AHIP 2027
MODULE’S 1-5
Actual Questions with Correct Answers
PASS THE "Final Exam" with a 90% or higher
What’s Included:
• 100 verified questions with Correct
answers with Rationales.
• Ideal for exam preparation and concept
reinforcement.
,Table of Contents
MODULE 1 ........................................................................................ 2
MODULE 2 ...................................................................................... 12
MODULE 3 ...................................................................................... 22
MODULE 4 ...................................................................................... 31
MODULE 5 ...................................................................................... 39
MODULE 1
1. 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 hospitalized. In general terms,
what could you tell him about his costs for inpatient hospital services under
Original Medicare?
A. There is no cost for the first 90 days of any hospital stay under Original Medicare
B. 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 pays a daily amount up to 60 lifetime reserve days,
after which he is responsible for all costs
C. He pays a flat 20% coinsurance for all hospital services regardless of length of stay
D. Original Medicare covers all inpatient costs after an annual deductible is met
Correct Answer: B
Rationale:
Original Medicare Part A uses a benefit-period structure: a single deductible covers
days 1–60; daily coinsurance applies for days 61–90; 60 lifetime reserve days are
available beyond that with higher daily cost-sharing; after reserve days are exhausted,
the beneficiary pays all costs.
,2. 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. He can enroll in both MA and Medigap simultaneously without restrictions
B. It is illegal for you to sell Mr. Capadona a Medigap plan if he is enrolled in an MA
plan, and Medigap only works with Original Medicare
C. Medigap plans are designed to cover all out-of-pocket costs in MA plans
D. He should drop his MA plan and keep only Medigap for comprehensive coverage
Correct Answer: B
Rationale:
Federal law prohibits the sale of a Medigap policy to a beneficiary already enrolled in a
Medicare Advantage plan. Medigap supplements Original Medicare (Fee-for-Service)
only and does not coordinate with MA plan cost-sharing.
3. Agent John Miller is meeting with Jerry Smith, a new prospect. Jerry is
currently enrolled in Medicare Parts A and B and has a Medicare Supplement
(Medigap) plan without drug benefits. How would you advise Agent Miller to
proceed?
A. Tell Jerry to drop his Medigap and enroll in an MA-PD plan immediately
B. Tell Jerry that he cannot get drug coverage because he has a Medigap plan
C. Tell Jerry Smith that he should consider adding a standalone Part D prescription drug
coverage policy to his present coverage
D. Tell Jerry to enroll in Original Medicare Part D and cancel his Medigap
Correct Answer: C
Rationale:
Beneficiaries with Original Medicare and Medigap may enroll in a standalone Medicare
Part D prescription drug plan to add drug coverage without disturbing their existing
Medigap or Original Medicare benefits.
4. 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
prescription drug costs?
A. He must pay full prescription costs out-of-pocket with no assistance available
B. Mr. Wu may still qualify for help in paying Part D costs through his State
Pharmaceutical Assistance Program
,C. He should enroll in a Medicare Advantage plan to receive automatic drug subsidies
D. He can only receive assistance through federal Medicaid programs
Correct Answer: B
Rationale:
Even if a beneficiary does not qualify for the federal Part D Low-Income Subsidy (LIS),
many states operate State Pharmaceutical Assistance Programs (SPAPs) that provide
additional cost-sharing or premium assistance.
5. Mr. Moy will soon turn age 65. He is slightly younger than his wife, who has a
Medicare Advantage plan, but he wants to understand what coverage Medicare
Supplemental Insurance provides since his health care needs differ. What could
you tell Mr. Moy?
A. Medicare Supplemental Insurance covers all prescription drug costs not covered by
his wife’s plan
B. Medicare Supplemental Insurance would help cover his Part A deductible and Part B
coinsurance or copayments in Original Fee-for-Service Medicare as well as possibly
some services that Medicare does not cover
C. It replaces his Medicare coverage entirely with private insurance
D. It only covers emergency services received outside the United States
Correct Answer: B
Rationale:
Medigap (Medicare Supplement) policies are standardized plans that fill gaps in Original
Medicare cost-sharing, such as deductibles, coinsurance, and copayments; some plans
also cover limited additional benefits not covered by Medicare.
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
offers employer-sponsored healthcare coverage. Juan is a naturalized citizen and
has contributed to Medicare for over 20 years. He asks if he will be entitled to
Medicare and how that will impact his employer coverage. How would you
respond?
A. Juan is not eligible for Medicare while he remains actively employed
B. Juan is likely to be eligible for Medicare once he turns age 65; 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
C. Juan must drop his employer coverage to enroll in Medicare
,D. Juan is eligible, but Smallcap must continue his employer coverage as the primary
payor and Medicare becomes secondary
Correct Answer: B
Rationale:
For employers with fewer than 20 employees, Medicare is the primary payer once the
employee enrolls. The employer is not required to maintain coverage comparable to
younger employees, though it may offer secondary coverage.
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?
A. Medicare eligibility is based on income, so she may not qualify
B. 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
C. She must spend down her assets to qualify for Medicare
D. She should enroll in Medicaid instead due to her income level
Correct Answer: B
Rationale:
Medicare eligibility is based primarily on age (65+), disability status, ESRD, or ALS—not
on income or assets. High-income beneficiaries may pay higher Part B and Part D
premiums (IRMAA), but they remain fully eligible.
