7/22/26, 8:29 AHIP - 2026 - Modules 1-5
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AHIP Medicare Training 2026 Modules 1–5 Exam
Questions & Verified Answers | Complete Medicare
Certification Study Guide | Parts A, B, C, D, Medigap,
Medicare Advantage, SNP, MSA & Enrollment Review.
Mr. Capadona would like to purchase a Medicare It is illegal for you to sell Mr. Capadona a
Medigap plan if he is enrolled in an MA Advantage (MA) plan and a Medigap plan to pick up costs
plan, and besides, Medigap only works with Original
Medicare.
not covered by that plan. What should you tell him?
Agent John Miller is meeting with Jerry Smith, a new Tell prospect Jerry Smith that he should
consider adding a standalone Part D prospect. Jerry is currently enrolled in Medicare Parts A
prescription drug coverage policy to his present
coverage.
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?
Mr. Wu is eligible for Medicare. He has Mr. Wu may still qualify for help in paying Part D costs
limited financial resources but failed to through his State Pharmaceutical Assistance Program
qualify for the Part D low-income (SPAP).
subsidy. Where might he turn for help
with his prescription drug costs?
Mr. Vasquez is in good health and is Under Original Medicare, there is a single deductible
preparing a budget in anticipation of his amount due for the first 60 days of any inpatient hospital
retirement when he turns 66. He wants stay, after which it converts into a per-day coinsurance
to understand the health care costs he amount through day 90. After day 90, he would pay a
might be exposed to under Medicare if daily amount up to 60 days over his lifetime, after which
he were to require hospitalization he would be responsible for all costs.
because of an illness. In general terms,
what could you tell him about his costs
for inpatient hospital services under
Original Medicare?
Mr. Moy will soon turn age 65. He is slightly younger than Medicare Supplemental Insurance would
help cover his Part A deductible and Part his wife. Mr. Moy's wife has a Medicare Advantage plan, B
coinsurance or copayments in Original Fee-for-Service (FFS) Medicare as well as but he wants to
understand what coverage Medicare possibly some services that Medicare does not cover.
Supplemental Insurance provides since
his health care needs are different from
his wife's needs. What could you tell Mr.
Moy?
Juan Perez, who is turning age 65 next month, intends to Juan is likely to be eligible for Medicare
once he turns age 65 and if he enrolls, work for several more years at Smallcap, Incorporated.
Medicare would become the primary payor of his
healthcare claims and Smallcap Smallcap has a workforce of 15 employees and offers does not have
to continue to offer him coverage comparable to those under age 65 employer-sponsored healthcare
coverage. Juan is a under its employer-sponsored group health plan. Juan is
likely to be eligible for naturalized citizen and has contributed to the Medicare Medicare once he
turns age 65 and if he enrolls, Medicare would become the system for over 20 years. Juan asks you if
he will be primary payor of his healthcare claims but Smallcap must
continue to offer him entitled to Medicare and if he enrolls how that will impact coverage under its
employer-sponsored group health plan and would become a his employer- sponsored healthcare
coverage. How would secondary payor.
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,7/22/26, 8:29 AHIP - 2026 - Modules 1-5
PM
you respond?
Ms. Kumar plans to retire when she Medicare is a program for people age 65 or older and
turns 65 in a few months. She is in those under age 65 with certain disabilities, end-stage
excellent health and will have renal disease, and Lou Gehrig's disease so she will be
considerable income when she retires. eligible for Medicare.
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?
Mrs. Ellis recently turned 66 and decided Part B primarily covers physician services. She will be
after many years of work to retire and paying a monthly premium and, except for many
begin receiving Social Security benefits. preventive and screening tests, generally will have 20%
Shortly thereafter Mrs. Ellis received a co-payments for these services, in addition to an annual
letter informing her that she had been deductible.
automatically enrolled in Medicare Part
B. She wants to understand what this
means. What should you tell Mrs. Ellis?
Mr. Singh would like drug coverage but Mr. Singh can enroll in a stand-alone prescription drug
does not want to be enrolled in a plan and continue to be covered for Part A and Part B
Medicare Advantage plan. What should services through Original Fee-for-Service Medicare.
you tell him?
Mrs. Cook is an elderly retiree. Mrs. She should contact her state Medicaid agency to see if
Cook has a low fixed income. What she qualifies for one of
could you tell Mrs. Cook that might be of several programs that can help with Medicare costs for
assistance? which she is responsible.
