AHIP - 2026 - MODULES
1-5 EXAM
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 REPLY -
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 REPLY -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 REPLY -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 REPLY -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 REPLY -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 REPLY -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
REPLY-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 REPLY -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 REPLY -Mr. Singh can enroll in a stand-
1-5 EXAM
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 REPLY -
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 REPLY -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 REPLY -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 REPLY -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 REPLY -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 REPLY -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
REPLY-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 REPLY -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 REPLY -Mr. Singh can enroll in a stand-
