AHIP - 2026 - Modules 1-5
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1. Mr. Capadona would like to purchase It is illegal for you to sell Mr. Capadona a
a Medicare Advantage (MA) plan and a Medigap plan if he is enrolled in an MA
Medigap plan to pick up costs not covered plan, and besides, Medigap only works with
by that plan. What should you tell him? Original Medicare.
2. Agent John Miller is meeting with Jerry Tell prospect Jerry Smith that he should con-
Smith, a new prospect. Jerry is currently sider adding a standalone Part D prescrip-
enrolled in Medicare Parts A and B. Jer- tion drug coverage policy to his present cov-
ry has also purchased a Medicare Supple- erage.
ment (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?
3. Mr. Wu is eligible for Medicare. He has Mr. Wu may still qualify for help in paying
limited financial resources but failed to Part D costs through his State Pharmaceuti-
qualify for the Part D low-income subsidy. cal Assistance Program (SPAP).
Where might he turn for help with his pre-
scription drug costs?
4. Mr. Vasquez is in good health and is Under Original Medicare, there is a single
preparing a budget in anticipation of his deductible amount due for the first 60 days
retirement when he turns 66. He wants to of any inpatient hospital stay, after which it
understand the health care costs he might converts into a per-day coinsurance amount
be exposed to under Medicare if he were through day 90. After day 90, he would pay a
to require hospitalization because of an ill- daily amount up to 60 days over his lifetime,
ness. In general terms, what could you tell after which he would be responsible for all
him about his costs for inpatient hospital costs.
services under Original Medicare?
5. Mr. Moy will soon turn age 65. He is slightly Medicare Supplemental Insurance would
younger than his wife. Mr. Moy's wife has a help cover his Part A deductible and Part
, AHIP - 2026 - Modules 1-5
Study online at https://quizlet.com/_hgxyw6
Medicare Advantage plan, but he wants to B coinsurance or copayments in Original
understand what coverage Medicare Sup- Fee-for-Service (FFS) Medicare as well as
plemental Insurance provides since his possibly some services that Medicare does
health care needs are different from his not cover.
wife's needs. What could you tell Mr. Moy?
6. Juan Perez, who is turning age 65 next Juan is likely to be eligible for Medicare
month, intends to work for several more once he turns age 65 and if he enrolls,
years at Smallcap, Incorporated. Smallcap Medicare would become the primary payor
has a workforce of 15 employees and of- of his healthcare claims and Smallcap does
fers employer-sponsored healthcare cov- not have to continue to offer him coverage
erage. Juan is a naturalized citizen and has comparable to those under age 65 under
contributed to the Medicare system for its employer-sponsored group health plan.
over 20 years. Juan asks you if he will be Juan is likely to be eligible for Medicare
entitled to Medicare and if he enrolls how once he turns age 65 and if he enrolls,
that will impact his employer- sponsored Medicare would become the primary payor
healthcare coverage. How would you re- of his healthcare claims but Smallcap must
spond? 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 Medicare is a program for people age 65 or
65 in a few months. She is in excellent older and those under age 65 with certain
health and will have considerable income disabilities, end-stage renal disease, and
when she retires. She is concerned that Lou Gehrig's disease so she will be eligible
her income will make it impossible for her for Medicare.
to qualify for Medicare. What could you tell
her to address her concern?
8. Mrs. Ellis recently turned 66 and decided Part B primarily covers physician services.
after many years of work to retire and She will be paying a monthly premium and,
begin receiving Social Security benefits. except for many preventive and screening
, AHIP - 2026 - Modules 1-5
Study online at https://quizlet.com/_hgxyw6
Shortly thereafter Mrs. Ellis received a let- tests, generally will have 20% co-payments
ter informing her that she had been au- for these services, in addition to an annual
tomatically enrolled in Medicare Part B. deductible.
She wants to understand what this means.
What should you tell Mrs. Ellis?
9. Mr. Singh would like drug coverage but Mr. Singh can enroll in a stand-alone pre-
does not want to be enrolled in a Medicare scription drug plan and continue to be cov-
Advantage plan. What should you tell him? ered for Part A and Part B services through
Original Fee-for-Service Medicare.
10. Mrs. Cook is an elderly retiree. Mrs. Cook She should contact her state Medicaid
has a low fixed income. What could you tell agency to see if she qualifies for one of sev-
Mrs. Cook that might be of assistance? eral programs that can help with Medicare
costs for which she is responsible.
11. Ms. Henderson believes that she will qual- To obtain Part B coverage, she must pay
ify for Medicare Coverage when she turns a standard monthly premium, though it is
65, without paying any premiums, be- higher for individuals with higher incomes.
cause she has been working for 40 years
and paying Medicare taxes. What should
you tell her?
12. Mr. Bauer is 49 years old, but eighteen After receiving such disability payments for
months ago he was declared disabled by 24 months, he will be automatically enrolled
the Social Security Administration and has in Medicare, regardless of age.
been receiving disability payments. He is
wondering whether he can obtain cover-
age under Medicare. What should you tell
him?