Ms. Henderson believes that she will To obtain Part B coverage, she must pay a standard
qualify for Medicare Coverage when she monthly premium, though it is higher for individuals with
turns 65, without paying any premiums, higher incomes.
because she has been working for 40
years and paying Medicare taxes. What
should you tell her?
Mr. Bauer is 49 years old, but eighteen After receiving such disability payments for 24 months,
months ago he was declared disabled by he will be automatically enrolled in Medicare, regardless
the Social Security Administration and of age.
has been receiving disability payments.
He is wondering whether he can obtain
coverage under Medicare. What should
you tell him?
Mr. Schmidt would like to plan for Part A, which covers hospital, skilled nursing facility,
retirement and has asked you what is hospice, and home health services and Part B, which
covered under Original Fee-for-Service covers professional services such as those provided by a
(FFS) Medicare. What could you tell him? doctor are covered under Original Medicare.
Anthony Boniface turned 65 in 2024. He was not receiving Anthony is eligible for a special
enrollment period (SEP) because he missed an
Social Security or Railroad Retirement Benefits on his 65th enrollment period due to the impact of the
Federally declared disaster. This SEP will birthday. He was interested in obtaining Medicare allow
Anthony to enroll in Part B up to six months after the end of the emergency coverage and is eligible
for premium-free Part A. Before he declaration. Anthony may enroll in premium-free Part A at
any time and his Part A could enroll in Medicare, his entire area was impacted by a coverage will
be retroactive for up to 6 months.
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
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, 7/22/26, 8:29 AHIP - 2026 - Modules 1-5
PM
expired. Anthony asks you how he can
now obtain Medicare coverage. What
should you say?
Ms. Lewis has aggressive cancer and Medicare covers hospice services, and they will be
would like to know if Medicare will cover available for her.
hospice services in case she needs
them. What should you tell her?
Edward suffered from serious kidney disease. As a result, Individuals eligible for Medicare based on
ESRD generally lose eligibility 36 months Edward became eligible for Medicare coverage due to
after the month in which the individual receives a kidney
transplant unless they are end-stage renal disease (ESRD). A close relative donated eligible for
Medicare on another basis such as age or disability. Edward may,
their kidney and Edward successfully underwent transplant however, remain enrolled in Part B but
solely for coverage of immunosuppressive surgery 12 months ago. Edward is now age 50 and asks
drugs if he has no other health care coverage that
would cover the drugs.
you if his Medicare coverage will
continue, what should you say?
Mrs. Foster is covered by Original Medicare will cover Mrs. Foster's skilled nursing services
Medicare. She sustained a hip fracture provided during the first 20 days of her stay, after
and is being successfully treated for that which she would have a copay until she has been in the
condition. However, she and her facility for 100 days.
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?
Madeline Martinez was widowed several You should tell Madeline that she will be able to enroll in
years ago. Her husband worked for Medicare Part A without paying monthly premiums due
many years and contributed into the to her husband's long work record and participation in
Medicare system. He also left a the Medicare system. You should also tell Madeline that
substantial estate which provides she will pay Part B premiums at more than the standard
Madeline with an annual income of lowest rate but less than the highest rate due her
approximately substantial income.
$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?
Mrs. Thomas is 66 years old, has coverage under an She may enroll at any time while she is covered
under her employer plan, but she employer plan, and will retire next year. She heard she will
have a special eight-month enrollment period after the last month on her
must enroll in Part B at the beginning of the year to ensure employer plan that differs from the
standard general enrollment period, during which no gap in coverage. What can you tell her? she may
enroll in Medicare Part B.
Mildred Savage enrolled in Allcare Mildred may remain enrolled in Allcare and make a
Medicare Advantage plan several years hospice election. Hospice benefits will be paid for by
ago. Mildred recently learned that she is Original Medicare under Part A and Allcare will continue
suffering from inoperable cancer and to pay for any non-hospice services.
has just a few months to live. She would
like to spend these final months in
hospice care. Mildred's family asks you
whether hospice benefits will be paid for
under the Allcare Medicare Advantage
plan. What should you say?
https://quizlet.com/1056383718/ahip-2026-modules-1-5- 3/16
flash-cards/
PM
AHIP Medicare Training 2026 Modules 1–5 Exam
Questions & Verified Answers | Complete Medicare
Certification Study Guide | Parts A, B, C, D, Medigap,
Medicare Advantage, SNP, MSA & Enrollment Review.
