,2027 AHIP FINAL EXAM – NEW QUESTIONS 1-250
(UPDATED)
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?
A) You can sell him a Medigap plan to help with costs not covered under Medicare
Advantage.
B) 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.
C) Medigap plans are designed to work alongside Medicare Advantage plans.
D) He must disenroll from his MA plan before buying a Medigap plan.
*B) 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 plans are supplemental policies that fill gaps in Original Medicare
(Parts A and B) coverage. Federal law prohibits issuance of a Medigap policy to anyone
currently enrolled in a Medicare Advantage plan; Medigap cannot pay costs associated
with MA .
2. Mr. Diaz continued working with his company and was insured under his
employer's group plan until he reached age 68. He has heard that there is a
premium penalty for those who did not sign up for Part B when first eligible and
wants to know how much he will have to pay. What should you tell him?
A) Mr. Diaz will pay a 10% penalty for each year he delayed enrollment.
B) Mr. Diaz will not pay any penalty because he had continuous coverage under his
employer's plan.
C) Mr. Diaz will pay a 20% penalty for each year he delayed enrollment.
D) Mr. Diaz must pay the full Part B premium with no penalty.
*B) Mr. Diaz will not pay any penalty because he had continuous coverage under
his employer's plan. *
,Rationale: Individuals who have continuous creditable coverage under an employer-
sponsored group health plan are not subject to the Part B late enrollment penalty when
they eventually enroll. This is a critical protection for those who continue working past age
65 .
3. 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. What should you tell
her?
A) Madeline will not qualify for Medicare because she has not worked enough.
B) Madeline will be able to enroll in Medicare Part A without paying monthly premiums
due to her husband's long work record. She will pay Part B premiums at more than the
standard lowest rate but less than the highest rate due to her substantial income.
C) Madeline will have to pay full premiums for both Part A and Part B.
D) Madeline should apply for Medicaid instead of Medicare.
*B) Madeline will be able to enroll in Medicare Part A without paying monthly
premiums due to her husband's long work record. She will pay Part B premiums at
more than the standard lowest rate but less than the highest rate due to her
substantial income. *
Rationale: Madeline qualifies for premium-free Part A based on her husband's work
record. Part B premiums are income-adjusted under IRMAA (Income-Related Monthly
Adjustment Amount), meaning those with higher incomes pay more than the standard
premium but less than the highest rate .
4. Mr. Moy will soon turn age 65. He wants to understand what coverage Medicare
Supplemental Insurance provides. What could you tell Mr. Moy?
A) It covers everything Original Medicare does not.
B) It provides prescription drug coverage.
C) 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.
D) It is only available for Medicare Advantage enrollees.
*C) 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. *
Rationale: Medigap policies pay many out-of-pocket costs not covered by Original
Medicare, such as deductibles, coinsurance, and copayments. Some plans also cover
foreign travel emergency care. Medigap does not cover services like long-term care, vision,
dental, hearing aids, or private nursing .
5. Ms. Kumar is concerned that her income will make her ineligible for Medicare at
age 65. What could you tell her?
A) High income makes one ineligible for Medicare.
B) Only low-income individuals qualify for Medicare.
C) 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.
D) She should apply for Medicaid instead.
*C) 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. *
Rationale: Eligibility for Medicare is based on age (65+), certain disabilities, and specific
diseases, not income. However, higher income can affect Part B and D premiums through
IRMAA but does not preclude eligibility itself .
6. Edward IP 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 tell him?
A) Edward's Medicare coverage will end immediately after the transplant.
B) Edward's Medicare coverage will continue for a period following the transplant,
typically 36 months after successful transplantation.
(UPDATED)
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?
A) You can sell him a Medigap plan to help with costs not covered under Medicare
Advantage.
B) 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.
C) Medigap plans are designed to work alongside Medicare Advantage plans.
D) He must disenroll from his MA plan before buying a Medigap plan.
*B) 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 plans are supplemental policies that fill gaps in Original Medicare
(Parts A and B) coverage. Federal law prohibits issuance of a Medigap policy to anyone
currently enrolled in a Medicare Advantage plan; Medigap cannot pay costs associated
with MA .
2. Mr. Diaz continued working with his company and was insured under his
employer's group plan until he reached age 68. He has heard that there is a
premium penalty for those who did not sign up for Part B when first eligible and
wants to know how much he will have to pay. What should you tell him?
A) Mr. Diaz will pay a 10% penalty for each year he delayed enrollment.
B) Mr. Diaz will not pay any penalty because he had continuous coverage under his
employer's plan.
C) Mr. Diaz will pay a 20% penalty for each year he delayed enrollment.
D) Mr. Diaz must pay the full Part B premium with no penalty.
*B) Mr. Diaz will not pay any penalty because he had continuous coverage under
his employer's plan. *
,Rationale: Individuals who have continuous creditable coverage under an employer-
sponsored group health plan are not subject to the Part B late enrollment penalty when
they eventually enroll. This is a critical protection for those who continue working past age
65 .
3. 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. What should you tell
her?
A) Madeline will not qualify for Medicare because she has not worked enough.
B) Madeline will be able to enroll in Medicare Part A without paying monthly premiums
due to her husband's long work record. She will pay Part B premiums at more than the
standard lowest rate but less than the highest rate due to her substantial income.
C) Madeline will have to pay full premiums for both Part A and Part B.
D) Madeline should apply for Medicaid instead of Medicare.
*B) Madeline will be able to enroll in Medicare Part A without paying monthly
premiums due to her husband's long work record. She will pay Part B premiums at
more than the standard lowest rate but less than the highest rate due to her
substantial income. *
Rationale: Madeline qualifies for premium-free Part A based on her husband's work
record. Part B premiums are income-adjusted under IRMAA (Income-Related Monthly
Adjustment Amount), meaning those with higher incomes pay more than the standard
premium but less than the highest rate .
4. Mr. Moy will soon turn age 65. He wants to understand what coverage Medicare
Supplemental Insurance provides. What could you tell Mr. Moy?
A) It covers everything Original Medicare does not.
B) It provides prescription drug coverage.
C) 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.
D) It is only available for Medicare Advantage enrollees.
*C) 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. *
Rationale: Medigap policies pay many out-of-pocket costs not covered by Original
Medicare, such as deductibles, coinsurance, and copayments. Some plans also cover
foreign travel emergency care. Medigap does not cover services like long-term care, vision,
dental, hearing aids, or private nursing .
5. Ms. Kumar is concerned that her income will make her ineligible for Medicare at
age 65. What could you tell her?
A) High income makes one ineligible for Medicare.
B) Only low-income individuals qualify for Medicare.
C) 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.
D) She should apply for Medicaid instead.
*C) 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. *
Rationale: Eligibility for Medicare is based on age (65+), certain disabilities, and specific
diseases, not income. However, higher income can affect Part B and D premiums through
IRMAA but does not preclude eligibility itself .
6. Edward IP 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 tell him?
A) Edward's Medicare coverage will end immediately after the transplant.
B) Edward's Medicare coverage will continue for a period following the transplant,
typically 36 months after successful transplantation.
