AHIP 2026 MODULES 1-5 UPDATED QUESTIONS AND
CORRECT ANSWERS
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?
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.
Question:
2. Agent John Miller is meeting with Jerry Smith, a new prospect. Jerry is currently enrolled in
Medicare Parts A and B. Jer-ry has also purchased a Medicare Supple-ment (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?
Answer:
Tell prospect Jerry Smith that he should con-sider adding a standalone Part D prescrip-tion drug
coverage policy to his present cov-erage.
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 pre-scription drug costs?
Answer:
Mr. Wu may still qualify for help in paying Part D costs through his State Pharmaceuti-cal Assistance
Program (SPAP).
Question:
4. 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 ill-ness. In general terms, what could you tell him about
his costs for inpatient hospital services under Original Medicare?
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.
Question:
5. Mr. Moy will soon turn age 65. He is slightly younger than his wife. Mr. Moy's wife has a
Medicare Advantage plan, but he wants to understand what coverage Medicare Sup-plemental
Insurance provides since his health care needs are different from his wife's needs. What could you tell
Mr. Moy?
Answer:
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.
,Question:
6. 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 of-fers employer-sponsored healthcare
cov-erage. 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 employer-
sponsored healthcare coverage. How would you re-spond?
Answer:
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. 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 but Smallcap must continue to offer him coverage under its
employer-sponsored group health plan and would become a secondary payor.
Question:
7. Ms. Kumar plans to retire when she turns 65 in a few months. She is in excellent health and will
have considerable income when she retires. 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?
Answer:
Medicare is a program for people age 65 or older and those under age 65 with certain disabilities,
end-stage renal disease, and Lou Gehrig's disease so she will be eligible for Medicare.
Question:
8. 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 let-ter informing her that she had
been au-tomatically enrolled in Medicare Part B. She wants to understand what this means. What
should you tell Mrs. Ellis?
Answer:
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:
9. Mr. Singh would like drug coverage but does not want to be enrolled in a Medicare Advantage
plan. What should you tell him?
Answer:
Mr. Singh can enroll in a stand-alone pre-scription drug plan and continue to be cov-ered for Part A
and Part B services through Original Fee-for-Service Medicare.
Question:
10. Mrs. Cook is an elderly retiree. Mrs. Cook has a low fixed income. What could you tell Mrs.
Cook that might be of assistance?
Answer:
She should contact her state Medicaid agency to see if she qualifies for one of sev-eral programs that
can help with Medicare costs for which she is responsible.
, Question:
11. Ms. Henderson believes that she will qual-ify for Medicare Coverage when she turns 65, without
paying any premiums, be-cause she has been working for 40 years and paying Medicare taxes. What
should you tell her?
Answer:
To obtain Part B coverage, she must pay a standard monthly premium, though it is higher for
individuals with higher incomes.
Question:
12. Mr. Bauer is 49 years old, but eighteen months ago he was declared disabled by the Social
Security Administration and has been receiving disability payments. He is wondering whether he can
obtain cover-age under Medicare. What should you tell him?
Answer:
After receiving such disability payments for 24 months, he will be automatically enrolled in
Medicare, regardless of age.
Question:
13. Mr. Schmidt would like to plan for re-tirement and has asked you what is cov-ered under Original
Fee-for-Service (FFS) Medicare. What could you tell him?
Answer:
Part A, which covers hospital, skilled nursing facility, hospice, and home health services and Part B,
which covers professional ser-vices such as those provided by a doctor are covered under Original
Medicare.
Question:
14. Anthony Boniface turned 65 in 2024. He was not receiving Social Security or Rail-road
Retirement Benefits on his 65th birthday. He was interested in obtaining Medicare coverage and is
eligible for pre-mium-free Part A. Before he could enroll in Medicare, his entire area was impact-ed
by a hurricane causing massive flood-ing 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 expired. Anthony asks you how he can now obtain Medicare coverage. What should you say?
Answer:
Anthony is eligible for a special enrollment period (SEP) because he missed an enroll-ment period
due to the impact of the Fed-erally declared disaster. This SEP will allow Anthony to enroll in Part B
up to six months after the end of the emergency declaration. Anthony may enroll in premium-free
Part A at any time and his Part A coverage will be retroactive for up to 6 months.
Question:
15. Ms. Lewis has aggressive cancer and would like to know if Medicare will cover hospice services
in case she needs them. What should you tell her?
Answer:
Medicare covers hospice services, and they will be available for her.
Question:
16. Edward suffered from serious kidney dis-ease. As a result, Edward became eligible for Medicare
coverage due to end-stage renal disease (ESRD). A close relative do-nated their kidney and Edward
success-fully underwent transplant surgery 12 months ago. Edward is now age 50 and asks you if his
Medicare coverage will con-tinue, what should you say?
