AHIP -2025/ 2026 - Modules 1-5 Midterm Exam
Question & Answers (Guarantee A+) 100%
verified
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?-
--
ANSWER>>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.-
-
2. Agent-John-Miller-is-meeting-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?---ANSWER>>Tell-prospect-Jerry-Smith-that-he-should-consider-adding-a-
standalone-Part-D-prescription-drug-coverage-policy-to-his-present-coverage.-
-
3. 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-
prescription-drug-costs?---ANSWER>>Mr.-Wu-may-still-qualify-for-help-in-paying-
Part-D-costs-through-his-State-Pharmaceutical-Assistance-Program-(SPAP).-
-
4. Mr.-Vasquez-is-in-good-health-and-is-preparing-a-budget-in-anticipation-of-his-
retirement-when-he-turns-66.-He-wants-to-understand-the-health-care-costs-he-
might-be-exposed-to-under-Medicare-if-he-were-to-require-hospitalization-because-
of-an-illness.-In-general-terms,-what-could-you-tell-him-about-his-costs-for-inpatient-
hospital-services-under-Original-Medicare?---ANSWER>>Under-Original-
, Medicare,-there-is-a-single-deductible-amount-due-for-the-first-60-days-of-any-
inpatient-hospital-stay,-after-which-it-converts-
into-a-per-day-coinsurance-amount-through-day-90.-After-day-90,-he-would-pay-a-daily-
amount-up-to-60-days-over-his-lifetime,-after-which-he-would-be-responsible-for-all-costs.-
-
5. 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?---
ANSWER>>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.-
-
6. 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-employersponsored-healthcare-coverage.-Juan-is-a-naturalized-citizen-and-
has-contributed-to-the-Medicare-system-for-over-20-years.-Juan-asks-you-if-he-will-
be-entitled-to-Medicare-and-if-he-enrolls-how-that-will-impact-his-employer--
sponsored-healthcare-coverage.-How-would-you-respond?---ANSWER>>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-continue-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-continue-to-offer-him-coverage-under-
its-employer-sponsored-group-health-plan-and-would-become-a-secondary-payor.-
-
7. Ms.-Kumar-plans-to-retire-when-she-turns-65-in-a-few-months.-She-is-in-excellent-
health-and-will-have-considerable-income-when-she-retires.-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?---ANSWER>>Medicare-is-a-program-for-people-age-
65-or-older-and-those-under-age-65-with-certain-disabilities,-end-stage-renal-
disease,-and-Lou-Gehrig's-disease-so-she-will-be-eligible-for-Medicare.-
-
8. Mrs.-Ellis-recently-turned-66-and-decided-after-many-years-of-work-to-retire-and-
begin-receiving-Social-Security-benefits.-Shortly-thereafter-Mrs.-Ellis-received-a-
letter-informing-her-that-she-had-been-automatically-enrolled-in-Medicare-Part-B.-
, She-wants-to-understand-what-this-means.-What-should-you-tell-Mrs.-Ellis?---
ANSWER>>Part-B-
primarily-covers-physician-services.-She-will-be-paying-a-monthly-premium-and,-except-
for-many-preventive-and-screening-tests,-generally-will-have-20%-co-payments-for-these-
services,-in-addition-to-an-annual-deductible.-
-
9. Mr.-Singh-would-like-drug-coverage-but-does-not-want-to-be-enrolled-in-a-Medicare-
Advantage-plan.-What-should-you-tell-him?---ANSWER>>Mr.-Singh-can-enroll-in-a-
stand-alone-prescription-drug-plan-and-continue-to-be-covered-for-Part-A-and-Part-
B-
services-through-Original-Fee-for-Service-Medicare.-
-
10. Mrs.-Cook-is-an-elderly-retiree.-Mrs.-Cook-has-a-low-fixed-income.-What-could-you-
tell-Mrs.-Cook-that-might-be-of-assistance?---ANSWER>>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.-
-
11. 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?---ANSWER>>To-
obtain-Part-B-coverage,-she-must-pay-a-standard-monthly-premium,-though-it-is-
higher-for-individuals-with-higher-incomes.-
-
12. Mr.-Bauer-is-49-years-old,-but-eighteen-months-ago-he-was-declared-disabled-by-the-
Social-Security-Administration-and-has-been-receiving-disability-payments.-He-is-
wondering-whether-he-can-obtain-coverage-under-Medicare.-What-should-you-tell-
him?---ANSWER>>After-receiving-such-disability-payments-for-24-months,-he-will-
be-automatically-enrolled-in-Medicare,-regardless-of-age.-
-
13. Mr.-Schmidt-would-like-to-plan-for-retirement-and-has-asked-you-what-is-covered-
under-Original-Fee-for-Service-(FFS)-Medicare.-What-could-you-tell-him?---
ANSWER>>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.-
