AHIP 2026 - MODULES 1-5 UPDATED ACTUAL QUESTIONS
AND CORRECT ANSWERS
Question:
1. MOD ! - Review - 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?
a.She should disenroll if she does not want to pay the monthly premiums. There is no disadvantage in
doing so.
b.She will need to pay no premiums for Part B as she qualifies for premium-free coverage due to the
number of quarters she has worked.
c.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.
d.Part B will cover her routine dental and vision needs.
Answer:
c.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.
Question:
2. MOD 1 - Review -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
employersponsored healthcare coverage. How would you respond?
a.Juan is likely to be ineligible for Medicare since he was born outside the United States and has only
contributed to the Medicare system for 20 years.
b.Juan is likely to be eligible for Medicare once he turns age 65 and if he enrolls his employer-sponsored
coverage would continue to be the primary payor while Medicare would be considered a secondary payor
of his healthcare claims.
c.Juan is likely to be eligible for Medicare once he turns age 65 and if h
Answer:
d.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 and would become a
secondary payor.
,Question:
3. MOD 1 - Review - 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?
a.Tell prospect Jerry Smith that he should consider adding a standalone Part D prescription drug coverage
policy to his present coverage.
b.Tell prospect Jerry Smith that he should drop his Medigap coverage and put those premium dollars
toward the purchase of a standalone Part D prescription drug plan because he can always reactivate his
Medigap policy on a guaranteed issue basis. Furthermore, because he has had Medigap Jerry will not incur
a Part D late enrollment penalty.
c.Tell prospect Jerry Smith that Medigap is simply a variation of a Medicare Advantage plan and the
companies John r
Answer:
a.Tell prospect Jerry Smith that he should consider adding a standalone Part D prescription drug coverage
policy to his present coverage.
Question:
4. MOD 1 - Review - Mildred Savage enrolled in Allcare Medicare Advantage plan several years ago.
Mildred recently learned that she is suffering from inoperable cancer and 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?
a.Hospice benefits will be available to Mildred but they will be paid for by Original Medicare under Part
B.
b.Hospice benefits will be paid for under Mildred's Allcare Medicare Advantage plan which must cover all
Medicare Part A and Part B benefits.
c.Mildred may remain enrolled in Allcare and make a hospice election. Hospice benefits will be paid for
by Original Medicare under Part A and Allcare will continue to pay for any non-hospice services
.d.Hospice benefits are not covered under Medicare and must be paid for using private f
Answer:
c.Mildred may remain enrolled in Allcare and make a hospice election. Hospice benefits will be paid for
by Original Medicare under Part A and Allcare will continue to pay for any non-hospice services
Question:
5. MOD 1 - Review - 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?
a.Under Original Medicare, if the inpatient hospital service is provided by a participating Medicare
provider, the co-payment is waived. Co-payments are only charged when a beneficiary opts to receive care
from a non-participating provider.
b.Under Original Medicare, the inpatient hospital co-payment is a percentage of allowed charges. The
percentage increases after 60 days and again after 90 days.
c.Under Original Medicare, there is a single deductible amount due for the first 60 days of any inpatient
hospital stay, after which it converts
,Answer:
c.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.
Question:
6. MOD 1. - Review - 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?
a.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.
b.Individuals eligible for Medicare based on ESRD generally lose eligibility 24 months after the month in
which the individual receives a kidney transplant unless t
Answer:
a.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.
Question:
7. MOD 1 - Review - 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 will help Mr. Capadona to select a Medigap plan that is designed to cover gaps in Medicare
Advantage
b.Medigap policies designed to cover costs not paid for by an MA plan can be purchased, but only if the
MA plan's design is considered to be the "defined standard benefit."
c.Medigap plans that cover costs not paid for by an MA plan are available only in Massachusetts,
Minnesota, and Wisconsin.
d.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.
Answer:
d.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.
, Question:
8. MOD 1 - Review - 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?
a.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.
b.You should tell Madeline that she will need to pay premiums for Part A because of her short work
history. You should also tell Madeline that s
Answer:
a.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.
Question:
9. MOD 1 - Review - Mrs. Cook is an elderly retiree. Mrs. Cook has a low fixed income. What could you
tell Mrs. Cook that might be of assistance?
a.She should contact her state Medicaid agency to see if she qualifies for one of several programs that can
help with Medicare costs for which she is responsible.
b.She can apply to the Medicare agency for lower premiums and cost-sharing .c.She should only seek help
from private organizations to cover her Medicare costs.d.She should not sign up for a Medicare Advantage
plan.
Answer:
a.She should contact her state Medicaid agency to see if she qualifies for one of several programs that can
help with Medicare costs for which she is responsible.
Question:
10. MOD 1 - Review - 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?
a.Once she has expended her liquid assets, Medicare will cover 80% of Mrs. Foster's long-term care costs.
b.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.
c.Mrs. Foster will have to apply for Medicaid to have her skilled nursing services covered because
Medicare does not provide such a benefit.
d.Medicare will cover an unlimited number of days in a skilled nursing facility, as long as a physician c
Answer:
b.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.
