AHIP CERTIFICATION ALL
MODULES OVER 100 QUESTIONS
AND CORRECT ANSWERS
VERIFIED AND GRADED A+ FOR A
GUARANTEE PASS LATEST
UPDATE 2026.
Agent Roderick enrolls retiree Mrs. Martinez in a medical savings account
(MSA) Medicare health plan. The MSA plan does not offer prescription drug
coverage, so Agent Roderick also enrolls Mrs. Martinez in a standalone
prescription drug plan (PDP). What CMS compensation rules apply to this
situation?
This situation is considered a "dual enrollment," and CMS compensation rules
are applied to the two plans at once and independently of each other.
Mr. Vega was intending to enroll in MaxCare's Medicare Advantage plan this
year. However, due to his current medical condition, his daughter Debbie has
been appointed as his legal representative over both health and financial
matters. Debbie would like to ensure that her father is still able to enroll in
MaxCare's plan, but she is unsure what her role is in helping with his
enrollment request. What advice can you give her?
Debbie can submit an telephonic enrollment request on Mr. Vega's behalf as
long as she attests that she has the legal authority to do so.
,Agent Chandler is conducting a sales presentation on senior issues where he
hopes to enroll some attendees in the Medicare Advantage (MA) plans he
represents. What action(s) may Agent Chandler take during the event?
Discuss plan specific information such as premiums and benefits.
Ms. Chase is interested in discussing various Medicare Advantage (MA) Plans
available in her area with you. She has heard that MA plans have something
called a "maximum out-of-pocket" limit. She asks you to explain what this
means. What do you say?
MA plans have a maximum out-of-pocket limit, known as the "MOOP", for Part
A and Part B benefits. Once a plan member pays a specified amount of cost-
sharing, the health plan covers 100 percent of covered medical services.
Mrs. Kirkland is enrolled in a Medicare Advantage HMO that offers a point of
service (POS) option. This allows Mrs. Kirkland to do which of the following?
Mrs. Kirkland can go to non-plan doctors for certain services without
receiving prior approval.
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?
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?
,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?
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?
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?
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?
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?
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?
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.
MODULES OVER 100 QUESTIONS
AND CORRECT ANSWERS
VERIFIED AND GRADED A+ FOR A
GUARANTEE PASS LATEST
UPDATE 2026.
Agent Roderick enrolls retiree Mrs. Martinez in a medical savings account
(MSA) Medicare health plan. The MSA plan does not offer prescription drug
coverage, so Agent Roderick also enrolls Mrs. Martinez in a standalone
prescription drug plan (PDP). What CMS compensation rules apply to this
situation?
This situation is considered a "dual enrollment," and CMS compensation rules
are applied to the two plans at once and independently of each other.
Mr. Vega was intending to enroll in MaxCare's Medicare Advantage plan this
year. However, due to his current medical condition, his daughter Debbie has
been appointed as his legal representative over both health and financial
matters. Debbie would like to ensure that her father is still able to enroll in
MaxCare's plan, but she is unsure what her role is in helping with his
enrollment request. What advice can you give her?
Debbie can submit an telephonic enrollment request on Mr. Vega's behalf as
long as she attests that she has the legal authority to do so.
,Agent Chandler is conducting a sales presentation on senior issues where he
hopes to enroll some attendees in the Medicare Advantage (MA) plans he
represents. What action(s) may Agent Chandler take during the event?
Discuss plan specific information such as premiums and benefits.
Ms. Chase is interested in discussing various Medicare Advantage (MA) Plans
available in her area with you. She has heard that MA plans have something
called a "maximum out-of-pocket" limit. She asks you to explain what this
means. What do you say?
MA plans have a maximum out-of-pocket limit, known as the "MOOP", for Part
A and Part B benefits. Once a plan member pays a specified amount of cost-
sharing, the health plan covers 100 percent of covered medical services.
Mrs. Kirkland is enrolled in a Medicare Advantage HMO that offers a point of
service (POS) option. This allows Mrs. Kirkland to do which of the following?
Mrs. Kirkland can go to non-plan doctors for certain services without
receiving prior approval.
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?
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?
,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?
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?
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?
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?
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?
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?
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.