-
Question & Answers (Guarantee A+) 100%
verified
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?-
--
ANSWER>>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.-
-
2. Agent-John-Miller-is-meeting-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?---ANSWER>>Tell-prospect-Jerry-Smith-that-he-should-consider-adding-a-
standalone-Part-D-prescription-drug-coverage-policy-to-his-present-coverage.-
-
3. 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-
prescription-drug-costs?---ANSWER>>Mr.-Wu-may-still-qualify-for-help-in-paying-
Part-D-costs-through-his-State-Pharmaceutical-Assistance-Program-(SPAP).-
-
4. Mr.-Vasquez-is-in-good-health-and-is-preparing-a-budget-in-anticipation-of-his-
retirement-when-he-turns-66.-He-wants-to-understand-the-health-care-costs-he-
might-be-exposed-to-under-Medicare-if-he-were-to-require-hospitalization-because-
of-an-illness.-In-general-terms,-what-could-you-tell-him-about-his-costs-for-inpatient-
hospital-services-under-Original-Medicare?---ANSWER>>Under-Original-
, Medicare,-there-is-a-single-deductible-amount-due-for-the-first-60-days-of-any-
inpatient-hospital-stay,-after-which-it-converts-
into-a-per-day-coinsurance-amount-through-day-90.-After-day-90,-he-would-pay-a-daily-
amount-up-to-60-days-over-his-lifetime,-after-which-he-would-be-responsible-for-all-costs.-
-
5. 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?---
ANSWER>>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.-
-
6. 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-employersponsored-healthcare-coverage.-Juan-is-a-naturalized-citizen-and-
has-contributed-to-the-Medicare-system-for-over-20-years.-Juan-asks-you-if-he-will-
be-entitled-to-Medicare-and-if-he-enrolls-how-that-will-impact-his-employer--
sponsored-healthcare-coverage.-How-would-you-respond?---ANSWER>>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-continue-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-continue-to-offer-him-coverage-under-
its-employer-sponsored-group-health-plan-and-would-become-a-secondary-payor.-
-
7. Ms.-Kumar-plans-to-retire-when-she-turns-65-in-a-few-months.-She-is-in-excellent-
health-and-will-have-considerable-income-when-she-retires.-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?---ANSWER>>Medicare-is-a-program-for-people-age-
65-or-older-and-those-under-age-65-with-certain-disabilities,-end-stage-renal-
disease,-and-Lou-Gehrig's-disease-so-she-will-be-eligible-for-Medicare.-
-
8. Mrs.-Ellis-recently-turned-66-and-decided-after-many-years-of-work-to-retire-and-
begin-receiving-Social-Security-benefits.-Shortly-thereafter-Mrs.-Ellis-received-a-
letter-informing-her-that-she-had-been-automatically-enrolled-in-Medicare-Part-B.-
, She-wants-to-understand-what-this-means.-What-should-you-tell-Mrs.-Ellis?---
ANSWER>>Part-B-
primarily-covers-physician-services.-She-will-be-paying-a-monthly-premium-and,-except-
for-many-preventive-and-screening-tests,-generally-will-have-20%-co-payments-for-these-
services,-in-addition-to-an-annual-deductible.-
-
9. Mr.-Singh-would-like-drug-coverage-but-does-not-want-to-be-enrolled-in-a-Medicare-
Advantage-plan.-What-should-you-tell-him?---ANSWER>>Mr.-Singh-can-enroll-in-a-
stand-alone-prescription-drug-plan-and-continue-to-be-covered-for-Part-A-and-Part-
B-
services-through-Original-Fee-for-Service-Medicare.-
-
10. Mrs.-Cook-is-an-elderly-retiree.-Mrs.-Cook-has-a-low-fixed-income.-What-could-you-
tell-Mrs.-Cook-that-might-be-of-assistance?---ANSWER>>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.-
-
11. 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?---ANSWER>>To-
obtain-Part-B-coverage,-she-must-pay-a-standard-monthly-premium,-though-it-is-
higher-for-individuals-with-higher-incomes.-
-
12. Mr.-Bauer-is-49-years-old,-but-eighteen-months-ago-he-was-declared-disabled-by-the-
Social-Security-Administration-and-has-been-receiving-disability-payments.-He-is-
wondering-whether-he-can-obtain-coverage-under-Medicare.-What-should-you-tell-
him?---ANSWER>>After-receiving-such-disability-payments-for-24-months,-he-will-
be-automatically-enrolled-in-Medicare,-regardless-of-age.-
-
13. Mr.-Schmidt-would-like-to-plan-for-retirement-and-has-asked-you-what-is-covered-
under-Original-Fee-for-Service-(FFS)-Medicare.-What-could-you-tell-him?---
ANSWER>>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.-
-