AND CORRECT ANSWERS
Question:
1. MOD ! - Review - 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?
a.She should disenroll if she does not want to pay the monthly premiums. There is no disadvantage in
doing so.
b.She will need to pay no premiums for Part B as she qualifies for premium-free coverage due to the
number of quarters she has worked.
c.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.
d.Part B will cover her routine dental and vision needs.
Answer:
c.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.
Question:
2. MOD 1 - Review -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
employersponsored healthcare coverage. How would you respond?
a.Juan is likely to be ineligible for Medicare since he was born outside the United States and has only
contributed to the Medicare system for 20 years.
b.Juan is likely to be eligible for Medicare once he turns age 65 and if he enrolls his employer-sponsored
coverage would continue to be the primary payor while Medicare would be considered a secondary payor
of his healthcare claims.
c.Juan is likely to be eligible for Medicare once he turns age 65 and if h
Answer:
d.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 and would become a
secondary payor.
,Question:
3. MOD 1 - Review - 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?
a.Tell prospect Jerry Smith that he should consider adding a standalone Part D prescription drug coverage
policy to his present coverage.
b.Tell prospect Jerry Smith that he should drop his Medigap coverage and put those premium dollars
toward the purchase of a standalone Part D prescription drug plan because he can always reactivate his
Medigap policy on a guaranteed issue basis. Furthermore, because he has had Medigap Jerry will not incur
a Part D late enrollment penalty.
c.Tell prospect Jerry Smith that Medigap is simply a variation of a Medicare Advantage plan and the
companies John r
Answer:
a.Tell prospect Jerry Smith that he should consider adding a standalone Part D prescription drug coverage
policy to his present coverage.
Question:
4. MOD 1 - Review - Mildred Savage enrolled in Allcare Medicare Advantage plan several years ago.
Mildred recently learned that she is suffering from inoperable cancer and 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?
a.Hospice benefits will be available to Mildred but they will be paid for by Original Medicare under Part
B.
b.Hospice benefits will be paid for under Mildred's Allcare Medicare Advantage plan which must cover all
Medicare Part A and Part B benefits.
c.Mildred may remain enrolled in Allcare and make a hospice election. Hospice benefits will be paid for
by Original Medicare under Part A and Allcare will continue to pay for any non-hospice services
.d.Hospice benefits are not covered under Medicare and must be paid for using private f
Answer:
c.Mildred may remain enrolled in Allcare and make a hospice election. Hospice benefits will be paid for
by Original Medicare under Part A and Allcare will continue to pay for any non-hospice services
Question:
5. MOD 1 - Review - 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?
a.Under Original Medicare, if the inpatient hospital service is provided by a participating Medicare
provider, the co-payment is waived. Co-payments are only charged when a beneficiary opts to receive care
from a non-participating provider.
b.Under Original Medicare, the inpatient hospital co-payment is a percentage of allowed charges. The
percentage increases after 60 days and again after 90 days.
c.Under Original Medicare, there is a single deductible amount due for the first 60 days of any inpatient
hospital stay, after which it converts
,Answer:
c.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.
Question:
6. MOD 1. - Review - 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?
a.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.
b.Individuals eligible for Medicare based on ESRD generally lose eligibility 24 months after the month in
which the individual receives a kidney transplant unless t
Answer:
a.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.
Question:
7. MOD 1 - Review - 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 will help Mr. Capadona to select a Medigap plan that is designed to cover gaps in Medicare
Advantage
b.Medigap policies designed to cover costs not paid for by an MA plan can be purchased, but only if the
MA plan's design is considered to be the "defined standard benefit."
c.Medigap plans that cover costs not paid for by an MA plan are available only in Massachusetts,
Minnesota, and Wisconsin.
d.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.
Answer:
d.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.
, Question:
8. MOD 1 - Review - 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?
a.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.
b.You should tell Madeline that she will need to pay premiums for Part A because of her short work
history. You should also tell Madeline that s
Answer:
a.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.
Question:
9. MOD 1 - Review - Mrs. Cook is an elderly retiree. Mrs. Cook has a low fixed income. What could you
tell Mrs. Cook that might be of assistance?
a.She should contact her state Medicaid agency to see if she qualifies for one of several programs that can
help with Medicare costs for which she is responsible.
b.She can apply to the Medicare agency for lower premiums and cost-sharing .c.She should only seek help
from private organizations to cover her Medicare costs.d.She should not sign up for a Medicare Advantage
plan.
Answer:
a.She should contact her state Medicaid agency to see if she qualifies for one of several programs that can
help with Medicare costs for which she is responsible.
Question:
10. MOD 1 - Review - 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?
a.Once she has expended her liquid assets, Medicare will cover 80% of Mrs. Foster's long-term care costs.
b.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.
c.Mrs. Foster will have to apply for Medicaid to have her skilled nursing services covered because
Medicare does not provide such a benefit.
d.Medicare will cover an unlimited number of days in a skilled nursing facility, as long as a physician c
Answer:
b.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.
