolled in a Medicare Advantage plan;
Medigap cannot pay costs associated with MA. This ensures coordination of
benefits and prevents duplicate coverage.
,2. Mr. Diaz continued working with his company and was insured
under his employer's group plan until he reached age 68. He has heard
that there is a premium penalty for those who did not sign up for Part
B when first eligible and wants to know how much he will have to pay.
What should you tell him?
A) Mr. Diaz will pay a 10% penalty for each year he delayed enrollment.
B) Mr. Diaz will not pay any penalty because he had continuous coverage
under his employer's plan.
C) Mr. Diaz will pay a 20% penalty for each year he delayed enrollment.
D) Mr. Diaz must pay the full Part B premium with no penalty.
*B) Mr. Diaz will not pay any penalty because he had continuous
coverage under his employer's plan. *
Rationale: Individuals who have continuous creditable coverage under an
employer-sponsored group health plan are not subject to the Part B late
enrollment penalty when they eventually enroll. This is a critical protection
for those who continue working past age 65.
3. Madeline Martinez was widowed several years ago. Her husband
worked for many years and contributed into the Medicare system. He
also left a substantial estate which provides Madeline with an annual
income of approximately $130,000. Madeline, who has only worked
part-time for the last three years, will soon turn age 65 and hopes to
enroll in Original Medicare. What should you tell her?
A) Madeline will not qualify for Medicare because she has not worked
enough.
B) Madeline will be able to enroll in Medicare Part A without paying
monthly premiums due to her husband's long work record. She will pay
Part B premiums at more than the standard lowest rate but less than the
highest rate due to her substantial income.
C) Madeline will have to pay full premiums for both Part A and Part B.
D) Madeline should apply for Medicaid instead of Medicare.
, *B) Madeline will be able to enroll in Medicare Part A without paying
monthly premiums due to her husband's long work record. She will
pay Part B premiums at more than the standard lowest rate but less
than the highest rate due to her substantial income. *
Rationale: Madeline qualifies for premium-free Part A based on her
husband's work record. Part B premiums are income-adjusted under IRMAA
(Income-Related Monthly Adjustment Amount), meaning those with higher
incomes pay more than the standard premium but less than the highest rate.
4. Mr. Moy will soon turn age 65. He wants to understand what
coverage Medicare Supplemental Insurance provides. What could you
tell Mr. Moy?
A) It covers everything Original Medicare does not.
B) It provides prescription drug coverage.
C) Medicare Supplemental Insurance would help cover his Part A deductible
and Part B coinsurance or copayments in Original Fee-for-Service (FFS)
Medicare as well as possibly some services that Medicare does not cover.
D) It is only available for Medicare Advantage enrollees.
*C) Medicare Supplemental Insurance would help cover his Part A
deductible and Part B coinsurance or copayments in Original Fee-for-
Service (FFS) Medicare as well as possibly some services that Medicare
does not cover. *
Rationale: Medigap policies pay many out-of-pocket costs not covered by
Original Medicare, such as deductibles, coinsurance, and copayments. Some
plans also cover foreign travel emergency care. Medigap does not cover
services like long-term care, vision, dental, hearing aids, or private nursing.
CERTIFICATION (QUESTIONS 1-200)
SECTION 1: MEDICARE BASICS & ELIGIBILITY
1. 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?
A) You can sell him a Medigap plan to help with costs not covered under
Medicare Advantage.
B) 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.
C) Medigap plans are designed to work alongside Medicare Advantage
plans.
D) He must disenroll from his MA plan before buying a Medigap plan.
*B) 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. *
Rationale: Medigap plans are supplemental policies that fill gaps in Original
Medicare (Parts A and B) coverage. Federal law prohibits issuance of a
Medigap policy to anyone currently enrolled in a Medicare Advantage plan;
Medigap cannot pay costs associated with MA. This ensures coordination of
benefits and prevents duplicate coverage.
,2. Mr. Diaz continued working with his company and was insured
under his employer's group plan until he reached age 68. He has heard
that there is a premium penalty for those who did not sign up for Part
B when first eligible and wants to know how much he will have to pay.
What should you tell him?
A) Mr. Diaz will pay a 10% penalty for each year he delayed enrollment.
B) Mr. Diaz will not pay any penalty because he had continuous coverage
under his employer's plan.
C) Mr. Diaz will pay a 20% penalty for each year he delayed enrollment.
D) Mr. Diaz must pay the full Part B premium with no penalty.
*B) Mr. Diaz will not pay any penalty because he had continuous
coverage under his employer's plan. *
Rationale: Individuals who have continuous creditable coverage under an
employer-sponsored group health plan are not subject to the Part B late
enrollment penalty when they eventually enroll. This is a critical protection
for those who continue working past age 65.
3. Madeline Martinez was widowed several years ago. Her husband
worked for many years and contributed into the Medicare system. He
also left a substantial estate which provides Madeline with an annual
income of approximately $130,000. Madeline, who has only worked
part-time for the last three years, will soon turn age 65 and hopes to
enroll in Original Medicare. What should you tell her?
A) Madeline will not qualify for Medicare because she has not worked
enough.
B) Madeline will be able to enroll in Medicare Part A without paying
monthly premiums due to her husband's long work record. She will pay
Part B premiums at more than the standard lowest rate but less than the
highest rate due to her substantial income.
C) Madeline will have to pay full premiums for both Part A and Part B.
D) Madeline should apply for Medicaid instead of Medicare.
, *B) Madeline will be able to enroll in Medicare Part A without paying
monthly premiums due to her husband's long work record. She will
pay Part B premiums at more than the standard lowest rate but less
than the highest rate due to her substantial income. *
Rationale: Madeline qualifies for premium-free Part A based on her
husband's work record. Part B premiums are income-adjusted under IRMAA
(Income-Related Monthly Adjustment Amount), meaning those with higher
incomes pay more than the standard premium but less than the highest rate.
4. Mr. Moy will soon turn age 65. He wants to understand what
coverage Medicare Supplemental Insurance provides. What could you
tell Mr. Moy?
A) It covers everything Original Medicare does not.
B) It provides prescription drug coverage.
C) Medicare Supplemental Insurance would help cover his Part A deductible
and Part B coinsurance or copayments in Original Fee-for-Service (FFS)
Medicare as well as possibly some services that Medicare does not cover.
D) It is only available for Medicare Advantage enrollees.
*C) Medicare Supplemental Insurance would help cover his Part A
deductible and Part B coinsurance or copayments in Original Fee-for-
Service (FFS) Medicare as well as possibly some services that Medicare
does not cover. *
Rationale: Medigap policies pay many out-of-pocket costs not covered by
Original Medicare, such as deductibles, coinsurance, and copayments. Some
plans also cover foreign travel emergency care. Medigap does not cover
services like long-term care, vision, dental, hearing aids, or private nursing.