13. Mr. Schmidt would like to plan for re- Part A, which covers hospital, skilled nursing
tirement and has asked you what is cov- facility, hospice, and home health services
Study online at https://quizlet.com/_hgxyw6
1. Mr. Capadona would like to purchase It is illegal for you to sell Mr. Capadona a
a Medicare Advantage (MA) plan and a Medigap plan if he is enrolled in an MA
Medigap plan to pick up costs not covered plan, and besides, Medigap only works with
by that plan. What should you tell him? Original Medicare.
2. Agent John Miller is meeting with Jerry Tell prospect Jerry Smith that he should con-
Smith, a new prospect. Jerry is currently sider adding a standalone Part D prescrip-
enrolled in Medicare Parts A and B. Jer- tion drug coverage policy to his present cov-
ry has also purchased a Medicare Supple- erage.
ment (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?
3. Mr. Wu is eligible for Medicare. He has Mr. Wu may still qualify for help in paying
limited financial resources but failed to Part D costs through his State Pharmaceuti-
qualify for the Part D low-income subsidy. cal Assistance Program (SPAP).
Where might he turn for help with his pre-
scription drug costs?
4. Mr. Vasquez is in good health and is Under Original Medicare, there is a single
preparing a budget in anticipation of his deductible amount due for the first 60 days
retirement when he turns 66. He wants to of any inpatient hospital stay, after which it
understand the health care costs he might converts into a per-day coinsurance amount
be exposed to under Medicare if he were through day 90. After day 90, he would pay a
to require hospitalization because of an ill- daily amount up to 60 days over his lifetime,
ness. In general terms, what could you tell after which he would be responsible for all
him about his costs for inpatient hospital costs.
services under Original Medicare?
5. Mr. Moy will soon turn age 65. He is slightly Medicare Supplemental Insurance would
younger than his wife. Mr. Moy's wife has a help cover his Part A deductible and Part
, AHIP - 2026 - Modules 1-5
Study online at https://quizlet.com/_hgxyw6
Medicare Advantage plan, but he wants to B coinsurance or copayments in Original
understand what coverage Medicare Sup- Fee-for-Service (FFS) Medicare as well as
plemental Insurance provides since his possibly some services that Medicare does
health care needs are different from his not cover.
wife's needs. What could you tell Mr. Moy?
6. Juan Perez, who is turning age 65 next Juan is likely to be eligible for Medicare
month, intends to work for several more once he turns age 65 and if he enrolls,
years at Smallcap, Incorporated. Smallcap Medicare would become the primary payor
has a workforce of 15 employees and of- of his healthcare claims and Smallcap does
fers employer-sponsored healthcare cov- not have to continue to offer him coverage
erage. Juan is a naturalized citizen and has comparable to those under age 65 under
contributed to the Medicare system for its employer-sponsored group health plan.
over 20 years. Juan asks you if he will be Juan is likely to be eligible for Medicare
entitled to Medicare and if he enrolls how once he turns age 65 and if he enrolls,
that will impact his employer- sponsored Medicare would become the primary payor
healthcare coverage. How would you re- of his healthcare claims but Smallcap must
spond? 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 Medicare is a program for people age 65 or
65 in a few months. She is in excellent older and those under age 65 with certain
health and will have considerable income disabilities, end-stage renal disease, and
when she retires. She is concerned that Lou Gehrig's disease so she will be eligible
her income will make it impossible for her for Medicare.
to qualify for Medicare. What could you tell
her to address her concern?
8. Mrs. Ellis recently turned 66 and decided Part B primarily covers physician services.
after many years of work to retire and She will be paying a monthly premium and,
begin receiving Social Security benefits. except for many preventive and screening
, AHIP - 2026 - Modules 1-5
Study online at https://quizlet.com/_hgxyw6
Shortly thereafter Mrs. Ellis received a let- tests, generally will have 20% co-payments
ter informing her that she had been au- for these services, in addition to an annual
tomatically enrolled in Medicare Part B. deductible.
She wants to understand what this means.
What should you tell Mrs. Ellis?
9. Mr. Singh would like drug coverage but Mr. Singh can enroll in a stand-alone pre-
does not want to be enrolled in a Medicare scription drug plan and continue to be cov-
Advantage plan. What should you tell him? ered for Part A and Part B services through
Original Fee-for-Service Medicare.
10. Mrs. Cook is an elderly retiree. Mrs. Cook She should contact her state Medicaid
has a low fixed income. What could you tell agency to see if she qualifies for one of sev-
Mrs. Cook that might be of assistance? eral programs that can help with Medicare
costs for which she is responsible.
11. Ms. Henderson believes that she will qual- To obtain Part B coverage, she must pay
ify for Medicare Coverage when she turns a standard monthly premium, though it is
65, without paying any premiums, be- higher for individuals with higher incomes.
cause she has been working for 40 years
and paying Medicare taxes. What should
you tell her?
12. Mr. Bauer is 49 years old, but eighteen After receiving such disability payments for
months ago he was declared disabled by 24 months, he will be automatically enrolled
the Social Security Administration and has in Medicare, regardless of age.
been receiving disability payments. He is
wondering whether he can obtain cover-
age under Medicare. What should you tell
him?
13. Mr. Schmidt would like to plan for re- Part A, which covers hospital, skilled nursing
tirement and has asked you what is cov- facility, hospice, and home health services
