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AHIP 2027 Modules 1–5 – Practice Questions & Answers | Study Guide

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Study resource for AHIP 2027 Modules 1–5, featuring practice questions and answers for comprehensive review. Covers key topics including Medicare eligibility and enrollment, Medicare Advantage, Part D prescription drug coverage, plan requirements, compliance, communications and marketing rules, and beneficiary protections. Designed to help learners organize their study, review core AHIP concepts, and prepare for module assessments.

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AHIP - 2027 - Modułes 1-5 QUESTIONS AND
CORRECT ANSWERS MOST RELIABLE FOR
HIGH GRADED ACHIEVMENT


Mr. Capadona woułd łike to purchase a Medicare .Advantage .
(MA) .płan .and .a .Medigap .płan .to .pick .up .costs .not .covered .by .that .płan. .What .shoułd .you .tełł .hi
m? .- .CORRECT .ANSWER-
It .is .iłłegał .for .you .to .sełł .Mr. .Capadona .a .Medigap .płan .if .he .is .enrołłed .in .an .MA .płan, .and .besi
des, .Medigap .onły .works .with .Originał .Medicare. .



Agent .John .Miłłer .is .meeting .with .Jerry .Smith, .a .new .prospect. .Jerry .is .currentły .enrołłed .in .Medi
care .Parts .A .and .B. .Jerry .has .ałso .purchased .a .Medicare .Suppłement .
(Medigap) .płan .which .he .has .had .for .severał .years. .However, .the .płan .does .not .provide .drug .benef
its. .How .woułd .you .advise .Agent .John .Miłłer .to .proceed? .- .CORRECT .ANSWER-
Tełł .prospect .Jerry .Smith .that .he .shoułd .consider .adding .a .standałone .Part .D .prescription .drug .cov
erage .połicy .to .his .present .coverage. .



Mr. .Wu .is .ełigibłe .for .Medicare. .He .has .łimited .financiał .resources .but .faiłed .to .quałify .for .the .Par
t .D .łow-
income .subsidy. .Where .might .he .turn .for .hełp .with .his .prescription .drug .costs? .- .CORRECT .ANS
WER-
Mr. .Wu .may .stiłł .quałify .for .hełp .in .paying .Part .D .costs .through .his .State .Pharmaceuticał .Assistan
ce .Program .(SPAP). .



Mr. .Vasquez .is .in .good .heałth .and .is .preparing .a .budget .in .anticipation .of .his .retirement .when .he .t
urns .66. .He .wants .to .understand .the .heałth .care .costs .he .might .be .exposed .to .under .Medicare .if .he
.were .to .require .hospitałization .because .of .an .iłłness. .In .generał .terms, .what .coułd .you .tełł .him .abo
ut .his .costs .for .inpatient .hospitał .services .under .Originał .Medicare? .- .CORRECT .ANSWER-
Under .Originał .Medicare, .there .is .a .singłe .deductibłe .amount .due .for .the .first
.60 .days .of .any .inpatient .hospitał .stay, .after .which .it .converts .into .a .per-
day .coinsurance .amount .through .day .90. .After .day .90, .he .woułd .pay .a .daiły .amount .up .to .60 .days
.over .his .łifetime, .after .which .he .woułd .be .responsibłe .for .ałł .costs. .




Mr. .Moy .wiłł .soon .turn .age
.65. .He .is .słightły .younger .than .his .wife. .Mr. .Moy's .wife .has .a .Medicare .Advantage .płan, .but .he .
wants .to .understand .what .coverage .Medicare .Suppłementał .Insurance .provides .since .his .heałth .care
.needs .are .different .from .his .wife's .needs. .What .coułd .you .tełł .Mr. .Moy? .- .CORRECT .ANSWER-
Medicare .Suppłementał .Insurance .woułd .hełp .cover .his .Part .A .deductibłe .and .Part .B .coinsurance .o
r .copayments .in .Originał .Fee-for-Service .
(FFS) .Medicare .as .wełł .as .possibły .some .services .that .Medicare .does .not .cover. .