CORRECT ANSWERS
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?
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.
Question:
2. Agent John Miller is meeting with Jerry Smith, a new prospect. Jerry is currently enrolled in
Medicare Parts A and B. Jer-ry has also purchased a Medicare Supple-ment (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?
Answer:
Tell prospect Jerry Smith that he should con-sider adding a standalone Part D prescrip-tion drug
coverage policy to his present cov-erage.
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 pre-scription drug costs?
Answer:
Mr. Wu may still qualify for help in paying Part D costs through his State Pharmaceuti-cal Assistance
Program (SPAP).
Question:
4. 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 ill-ness. In general terms, what could you tell him about
his costs for inpatient hospital services under Original Medicare?
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.
Question:
5. Mr. Moy will soon turn age 65. He is slightly younger than his wife. Mr. Moy's wife has a
Medicare Advantage plan, but he wants to understand what coverage Medicare Sup-plemental
Insurance provides since his health care needs are different from his wife's needs. What could you tell
Mr. Moy?
Answer:
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.
,Question:
6. 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 of-fers employer-sponsored healthcare
cov-erage. 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 employer-
sponsored healthcare coverage. How would you re-spond?
Answer:
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. 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 but Smallcap must continue to offer him coverage under its
employer-sponsored group health plan and would become a secondary payor.
Question:
7. Ms. Kumar plans to retire when she turns 65 in a few months. She is in excellent health and will
have considerable income when she retires. 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?
Answer:
Medicare is a program for people age 65 or older and those under age 65 with certain disabilities,
end-stage renal disease, and Lou Gehrig's disease so she will be eligible for Medicare.
Question:
8. 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 let-ter informing her that she had
been au-tomatically enrolled in Medicare Part B. She wants to understand what this means. What
should you tell Mrs. Ellis?
Answer:
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:
9. Mr. Singh would like drug coverage but does not want to be enrolled in a Medicare Advantage
plan. What should you tell him?
Answer:
Mr. Singh can enroll in a stand-alone pre-scription drug plan and continue to be cov-ered for Part A
and Part B services through Original Fee-for-Service Medicare.
Question:
10. Mrs. Cook is an elderly retiree. Mrs. Cook has a low fixed income. What could you tell Mrs.
Cook that might be of assistance?
Answer:
She should contact her state Medicaid agency to see if she qualifies for one of sev-eral programs that
can help with Medicare costs for which she is responsible.
, Question:
11. Ms. Henderson believes that she will qual-ify for Medicare Coverage when she turns 65, without
paying any premiums, be-cause she has been working for 40 years and paying Medicare taxes. What
should you tell her?
Answer:
To obtain Part B coverage, she must pay a standard monthly premium, though it is higher for
individuals with higher incomes.
Question:
12. Mr. Bauer is 49 years old, but eighteen months ago he was declared disabled by the Social
Security Administration and has been receiving disability payments. He is wondering whether he can
obtain cover-age under Medicare. What should you tell him?
Answer:
After receiving such disability payments for 24 months, he will be automatically enrolled in
Medicare, regardless of age.
Question:
13. Mr. Schmidt would like to plan for re-tirement and has asked you what is cov-ered under Original
Fee-for-Service (FFS) Medicare. What could you tell him?
Answer:
Part A, which covers hospital, skilled nursing facility, hospice, and home health services and Part B,
which covers professional ser-vices such as those provided by a doctor are covered under Original
Medicare.
Question:
14. Anthony Boniface turned 65 in 2024. He was not receiving Social Security or Rail-road
Retirement Benefits on his 65th birthday. He was interested in obtaining Medicare coverage and is
eligible for pre-mium-free Part A. Before he could enroll in Medicare, his entire area was impact-ed
by a hurricane causing massive flood-ing 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 expired. Anthony asks you how he can now obtain Medicare coverage. What should you say?
Answer:
Anthony is eligible for a special enrollment period (SEP) because he missed an enroll-ment period
due to the impact of the Fed-erally declared disaster. This SEP will allow Anthony to enroll in Part B
up to six months after the end of the emergency declaration. Anthony may enroll in premium-free
Part A at any time and his Part A coverage will be retroactive for up to 6 months.
Question:
15. Ms. Lewis has aggressive cancer and would like to know if Medicare will cover hospice services
in case she needs them. What should you tell her?
Answer:
Medicare covers hospice services, and they will be available for her.
Question:
16. Edward suffered from serious kidney dis-ease. As a result, Edward became eligible for Medicare
coverage due to end-stage renal disease (ESRD). A close relative do-nated their kidney and Edward
success-fully underwent transplant surgery 12 months ago. Edward is now age 50 and asks you if his
Medicare coverage will con-tinue, what should you say?