Mr. Capadona would like to purchase a Medicare It is illegal for you to sell Mr. Capadona a
Medigap plan if he is enrolled in an MA Advantage (MA) plan and a Medigap plan to pick up costs
plan, and besides, Medigap only works with Original
Medicare.
not covered by that plan. What should you tell him?
Agent John Miller is meeting with Jerry Smith, a new Tell prospect Jerry Smith that he should
consider adding a standalone Part D prospect. Jerry is currently enrolled in Medicare Parts A
prescription drug coverage policy to his present
coverage.
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?
Mr. Wu is eligible for Medicare. He has Mr. Wu may still qualify for help in paying Part D costs
limited financial resources but failed to through his State Pharmaceutical Assistance Program
qualify for the Part D low-income (SPAP).
subsidy. Where might he turn for help
with his prescription drug costs?
Mr. Vasquez is in good health and is Under Original Medicare, there is a single deductible
preparing a budget in anticipation of his amount due for the first 60 days of any inpatient hospital
retirement when he turns 66. He wants stay, after which it converts into a per-day coinsurance
to understand the health care costs he amount through day 90. After day 90, he would pay a
might be exposed to under Medicare if daily amount up to 60 days over his lifetime, after which
he were to require hospitalization he would be responsible for all costs.
because of an illness. In general terms,
what could you tell him about his costs
for inpatient hospital services under
Original Medicare?
Mr. Moy will soon turn age 65. He is slightly younger than Medicare Supplemental Insurance would
help cover his Part A deductible and Part his wife. Mr. Moy's wife has a Medicare Advantage plan, B
coinsurance or copayments in Original Fee-for-Service (FFS) Medicare as well as but he wants to
understand what coverage Medicare possibly some services that Medicare does not cover.
Supplemental Insurance provides since
his health care needs are different from
his wife's needs. What could you tell Mr.
Moy?
Juan Perez, who is turning age 65 next month, intends to Juan is likely to be eligible for Medicare
once he turns age 65 and if he enrolls, work for several more years at Smallcap, Incorporated.
Medicare would become the primary payor of his
healthcare claims and Smallcap Smallcap has a workforce of 15 employees and offers does not have
to continue to offer him coverage comparable to those under age 65 employer-sponsored healthcare
coverage. Juan is a under its employer-sponsored group health plan. Juan is
likely to be eligible for naturalized citizen and has contributed to the Medicare Medicare once he
turns age 65 and if he enrolls, Medicare would become the system for over 20 years. Juan asks you if
he will be primary payor of his healthcare claims but Smallcap must
continue to offer him entitled to Medicare and if he enrolls how that will impact coverage under its
employer-sponsored group health plan and would become a his employer- sponsored healthcare
coverage. How would secondary payor.
https://quizlet.com/1056383718/ahip-2026-modules-1-5- 1/16
flash-cards/
,7/22/26, 8:29 AHIP - 2026 - Modules 1-5
PM
you respond?
Ms. Kumar plans to retire when she Medicare is a program for people age 65 or older and
turns 65 in a few months. She is in those under age 65 with certain disabilities, end-stage
excellent health and will have renal disease, and Lou Gehrig's disease so she will be
considerable income when she retires. eligible for Medicare.
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?
Mrs. Ellis recently turned 66 and decided Part B primarily covers physician services. She will be
after many years of work to retire and paying a monthly premium and, except for many
begin receiving Social Security benefits. preventive and screening tests, generally will have 20%
Shortly thereafter Mrs. Ellis received a co-payments for these services, in addition to an annual
letter informing her that she had been deductible.
automatically enrolled in Medicare Part
B. She wants to understand what this
means. What should you tell Mrs. Ellis?
Mr. Singh would like drug coverage but Mr. Singh can enroll in a stand-alone prescription drug
does not want to be enrolled in a plan and continue to be covered for Part A and Part B
Medicare Advantage plan. What should services through Original Fee-for-Service Medicare.
you tell him?
