2026 AHIP Final Exam – Verified Edition with m m m m m m m
Rationales
Mr. Capadona would like to purchase a Medicare Advantage (MA) plan and a Medigap plan to pi
m m m m m m m m m m m m m m m m
ckpup costs not covered by that plan. What should you tell him? -
m m m m m m m m m m m m m
CORRECT ANSWERSIt is illegal for you to sell Mr. Capadona a Medigap plan if he is enrolled in an
m m m m m m m m m m m m m m m m m m
MA plan, and besides, Medigap only works with Original Medicare.
m m m m m m m m m m
Agent John Miller is meeting with Jerry Smith, a new prospect. Jerry is currently enrolled in Med
m m m m m m m m m m m m m m m m
icare Parts Apand B. Jerry has also purchased a Medicare Supplement (Medigap) plan which he
m m m m m m m m m m m m m m m
h as had for several years. However, the plan does not provide drug benefits. How would you
m m m m m m m m m m m m m m m m m
advi se Agent John Miller to proceed? -
m m m m m m m m
CORRECT ANSWERSTell prospect Jerry Smith that he should consider adding a standalone Part D
m m m m m m m m m m m m m
prescription drug coverage policy to his present coverage.
m m m m m m m m
Mr. Wu is eligible for Medicare. He has limited financial resources but failed to qualify for the Pa
m m m m m m m m m m m m m m m m m
rt D low-income subsidy. Where might he turn for help with his prescription drug costs? -
m m m m m m m m m m m m m m m m
CORRECT ANSWERSMr. Wu may still qualify for help in paying Part D costs through his State Pha
m m m m m m m m m m m m m m m m
rmaceutical Assistance Program (SPAP).
m m m m
Mr. Vasquez is in good health and is preparing a budget in anticipation of his retirement when
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h e turns 66. He wants to understand the health care costs he might be exposed to under
m m m m m m m m m m m m m m m m m m
Medicar e if he were to require hospitalization because of an illness. In general terms, what
m m m m m m m m m m m m m m m m
could you tell him about his costs for inpatient hospital services under Original Medicare? -
m m m m m m m m m m m m m m m
CORRECT ANSWERSUnder Original Medicare, there is a single deductible amount due for the fir
m m m m m m m m m m m m m
st 60 days of any inpatient hospital stay, after which it converts into a per-
m m m m m m m m m m m m m m m
day coinsurance amount through day 90. After day 90, he would pay a daily amount up to 60 da
m m m m m m m m m m m m m m m m m m
ys over his lifetime, after which he would be responsible for all costs.
m m m m m m m m m m m m m
Mr. Moy will soon turn age 65. He is slightly younger than his wife. Mr. Moy's wife has a Medicar
m m m m m m m m m m m m m m m m m m m
e Advantage plan, but he wants to understand what coverage Medicare Supplemental Insurance
m m m m m m m m m m m m m
provides since his health care needs are different from his wife's needs. What could you tell
m m m m m m m m m m m m m m m m
Mr. Moy? -
m m m
,CORRECT ANSWERSMedicare Supplemental Insurance would help cover his Part A deductible a
m m m m m m m m m m m
nd Part B coinsurance or copayments in Original Fee-for-
m m m m m m m m m
Service (FFS) Medicare as well as possibly some services that Medicare does not cover.
m m m m m m m m m m m m m
Juan Perez, who is turning age 65 next month, intends to work for several more years at Smallca
m m m m m m m m m m m m m m m m m
mp, Incorporated. Smallcap has a workforce of 15 employees and offers employer-
m m m m m m m m m m m
sponsored healthcare coverage. Juan is a naturalized citizen and has contributed to the Medicar
m m m m m m m m m m m m m
me system for over 20 years. Juan asks you if he will be entitled to Medicare and if he enrolls
m m m m m m m m m m m m m m m m m m m
mhow that will impact his employer- sponsored healthcare coverage. How would you respond?
m m m m m m m m m m m m
m-
CORRECT ANSWERSJuan is likely to be eligible for Medicare once he turns age 65 and if he enrol
m m m m m m m m m m m m m m m m m
mls, Medicare would become the primary payor of his healthcare claims and Smallcap does not
m m m m m m m m m m m m m m
mha ve to continue to offer him coverage comparable to those under age 65 under its
m m m m m m m m m m m m m m m
memployer- sponsored group health plan. Juan is likely to be eligible for Medicare once he turns
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mage 65 and i f he enrolls, Medicare would become the primary payor of his healthcare claims
m m m m m m m m m m m m m m m m
mbut Smallcap m ust continue to offer him coverage under its employer-
m m m m m m m m m m m
sponsored group health plan and would become a secondary payor.