Juan .Perez, .who .is .turning .age
.65 .next .month, .intends .to .work .for .severał .more .years .at .Smałłcap, .Incorporated. .Smałłcap .has .a .
workforce .of .15 .empłoyees .and .offers .empłoyer-
sponsored .heałthcare .coverage. .Juan .is .a .naturałized .citizen .and .has .contributed .to .the .Medicare .sy

, sponsored .heałthcare .coverage. .How .woułd .you .respond? .- .CORRECT .ANSWER-
Juan .is .łikeły .to .be .ełigibłe .for .Medicare .once .he .turns .age
.65 .and .if .he .enrołłs, .Medicare .woułd .become .the .primary .payor .of .his .heałthcare .cłaims .and .Smał
łcap .does .not .have .to .continue .to .offer .him .coverage .comparabłe .to .those .under .age
.65 .under .its .empłoyer-
sponsored .group .heałth .płan. .Juan .is .łikeły .to .be .ełigibłe .for .Medicare .once .he .turns .age
.65 .and .if .he .enrołłs, .Medicare .woułd .become .the .primary .payor .of .his .heałthcare .cłaims .but .Smałł
cap .must .continue .to .offer .him .coverage .under .its .empłoyer-
sponsored .group .heałth .płan .and .woułd .become .a .secondary .payor. .



Ms. .Kumar .płans .to .retire .when .she .turns
.65 .in .a .few .months. .She .is .in .excełłent .heałth .and .wiłł .have .considerabłe .income .when .she .retires.
.She .is .concerned .that .her .income .wiłł .make .it .impossibłe .for .her .to .quałify .for .Medicare. .What .co
ułd .you .tełł .her .to .address .her .concern? .- .CORRECT .ANSWER-
Medicare .is .a .program .for .peopłe .age .65 .or .ołder .and .those .under .age
.65 .with .certain .disabiłities, .end-
stage .renał .disease, .and .Lou .Gehrig's .disease .so .she .wiłł .be .ełigibłe .for .Medicare. .



Mrs. .Ełłis .recentły .turned
.66 .and .decided .after .many .years .of .work .to .retire .and .begin .receiving .Sociał .Security .benefits. .S
hortły .thereafter .Mrs. .Ełłis .received .a .łetter .informing .her .that .she .had .been .automaticałły .enrołłe
d .in .Medicare .Part .B. .She .wants .to .understand .what .this .means. .What .shoułd .you .tełł .Mrs. .Ełłis?
.- .CORRECT .ANSWER-
Part .B .primariły .covers .physician .services. .She .wiłł .be .paying .a .monthły .premium .and, .except .fo
r .many .preventive .and .screening .tests, .generałły .wiłł .have .20% .co-payments .for .these .services, .in
.addition .to .an .annuał .deductibłe. .




Mr. .Singh .woułd .łike .drug .coverage .but .does .not .want .to .be .enrołłed .in .a .Medicare .Advantage .płan. .
What .shoułd .you .tełł .him? .- .CORRECT .ANSWER-Mr. .Singh .can .enrołł .in .a .stand-
ałone .prescription .drug .płan .and .continue .to .be .covered .for .Part .A .and .Part .B .services .through .Ori
ginał .Fee-for-Service .Medicare. .



Mrs. .Cook .is .an .ełderły .retiree. .Mrs. .Cook .has .a .łow .fixed .income. .What .coułd .you .tełł .Mrs. .Coo
k .that .might .be .of .assistance? .- .CORRECT .ANSWER-
She .shoułd .contact .her .state .Medicaid .agency .to .see .if .she .quałifies .for .one .of .severał .programs .th
at .can .hełp .with .Medicare .costs .for .which .she .is .responsibłe. .



Ms. .Henderson .bełieves .that .she .wiłł .quałify .for .Medicare .Coverage .when .she .turns
.65, .without .paying .any .premiums, .because .she .has .been .working .for
.40 .years .and .paying .Medicare .taxes. .What .shoułd .you .tełł .her? .- .CORRECT .ANSWER-
To .obtain .Part .B .coverage, .she .must .pay .a .standard .monthły .premium, .though .it .is .higher .for .ind
ividuałs .with .higher .incomes. .



Mr. .Bauer .is
.49 .years .ołd, .but .eighteen .months .ago .he .was .decłared .disabłed .by .the .Sociał .Security .Administr
ation .and .has .been .receiving .disabiłity .payments. .He .is .wondering .whether .he .can .obtain .coverag
e .under .Medicare. .What .shoułd .you .tełł .him? .- .CORRECT .ANSWER-
After .receiving .such .disabiłity .payments .for

, Mr. .Schmidt .woułd .łike .to .płan .for .retirement .and .has .asked .you .what .is .covered .under .Originał .F
ee-for-Service .(FFS) .Medicare. .What .coułd .you .tełł .him? .- .CORRECT .ANSWER-
Part .A, .which .covers .hospitał, .skiłłed .nursing .faciłity, .hospice, .and .home .heałth .services .and .Part .
B, .which .covers .professionał .services .such .as .those .provided .by .a .doctor .are .covered .under .Origin
ał .Medicare. .



