AHIP Final Exam 2026– Verified
Edition with correct rationale
Question 1: 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.
Rationale: Medigap policies are designed solely to supplement Original Medicare
(Parts A and B). Federal law prohibits the sale of a Medigap policy to someone
enrolled in a Medicare Advantage plan, as Medigap cannot pay for MA plan
copayments, deductibles, or other costs.
Question 2: 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.
Rationale: Medigap policies sold after 2006 do not include prescription drug
coverage. Beneficiaries who need drug coverage must enroll in a standalone
Medicare Part D plan, which can be paired with their existing Medigap and Original
Medicare coverage.
,Question 3: 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).
Rationale: Many states offer SPAPs to assist residents who do not qualify for the
federal Low-Income Subsidy but still need help with Part D premiums, deductibles,
and copayments. Eligibility and benefits vary by state.
Question 4: Mr. Vasquez is in good health and wants to understand the health care
costs for inpatient hospital services under Original Medicare. What could you tell
him?
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.
Rationale: Medicare Part A covers inpatient hospital stays with a benefit-period
structure: a deductible for days 1–60, daily coinsurance for days 61–90, and lifetime
reserve days (up to 60 total) with higher daily coinsurance. Once reserve days are
exhausted, the beneficiary pays 100% of costs.
Question 5: Mr. Moy will soon turn age 65. He wants to understand what coverage
Medicare Supplemental Insurance provides. 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
Medicare as well as possibly some services that Medicare does not cover.
Rationale: Medigap policies help pay out-of-pocket costs like deductibles,
coinsurance, and copayments under Original Medicare. Some plans also cover
foreign travel emergency care. They do not cover long-term care, vision, dental,
hearing aids, or private-duty nursing.
Question 6: Juan Perez intends to work at Smallcap, Incorporated, which has 15
employees and offers employer-sponsored coverage. He asks about his Medicare
eligibility and impact on employer coverage. How would you respond?
Correct Answer: Juan is likely to be eligible for Medicare once he turns 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.
Rationale: For employers with fewer than 20 employees, Medicare becomes the
primary payer when an eligible employee enrolls. The employer is not required to
offer coverage comparable to that provided to younger workers.
Question 7: Ms. Kumar is concerned that her income will make her ineligible for
Medicare at age 65. What could you tell her?
Correct Answer: Medicare is a program for people age 65 or older and those under
age 65 with certain disabilities, ESRD, and ALS, so she will be eligible for Medicare.
Edition with correct rationale
Question 1: 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.
Rationale: Medigap policies are designed solely to supplement Original Medicare
(Parts A and B). Federal law prohibits the sale of a Medigap policy to someone
enrolled in a Medicare Advantage plan, as Medigap cannot pay for MA plan
copayments, deductibles, or other costs.
Question 2: 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.
Rationale: Medigap policies sold after 2006 do not include prescription drug
coverage. Beneficiaries who need drug coverage must enroll in a standalone
Medicare Part D plan, which can be paired with their existing Medigap and Original
Medicare coverage.
,Question 3: 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).
Rationale: Many states offer SPAPs to assist residents who do not qualify for the
federal Low-Income Subsidy but still need help with Part D premiums, deductibles,
and copayments. Eligibility and benefits vary by state.
Question 4: Mr. Vasquez is in good health and wants to understand the health care
costs for inpatient hospital services under Original Medicare. What could you tell
him?
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.
Rationale: Medicare Part A covers inpatient hospital stays with a benefit-period
structure: a deductible for days 1–60, daily coinsurance for days 61–90, and lifetime
reserve days (up to 60 total) with higher daily coinsurance. Once reserve days are
exhausted, the beneficiary pays 100% of costs.
Question 5: Mr. Moy will soon turn age 65. He wants to understand what coverage
Medicare Supplemental Insurance provides. 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
Medicare as well as possibly some services that Medicare does not cover.
Rationale: Medigap policies help pay out-of-pocket costs like deductibles,
coinsurance, and copayments under Original Medicare. Some plans also cover
foreign travel emergency care. They do not cover long-term care, vision, dental,
hearing aids, or private-duty nursing.
Question 6: Juan Perez intends to work at Smallcap, Incorporated, which has 15
employees and offers employer-sponsored coverage. He asks about his Medicare
eligibility and impact on employer coverage. How would you respond?
Correct Answer: Juan is likely to be eligible for Medicare once he turns 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.
Rationale: For employers with fewer than 20 employees, Medicare becomes the
primary payer when an eligible employee enrolls. The employer is not required to
offer coverage comparable to that provided to younger workers.
Question 7: Ms. Kumar is concerned that her income will make her ineligible for
Medicare at age 65. What could you tell her?
Correct Answer: Medicare is a program for people age 65 or older and those under
age 65 with certain disabilities, ESRD, and ALS, so she will be eligible for Medicare.