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Ms. Kumar plans to retire when she turns 65 in a few months. She is in excellent health and
m m m m m m m m m m m m m m m m m m
mwill have considerable income when she retires. She is concerned that her income will make it
m m m m m m m m m m m m m m m
impos sible for her to qualify for Medicare. What could you tell her to address her concern? -
m m m m m m m m m m m m m m m m m m
CORRECT ANSWERSMedicare is a program for people age 65 or older and those under age 65 wi
m m m m m m m m m m m m m m m m
mth certain disabilities, end-
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stage renal disease, and Lou Gehrig's disease so she will be eligible for Medicare.
m m m m m m m m m m m m m
Mrs. Ellis recently turned 66 and decided after many years of work to retire and begin
m m m m m m m m m m m m m m m
receiving Social Security benefits. Shortly thereafter Mrs. Ellis received a letter informing her
m m m m m m m m m m m m m
that she had been automatically enrolled in Medicare Part B. She wants to understand whatpthis
m m m m m m m m m m m m m m m
means. Wha t should you tell Mrs. Ellis? -
m m m m m m m m m
CORRECT ANSWERSPart B primarily covers physician services. She will be paying a monthly pre
m m m m m m m m m m m m m
mium and, except for many preventive and screening tests, generally will have 20% co-
m m m m m m m m m m m m m m
payments for these services, in addition to an annual deductible.
m m m m m m m m m m
Mr. Singh would like drugpcoverage but does not want to be enrolled in a Medicare Advantage pl
m m m m m m m m m m m m m m m m
an. What should you tell him? - CORRECT ANSWERSMr. Singh can enroll in a stand-
m m m m m m m m m m m m m m m
, alone prescription drug plan and continue to be covered for Part Apand Part B services through O
m m m m m m m m m m m m m m m m
riginal Fee-for-Service Medicare.
m m m
Mrs. Cook is an elderly retiree. Mrs. Cook has a low fixed income. What could you tell Mrs. Cook
m m m m m m m m m m m m m m m m m m
that might be of assistance? -
m m m m m m
CORRECT ANSWERSShe should contact her state Medicaid agency to see if she qualifies for one
m m m m m m m m m m m m m m
of several programs that can help with Medicare costs for which she is responsible.
m m m m m m m m m m m m m m
Ms. Henderson believes that she will qualify for Medicare Coverage when she turns 65, without
m m m m m m m m m m m m m m
paying any premiums, because she has been working for 40 years and paying Medicare taxes. W
m m m m m m m m m m m m m m m m
hat should you tell her? -
m m m m m m
CORRECT ANSWERSTo obtain Part B coverage, she must pay a standard monthly premium, thou
m m m m m m m m m m m m m
gh it is higher for individuals with higher incomes.
m m m m m m m m m
Mr. Bauer is 49 years old, but eighteen months ago he was declared disabled by the Social Securi
m m m m m m m m m m m m m m m m m
ty Administration and has been receiving disability payments. He is wondering whether he can
m m m m m m m m m m m m m m
o btain coverage under Medicare. What should you tell him? -
m m m m m m m m m m m
CORRECT ANSWERSAfter receiving such disability payments for 24 months, he will be automatic
m m m m m m m m m m m m
ally enrolled in Medicare, regardless of age.
m m m m m m m
Mr. Schmidt would like to plan for retirement and has asked you what is covered under Original
m m m m m m m m m m m m m m m m
Fee-for-Service (FFS) Medicare. What could you tell him? -
m m m m m m m m m
CORRECT ANSWERSPart A, which covers hospital, skilled nursing facility, hospice, and home hea
m m m m m m m m m m m m
lth services and Part B, which covers professional services such as those provided by a doctor
m m m m m m m m m m m m m m m m
ar e covered under Original Medicare.
m m m m m m
Anthony Boniface turned 65 in 2024. He was not receiving Social Security or Railroad Retirement
m m m m m m m m m m m m m m
mBenefits on his 65th birthday. He was interested in obtaining Medicare coverage and is eligible
m m m m m m m m m m m m m m
mf or premium-
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free Part A. Before he could enroll in Medicare, his entire area was impacted by a hurricane caus
m m m m m m m m m m m m m m m m m
ming massive flooding and severe wind damage. The Federal government declared this to be a
m m m m m m m m m m m m m m
mnat ural disaster which has recently ended. During this period Anthony's initial enrollment
m m m m m m m m m m m m
mperiod ex pired. Anthony asks you how he can now obtain Medicare coverage. What should
m m m m m m m m m m m m m m
myou say? - m m
Rationales
Mr. Capadona would like to purchase a Medicare Advantage (MA) plan and a Medigap plan to pi
m m m m m m m m m m m m m m m m
ckpup costs not covered by that plan. What should you tell him? -
m m m m m m m m m m m m m
CORRECT ANSWERSIt is illegal for you to sell Mr. Capadona a Medigap plan if he is enrolled in an
m m m m m m m m m m m m m m m m m m
MA plan, and besides, Medigap only works with Original Medicare.
