2026 AHIP Final Exam – Verified Edition with Rationales

,2026 ahip final exam verified edition with r x4 x4 x4 x4 x4 x4 x4




ationales
Mr. Capadona would like to purchase a Medicare Advantage (MA) plan and a Medigap plan to pi ckpup
x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4




costs not covered by that plan. What should you tell him? -
x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4




CORRECT ANSWERSIt is illegal for you to sell Mr. Capadona a Medigap plan if he is enrolled in an MA x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4




plan, and besides, Medigap only works with Original Medicare.
x4 x4 x4 x4 x4 x4 x4 x4 x4




Agent John Miller is meeting with Jerry Smith, a new prospect. Jerry is currently enrolled in Med icare
x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4




Parts Apand B. Jerry has also purchased a Medicare Supplement (Medigap) plan which he h as had for
x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4




several years. However, the plan does not provide drug benefits. How would you advi se Agent John
x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4




Miller to proceed? -
x4 x4 x4 x4




CORRECT ANSWERSTell prospect Jerry Smith that he should consider adding a standalone Part D x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4




prescription drug coverage policy to his present coverage.
x4 x4 x4 x4 x4 x4 x4 x4




Mr. Wu is eligible for Medicare. He has limited financial resources but failed to qualify for the Pa rt D
x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4




low-income subsidy. Where might he turn for help with his prescription drug costs? -
x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4




CORRECT ANSWERSMr. Wu may still qualify for help in paying Part D costs through his State Pha x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4




rmaceutical Assistance Program (SPAP).
x4 x4 x4 x4




Mr. Vasquez is in good health and is preparing a budget in anticipation of his retirement when h e turns
x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4




66. He wants to understand the health care costs he might be exposed to under Medicar e if he were to
x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4




require hospitalization because of an illness. In general terms, what could you tell him about his costs
x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4




for inpatient hospital services under Original Medicare? -
x4 x4 x4 x4 x4 x4 x4 x4




CORRECT ANSWERSUnder Original Medicare, there is a single deductible amount due for the fir st 60
x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4




days of any inpatient hospital stay, after which it converts into a per-
x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4




day coinsurance amount through day 90. After day 90, he would pay a daily amount up to 60da ys over
x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4




his lifetime, after which he would be responsible for all costs.
x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4




Mr. Moy will soon turn age 65. He is slightly younger than his wife. Mr. Moy's wife has a Medicar e
x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4




Advantage plan, but he wants to understand what coverage Medicare Supplemental Insurance
x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4




provides since his health care needs are different from his wife's needs. What could you tell Mr. Moy?
x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4




-
x4

, CORRECT ANSWERSMedicare Supplemental Insurance would help cover his Part A deductible a nd x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4




Part B coinsurance or copayments in Original Fee-for-
x4 x4 x4 x4 x4 x4 x4 x4




Service(FFS) Medicare as well aspossibly some services thatMedicare does not cover.
x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4




Juan Perez, who is turning age 65 next month, intends to work for several more years at Smallca p,
x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4




Incorporated. Smallcap has a workforce of 15 employees and offers employer-
x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4




sponsored healthcare coverage. Juan is a naturalized citizen and has contributed to the Medicar e x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4




system for over 20 years. Juan asks you if he will be entitled to Medicare and if he enrolls how that will
x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4




impact his employer- sponsored healthcare coverage. How would you respond? -
x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4




CORRECT ANSWERSJuan is likely to be eligible forMedicare oncehe turnsage 65 and ifheenrol ls, x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4




Medicare wouldbecome the primarypayor ofhis healthcare claims andSmallcap does notha ve to
x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4




continue to offer him coverage comparable to those under age 65 under its employer- sponsored
x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4




group health plan. Juan is likelyto be eligible for Medicare oncehe turns age 65 and i f he enrolls,
x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4




Medicare would become the primary payor of his healthcare claims but Smallcap m ust continue to
x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4




offer him coverage under its employer-
x4 x4 x4 x4 x4 x4




sponsoredgrouphealthplan andwouldbecomea secondary payor. x4 x4 x4 x4 x4 x4 x4 x4 x4




Ms. Kumar plans to retire when she turns 65 in a few months. She is in excellent health and will have
x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4




considerableincomewhensheretires.Sheisconcernedthatherincomewillmakeitimpos sible for her
x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4




to qualify for Medicare. What could you tell her to address her concern? -
x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4




CORRECTANSWERSMedicare isaprogramforpeople age65orolderandthose underage65wi th x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4




certain disabilities, end-
x4 x4 x4




stagerenaldisease, andLou Gehrig'sdisease soshe willbeeligible for Medicare.
x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4




Mrs. Ellis recently turned 66 and decided after many years of work to retire and begin receiving Social
x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4




Security benefits. Shortly thereafter Mrs. Ellis received a letter informing her that she had been
x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4




automatically enrolled in Medicare Part B. She wants to understand whatpthis means. Wha t should
x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4




you tell Mrs. Ellis? -
x4 x4 x4 x4 x4




CORRECTANSWERSPartBprimarilycoversphysicianservices.Shewillbepayingamonthlypre mium x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4




and, except for many preventive and screening tests, generally will have 20% co- payments for these
x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4




services, in addition to an annual deductible.
x4 x4 x4 x4 x4 x4 x4




Mr.SinghwouldlikedrugpcoveragebutdoesnotwanttobeenrolledinaMedicareAdvantagepl an.
x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4




What should you tell him? - CORRECT ANSWERSMr. Singh can enroll in a stand-
x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4 x4