AHIP FINAL EXAM Questions and Answers 2026
| Simplified Study Notes with Rationales | A+
Verified
• 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.
• Mr. Singh would like drug coverage but does not want to be enrolled in a Medicare
Advantage plan. What should you tell him? -✓✓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? -✓✓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?
-✓✓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? -✓✓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? -
✓✓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? -✓✓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? -✓✓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? -✓✓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? -
✓✓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 record and participation in the
Medicare system. You should also tell Madeline that she will pay Part B premiums at
more than the standard lowest rate but less than the highest rate due her substantial
income.
| Simplified Study Notes with Rationales | A+
Verified
• 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.
• Mr. Singh would like drug coverage but does not want to be enrolled in a Medicare
Advantage plan. What should you tell him? -✓✓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? -✓✓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?
-✓✓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? -✓✓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? -
✓✓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? -✓✓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? -✓✓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? -✓✓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? -
✓✓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 record and participation in the
Medicare system. You should also tell Madeline that she will pay Part B premiums at
more than the standard lowest rate but less than the highest rate due her substantial
income.