m m m m m m m m m m
Agent John Miller is meeting with Jerry Smith, a new prospect. Jerry is currently enrolled in Med
m m m m m m m m m m m m m m m m
icare Parts Apand B. Jerry has also purchased a Medicare Supplement (Medigap) plan which he
m m m m m m m m m m m m m m m
h as had for several years. However, the plan does not provide drug benefits. How would you
m m m m m m m m m m m m m m m m m
advi se Agent John Miller to proceed? -
m m m m m m m m
CORRECT ANSWERSTell prospect Jerry Smith that he should consider adding a standalone Part D
m m m m m m m m m m m m m
prescription drug coverage policy to his present coverage.
m m m m m m m m
Mr. Wu is eligible for Medicare. He has limited financial resources but failed to qualify for the Pa
m m m m m m m m m m m m m m m m m
rt D low-income subsidy. Where might he turn for help with his prescription drug costs? -
m m m m m m m m m m m m m m m m
CORRECT ANSWERSMr. Wu may still qualify for help in paying Part D costs through his State Pha
m m m m m m m m m m m m m m m m
rmaceutical Assistance Program (SPAP).
m m m m
Mr. Vasquez is in good health and is preparing a budget in anticipation of his retirement when
m m m m m m m m m m m m m m m m
h e turns 66. He wants to understand the health care costs he might be exposed to under
m m m m m m m m m m m m m m m m m m
Medicar e if he were to require hospitalization because of an illness. In general terms, what
m m m m m m m m m m m m m m m m
could you tell him about his costs for inpatient hospital services under Original Medicare? -
m m m m m m m m m m m m m m m
CORRECT ANSWERSUnder Original Medicare, there is a single deductible amount due for the fir
m m m m m m m m m m m m m
st 60 days of any inpatient hospital stay, after which it converts into a per-
m m m m m m m m m m m m m m m
day coinsurance amount through day 90. After day 90, he would pay a daily amount up to 60 da
m m m m m m m m m m m m m m m m m m
ys over his lifetime, after which he would be responsible for all costs.
m m m m m m m m m m m m m
Mr. Moy will soon turn age 65. He is slightly younger than his wife. Mr. Moy's wife has a Medicar
m m m m m m m m m m m m m m m m m m m
e Advantage plan, but he wants to understand what coverage Medicare Supplemental Insurance
m m m m m m m m m m m m m
provides since his health care needs are different from his wife's needs. What could you tell
m m m m m m m m m m m m m m m m
Mr. Moy? -
m m m
,CORRECT ANSWERSMedicare Supplemental Insurance would help cover his Part A deductible a
m m m m m m m m m m m
nd Part B coinsurance or copayments in Original Fee-for-
m m m m m m m m m
Service (FFS) Medicare as well as possibly some services that Medicare does not cover.
m m m m m m m m m m m m m
Juan Perez, who is turning age 65 next month, intends to work for several more years at Smallca
m m m m m m m m m m m m m m m m m
mp, Incorporated. Smallcap has a workforce of 15 employees and offers employer-
m m m m m m m m m m m
sponsored healthcare coverage. Juan is a naturalized citizen and has contributed to the Medicar
m m m m m m m m m m m m m
me system for over 20 years. Juan asks you if he will be entitled to Medicare and if he enrolls
m m m m m m m m m m m m m m m m m m m
mhow that will impact his employer- sponsored healthcare coverage. How would you respond?
m m m m m m m m m m m m
m-
CORRECT ANSWERSJuan is likely to be eligible for Medicare once he turns age 65 and if he enrol
m m m m m m m m m m m m m m m m m
mls, Medicare would become the primary payor of his healthcare claims and Smallcap does not
m m m m m m m m m m m m m m
mha ve to continue to offer him coverage comparable to those under age 65 under its
m m m m m m m m m m m m m m m
memployer- sponsored group health plan. Juan is likely to be eligible for Medicare once he turns
m m m m m m m m m m m m m m m
mage 65 and i f he enrolls, Medicare would become the primary payor of his healthcare claims
m m m m m m m m m m m m m m m m
mbut Smallcap m ust continue to offer him coverage under its employer-
m m m m m m m m m m m
sponsored group health plan and would become a secondary payor.