Mrs. Cook is an elderly retiree. Mrs. She should contact her state Medicaid agency to see if
Cook has a low fixed income. What she qualifies for one of
could you tell Mrs. Cook that might be of several programs that can help with Medicare costs for
assistance? which she is responsible.
Ms. Henderson believes that she will To obtain Part B coverage, she must pay a standard
qualify for Medicare Coverage when she monthly premium, though it is higher for individuals with
turns 65, without paying any premiums, higher incomes.
because she has been working for 40
years and paying Medicare taxes. What
should you tell her?
Mr. Bauer is 49 years old, but eighteen After receiving such disability payments for 24 months,
months ago he was declared disabled by he will be automatically enrolled in Medicare, regardless
the Social Security Administration and of age.
has been receiving disability payments.
He is wondering whether he can obtain
coverage under Medicare. What should
you tell him?
Mr. Schmidt would like to plan for Part A, which covers hospital, skilled nursing facility,
retirement and has asked you what is hospice, and home health services and Part B, which
covered under Original Fee-for-Service covers professional services such as those provided by a
(FFS) Medicare. What could you tell him? doctor are covered under Original Medicare.
Anthony Boniface turned 65 in 2024. He was not receiving Anthony is eligible for a special
enrollment period (SEP) because he missed an
Social Security or Railroad Retirement Benefits on his 65th enrollment period due to the impact of the
Federally declared disaster. This SEP will birthday. He was interested in obtaining Medicare allow
Anthony to enroll in Part B up to six months after the end of the emergency coverage and is eligible
for premium-free Part A. Before he declaration. Anthony may enroll in premium-free Part A at
any time and his Part A could enroll in Medicare, his entire area was impacted by a coverage will
be retroactive for up to 6 months.
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
https://quizlet.com/1056383718/ahip-2026-modules-1-5- 2/16
flash-cards/
, 7/22/26, 8:29 AHIP - 2026 - Modules 1-5
PM
expired. Anthony asks you how he can
now obtain Medicare coverage. What
should you say?
Ms. Lewis has aggressive cancer and Medicare covers hospice services, and they will be
would like to know if Medicare will cover available for her.
hospice services in case she needs
them. What should you tell her?
Edward suffered from serious kidney disease. As a result, Individuals eligible for Medicare based on
ESRD generally lose eligibility 36 months Edward became eligible for Medicare coverage due to
after the month in which the individual receives a kidney
transplant unless they are end-stage renal disease (ESRD). A close relative donated eligible for
Medicare on another basis such as age or disability. Edward may,
their kidney and Edward successfully underwent transplant however, remain enrolled in Part B but
solely for coverage of immunosuppressive surgery 12 months ago. Edward is now age 50 and asks
drugs if he has no other health care coverage that
would cover the drugs.
you if his Medicare coverage will
continue, what should you say?
Mrs. Foster is covered by Original Medicare will cover Mrs. Foster's skilled nursing services
Medicare. She sustained a hip fracture provided during the first 20 days of her stay, after
and is being successfully treated for that which she would have a copay until she has been in the
condition. However, she and her facility for 100 days.
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?
Madeline Martinez was widowed several You should tell Madeline that she will be able to enroll in
years ago. Her husband worked for Medicare Part A without paying monthly premiums due
many years and contributed into the to her husband's long work record and participation in
Medicare system. He also left a the Medicare system. You should also tell Madeline that
substantial estate which provides she will pay Part B premiums at more than the standard
Madeline with an annual income of lowest rate but less than the highest rate due her
approximately substantial income.
$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?
Mrs. Thomas is 66 years old, has coverage under an She may enroll at any time while she is covered
under her employer plan, but she employer plan, and will retire next year. She heard she will
have a special eight-month enrollment period after the last month on her
must enroll in Part B at the beginning of the year to ensure employer plan that differs from the
standard general enrollment period, during which no gap in coverage. What can you tell her? she may
enroll in Medicare Part B.
Mildred Savage enrolled in Allcare Mildred may remain enrolled in Allcare and make a
Medicare Advantage plan several years hospice election. Hospice benefits will be paid for by
ago. Mildred recently learned that she is Original Medicare under Part A and Allcare will continue
suffering from inoperable cancer and to pay for any non-hospice services.
has just a few months to live. She would
like to spend these final months in
hospice care. Mildred's family asks you
whether hospice benefits will be paid for
under the Allcare Medicare Advantage
plan. What should you say?
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