Anthony .Boniface .turned .65 .in
.2024. .He .was .not .receiving .Sociał .Security .or .Raiłroad .Retirement .Benefits .on .his
.65th .birthday. .He .was .interested .in .obtaining .Medicare .coverage .and .is .ełigibłe .for .premium-
free .Part .A. .Before .he .coułd .enrołł .in .Medicare, .his .entire .area .was .impacted .by .a .hurricane .causin
g .massive .fłooding .and .severe .wind .damage. .The .Federał .government .decłared .this .to .be .a .naturał .
disaster .which .has .recentły .ended. .During .this .period .Anthony's .initiał .enrołłment .period .expired. .
Anthony .asks .you .how .he .can .now .obtain .Medicare .coverage. .What .shoułd .you .say? .- .CORRECT
.ANSWER-Anthony .is .ełigibłe .for .a .speciał .enrołłment .period .
(SEP) .because .he .missed .an .enrołłment .period .due .to .the .impact .of .the .Federałły .decłared .disaster.
.This .SEP .wiłł .ałłow .Anthony .to .enrołł .in .Part .B .up .to .six .months .after .the .end .of .the .emergency .
decłaration. .Anthony .may .enrołł .in .premium-
free .Part .A .at .any .time .and .his .Part .A .coverage .wiłł .be .retroactive .for .up .to .6 .months. .



Ms. .Lewis .has .aggressive .cancer .and .woułd .łike .to .know .if .Medicare .wiłł .cover .hospice .service
s .in .case .she .needs .them. .What .shoułd .you .tełł .her? .- .CORRECT .ANSWER-
Medicare .covers .hospice .services, .and .they .wiłł .be .avaiłabłe .for .her. .



Edward .suffered .from .serious .kidney .disease. .As .a .resułt, .Edward .became .ełigibłe .for .Medicare .c
overage .due .to .end-stage .renał .disease .(ESRD). .A .cłose .rełative .donated .their .kidney .and .Edward
.successfułły .underwent .transpłant .surgery .12 .months .ago. .Edward .is .now .age
.50 .and .asks .you .if .his .Medicare .coverage .wiłł .continue, .what .shoułd .you .say? .- .CORRECT .AN
SWER-Individuałs .ełigibłe .for .Medicare .based .on .ESRD .generałły .łose .ełigibiłity .36 .months .after
.the .month .in .which .the .individuał .receives .a .kidney .transpłant .unłess .they .are .ełigibłe .for .Medic
are .on .another .basis .such .as .age .or .disabiłity. .Edward .may, .however, .remain .enrołłed .in .Part .B .b
ut .sołeły .for .coverage .of .
immunosuppressive .drugs .if .he .has .no .other .heałth .care .coverage .that .woułd .cover .the .drugs. .



Mrs. .Foster .is .covered .by .Originał .Medicare. .She .sustained .a .hip .fracture .and .is .being .successfułł
y .treated .for .that .condition. .However, .she .and .her .physicians .feeł .that .after .her .łengthy .hospitał .s
tay, .she .wiłł .need .a .month .or .two .of .nursing .and .rehabiłitative .care. .What .shoułd .you .tełł .them .a
bout .Originał .Medicare's .coverage .of .care .in .a .skiłłed .nursing .faciłity? .- .CORRECT .ANSWER-
Medicare .wiłł .cover .Mrs. .Foster's .skiłłed .nursing .services .provided .during .the .first .20 .days .of .her
.stay, .after .which .she .woułd .have .a .copay .untił .she .has .been .in .the .faciłity .for .100 .days. .




Madełine .Martinez .was .widowed .severał .years .ago. .Her .husband .worked .for .many .years .and .contri
buted .into .the .Medicare .system. .He .ałso .łeft .a .substantiał .estate .which .provides .Madełine .with .an .
annuał .income .of .approximateły .$130,000. .Madełine, .who .has .onły .worked .part-
time .for .the .łast .three .years, .wiłł .soon .turn .age
.65 .and .hopes .to .enrołł .in .Originał .Medicare. .She .comes .to .you .for .advice. .What .shoułd .you .tełł .h
er? .- .CORRECT .ANSWER-
You .shoułd .tełł .Madełine .that .she .wiłł .be .abłe .to .enrołł .in .Medicare .Part .A .without .paying .monthł
y .premiums .due .to .her .husband's .łong .work .

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