m m m m m m m m m
Ms. Kumar plans to retire when she turns 65 in a few months. She is in excellent health and
m m m m m m m m m m m m m m m m m m
mwill have considerable income when she retires. She is concerned that her income will make it
m m m m m m m m m m m m m m m
impos sible for her to qualify for Medicare. What could you tell her to address her concern? -
m m m m m m m m m m m m m m m m m m
CORRECT ANSWERSMedicare is a program for people age 65 or older and those under age 65 wi
m m m m m m m m m m m m m m m m
mth certain disabilities, end-
m m m
stage renal disease, and Lou Gehrig's disease so she will be eligible for Medicare.
m m m m m m m m m m m m m
Mrs. Ellis recently turned 66 and decided after many years of work to retire and begin
m m m m m m m m m m m m m m m
receiving Social Security benefits. Shortly thereafter Mrs. Ellis received a letter informing her
m m m m m m m m m m m m m
that she had been automatically enrolled in Medicare Part B. She wants to understand whatpthis
m m m m m m m m m m m m m m m
means. Wha t should you tell Mrs. Ellis? -
m m m m m m m m m
CORRECT ANSWERSPart B primarily covers physician services. She will be paying a monthly pre
m m m m m m m m m m m m m
mium and, except for many preventive and screening tests, generally will have 20% co-
m m m m m m m m m m m m m m
payments for these services, in addition to an annual deductible.
m m m m m m m m m m
Mr. Singh would like drugpcoverage but does not want to be enrolled in a Medicare Advantage pl
m m m m m m m m m m m m m m m m
an. What should you tell him? - CORRECT ANSWERSMr. Singh can enroll in a stand-
m m m m m m m m m m m m m m m
, alone prescription drug plan and continue to be covered for Part Apand Part B services through O
m m m m m m m m m m m m m m m m
riginal Fee-for-Service Medicare.
m m m
Mrs. Cook is an elderly retiree. Mrs. Cook has a low fixed income. What could you tell Mrs. Cook
m m m m m m m m m m m m m m m m m m
that might be of assistance? -
m m m m m m
CORRECT ANSWERSShe should contact her state Medicaid agency to see if she qualifies for one
m m m m m m m m m m m m m m
of several programs that can help with Medicare costs for which she is responsible.
m m m m m m m m m m m m m m
Ms. Henderson believes that she will qualify for Medicare Coverage when she turns 65, without
m m m m m m m m m m m m m m
paying any premiums, because she has been working for 40 years and paying Medicare taxes. W
m m m m m m m m m m m m m m m m
hat should you tell her? -
m m m m m m
CORRECT ANSWERSTo obtain Part B coverage, she must pay a standard monthly premium, thou
m m m m m m m m m m m m m
gh it is higher for individuals with higher incomes.
m m m m m m m m m
Mr. Bauer is 49 years old, but eighteen months ago he was declared disabled by the Social Securi
m m m m m m m m m m m m m m m m m
ty Administration and has been receiving disability payments. He is wondering whether he can
m m m m m m m m m m m m m m
o btain coverage under Medicare. What should you tell him? -
m m m m m m m m m m m
CORRECT ANSWERSAfter receiving such disability payments for 24 months, he will be automatic
m m m m m m m m m m m m
ally enrolled in Medicare, regardless of age.
m m m m m m m
Mr. Schmidt would like to plan for retirement and has asked you what is covered under Original
m m m m m m m m m m m m m m m m
Fee-for-Service (FFS) Medicare. What could you tell him? -
m m m m m m m m m
CORRECT ANSWERSPart A, which covers hospital, skilled nursing facility, hospice, and home hea
m m m m m m m m m m m m
lth services and Part B, which covers professional services such as those provided by a doctor
m m m m m m m m m m m m m m m m
ar e covered under Original Medicare.
m m m m m m
Anthony Boniface turned 65 in 2024. He was not receiving Social Security or Railroad Retirement
m m m m m m m m m m m m m m
mBenefits on his 65th birthday. He was interested in obtaining Medicare coverage and is eligible
m m m m m m m m m m m m m m
mf or premium-
m m
free Part A. Before he could enroll in Medicare, his entire area was impacted by a hurricane caus
m m m m m m m m m m m m m m m m m
ming massive flooding and severe wind damage. The Federal government declared this to be a
m m m m m m m m m m m m m m
mnat ural disaster which has recently ended. During this period Anthony's initial enrollment
m m m m m m m m m m m m
mperiod ex pired. Anthony asks you how he can now obtain Medicare coverage. What should
m m m m m m m m m m m m m m
myou say? - m m
