AHIP - 2026 - Modules 1-5 QUESTIONS AND
CORRECT ANSWERS MOST RELIABLE FOR
HIGH GRADED ACHIEVMENT
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? - CORRECT 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.
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? - CORRECT ANSWER-Tell prospect Jerry Smith that he should consider adding a
standalone Part D prescription drug coverage policy to his present coverage.
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? - CORRECT
ANSWER-Mr. Wu may still qualify for help in paying Part D costs through his State Pharmaceutical
Assistance Program (SPAP).
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? - CORRECT 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.
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?
- CORRECT 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.
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 employer-sponsored 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? - CORRECT 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.
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? - CORRECT 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.
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? - CORRECT 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.
Mr. Singh would like drug coverage but does not want to be enrolled in a Medicare Advantage plan.
What should you tell him? - CORRECT 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.
Mrs. Cook is an elderly retiree. Mrs. Cook has a low fixed income. What could you tell Mrs. Cook that
might be of assistance? - CORRECT 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.
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? - CORRECT ANSWER-To obtain Part B coverage, she must pay a standard
monthly premium, though it is higher for individuals with higher incomes.
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? - CORRECT ANSWER-After receiving such
disability payments for 24 months, he will be automatically enrolled in Medicare, regardless of age.
, 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? - CORRECT 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.
Anthony Boniface turned 65 in 2024. He was not receiving Social Security or Railroad Retirement
Benefits on his 65th birthday. He was interested in obtaining Medicare coverage and is eligible for
premium-free Part A. Before he could enroll in Medicare, his entire area was impacted by a hurricane
causing massive flooding and severe wind damage. The Federal government declared this to be a
natural disaster which has recently ended. During this period Anthony's initial enrollment period
expired. Anthony asks you how he can now obtain Medicare coverage. What should you say? -
CORRECT ANSWER-Anthony is eligible for a special enrollment period (SEP) because he missed an
enrollment period due to the impact of the Federally declared disaster. This SEP will allow Anthony to
enroll in Part B up to six months after the end of the emergency declaration. Anthony may enroll in
premium-free Part A at any time and his Part A coverage will be retroactive for up to 6 months.
Ms. Lewis has aggressive cancer and would like to know if Medicare will cover hospice services in
case she needs them. What should you tell her? - CORRECT ANSWER-Medicare covers hospice
services, and they will be available for her.
Edward suffered from serious kidney disease. As a result, Edward became eligible for Medicare
coverage due to end-stage renal disease (ESRD). A close relative donated their kidney and Edward
successfully underwent transplant surgery 12 months ago. Edward is now age 50 and asks you if his
Medicare coverage will continue, what should you say? - CORRECT ANSWER-Individuals eligible for
Medicare based on ESRD generally lose eligibility 36 months after the month in which the individual
receives a kidney transplant unless they are eligible for Medicare on another basis such as age or
disability. Edward may, however, remain enrolled in Part B but solely for coverage of
immunosuppressive drugs if he has no other health care coverage that would cover the drugs.
Mrs. Foster is covered by Original Medicare. She sustained a hip fracture and is being successfully
treated for that condition. However, she and her physicians feel that after her lengthy hospital stay,
she will need a month or two of nursing and rehabilitative care. What should you tell them about
Original Medicare's coverage of care in a skilled nursing facility? - CORRECT ANSWER-Medicare will
cover Mrs. Foster's skilled nursing services provided during the first 20 days of her stay, after which
she would have a copay until she has been in the facility for 100 days.
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. She comes to you for
advice. What should you tell her? - CORRECT ANSWER-You should tell Madeline that she will be able
to enroll in Medicare Part A without paying monthly premiums due to her husband's long work
CORRECT ANSWERS MOST RELIABLE FOR
HIGH GRADED ACHIEVMENT
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? - CORRECT 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.
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? - CORRECT ANSWER-Tell prospect Jerry Smith that he should consider adding a
standalone Part D prescription drug coverage policy to his present coverage.
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? - CORRECT
ANSWER-Mr. Wu may still qualify for help in paying Part D costs through his State Pharmaceutical
Assistance Program (SPAP).
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? - CORRECT 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.
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?
- CORRECT 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.
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 employer-sponsored 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? - CORRECT 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.
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? - CORRECT 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.
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? - CORRECT 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.
Mr. Singh would like drug coverage but does not want to be enrolled in a Medicare Advantage plan.
What should you tell him? - CORRECT 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.
Mrs. Cook is an elderly retiree. Mrs. Cook has a low fixed income. What could you tell Mrs. Cook that
might be of assistance? - CORRECT 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.
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? - CORRECT ANSWER-To obtain Part B coverage, she must pay a standard
monthly premium, though it is higher for individuals with higher incomes.
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? - CORRECT ANSWER-After receiving such
disability payments for 24 months, he will be automatically enrolled in Medicare, regardless of age.
, 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? - CORRECT 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.
Anthony Boniface turned 65 in 2024. He was not receiving Social Security or Railroad Retirement
Benefits on his 65th birthday. He was interested in obtaining Medicare coverage and is eligible for
premium-free Part A. Before he could enroll in Medicare, his entire area was impacted by a hurricane
causing massive flooding and severe wind damage. The Federal government declared this to be a
natural disaster which has recently ended. During this period Anthony's initial enrollment period
expired. Anthony asks you how he can now obtain Medicare coverage. What should you say? -
CORRECT ANSWER-Anthony is eligible for a special enrollment period (SEP) because he missed an
enrollment period due to the impact of the Federally declared disaster. This SEP will allow Anthony to
enroll in Part B up to six months after the end of the emergency declaration. Anthony may enroll in
premium-free Part A at any time and his Part A coverage will be retroactive for up to 6 months.
Ms. Lewis has aggressive cancer and would like to know if Medicare will cover hospice services in
case she needs them. What should you tell her? - CORRECT ANSWER-Medicare covers hospice
services, and they will be available for her.
Edward suffered from serious kidney disease. As a result, Edward became eligible for Medicare
coverage due to end-stage renal disease (ESRD). A close relative donated their kidney and Edward
successfully underwent transplant surgery 12 months ago. Edward is now age 50 and asks you if his
Medicare coverage will continue, what should you say? - CORRECT ANSWER-Individuals eligible for
Medicare based on ESRD generally lose eligibility 36 months after the month in which the individual
receives a kidney transplant unless they are eligible for Medicare on another basis such as age or
disability. Edward may, however, remain enrolled in Part B but solely for coverage of
immunosuppressive drugs if he has no other health care coverage that would cover the drugs.
Mrs. Foster is covered by Original Medicare. She sustained a hip fracture and is being successfully
treated for that condition. However, she and her physicians feel that after her lengthy hospital stay,
she will need a month or two of nursing and rehabilitative care. What should you tell them about
Original Medicare's coverage of care in a skilled nursing facility? - CORRECT ANSWER-Medicare will
cover Mrs. Foster's skilled nursing services provided during the first 20 days of her stay, after which
she would have a copay until she has been in the facility for 100 days.
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. She comes to you for
advice. What should you tell her? - CORRECT ANSWER-You should tell Madeline that she will be able
to enroll in Medicare Part A without paying monthly premiums due to her husband's long work