8. Mrs. Ellis recently turned 66 and decided to retire and begin receiving Social
Security benefits. Shortly thereafter she 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. Part B is free and covers all medical services without any cost-sharing
B. 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%
copayments for these services, in addition to an annual deductible
C. Part B only covers inpatient hospital services
D. Part B enrollment is voluntary and she can decline without any future penalty
Correct Answer: B
Rationale:
, Individuals already receiving Social Security or Railroad Retirement benefits are
automatically enrolled in Part B at age 65. Part B covers outpatient and physician
services, subject to a monthly premium, an annual deductible, and 20% coinsurance for
most services.
9. Mr. Singh would like drug coverage but does not want to be enrolled in a
Medicare Advantage plan. What should you tell him?
A. He must enroll in an MA plan to obtain prescription drug coverage
B. Mr. Singh can enroll in a stand-alone prescription drug plan and continue to be
covered for Part A and Part B services through Original Fee-for-Service Medicare
C. He cannot obtain drug coverage without switching to Original Medicare
D. He should purchase a Medigap plan that includes drug coverage
Correct Answer: B
Rationale:
Beneficiaries who prefer Original Medicare may add drug coverage by enrolling in a
standalone Medicare Part D Prescription Drug Plan (PDP) without joining a Medicare
Advantage plan.
10. Mrs. Cook is an elderly retiree with a low fixed income. What could you tell
Mrs. Cook that might be of assistance?
A. She should sell assets to qualify for Medicare premium assistance
B. She should contact her state Medicaid agency to see if she qualifies for one of
several programs that can help with Medicare costs
C. She is not eligible for any assistance programs because she is on Medicare
D. She must enroll in a Medicare Advantage plan to receive financial help
Correct Answer: B
Rationale:
Low-income Medicare beneficiaries may qualify for Medicare Savings Programs (QMB,
SLMB, QI) administered through state Medicaid agencies. These programs help pay
premiums, deductibles, coinsurance, and copayments.
11. Ms. Henderson believes that she will qualify for Medicare Coverage when she
turns 65, without paying any premiums, because she has been working for 40
years and paying Medicare taxes. What should you tell her?
MODULE’S 1-5
Actual Questions with Correct Answers
PASS THE "Final Exam" with a 90% or higher
What’s Included:
• 100 verified questions with Correct
answers with Rationales.
• Ideal for exam preparation and concept
reinforcement.
,Table of Contents
MODULE 1 ........................................................................................ 2
MODULE 2 ...................................................................................... 12
MODULE 3 ...................................................................................... 22
MODULE 4 ...................................................................................... 31
MODULE 5 ...................................................................................... 39
MODULE 1
1. 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 hospitalized. In general terms,
what could you tell him about his costs for inpatient hospital services under
Original Medicare?
A. There is no cost for the first 90 days of any hospital stay under Original Medicare
B. 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 pays a daily amount up to 60 lifetime reserve days,
after which he is responsible for all costs
C. He pays a flat 20% coinsurance for all hospital services regardless of length of stay
D. Original Medicare covers all inpatient costs after an annual deductible is met
Correct Answer: B
Rationale:
Original Medicare Part A uses a benefit-period structure: a single deductible covers
days 1–60; daily coinsurance applies for days 61–90; 60 lifetime reserve days are
available beyond that with higher daily cost-sharing; after reserve days are exhausted,
the beneficiary pays all costs.
,2. 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. He can enroll in both MA and Medigap simultaneously without restrictions
B. It is illegal for you to sell Mr. Capadona a Medigap plan if he is enrolled in an MA
plan, and Medigap only works with Original Medicare
C. Medigap plans are designed to cover all out-of-pocket costs in MA plans
D. He should drop his MA plan and keep only Medigap for comprehensive coverage
Correct Answer: B
Rationale:
Federal law prohibits the sale of a Medigap policy to a beneficiary already enrolled in a
Medicare Advantage plan. Medigap supplements Original Medicare (Fee-for-Service)
only and does not coordinate with MA plan cost-sharing.
3. Agent John Miller is meeting with Jerry Smith, a new prospect. Jerry is
currently enrolled in Medicare Parts A and B and has a Medicare Supplement
(Medigap) plan without drug benefits. How would you advise Agent Miller to
proceed?
A. Tell Jerry to drop his Medigap and enroll in an MA-PD plan immediately
B. Tell Jerry that he cannot get drug coverage because he has a Medigap plan
C. Tell Jerry Smith that he should consider adding a standalone Part D prescription drug
coverage policy to his present coverage
D. Tell Jerry to enroll in Original Medicare Part D and cancel his Medigap
Correct Answer: C
Rationale:
Beneficiaries with Original Medicare and Medigap may enroll in a standalone Medicare
Part D prescription drug plan to add drug coverage without disturbing their existing
Medigap or Original Medicare benefits.
4. 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
prescription drug costs?
A. He must pay full prescription costs out-of-pocket with no assistance available
B. Mr. Wu may still qualify for help in paying Part D costs through his State
Pharmaceutical Assistance Program
,C. He should enroll in a Medicare Advantage plan to receive automatic drug subsidies
D. He can only receive assistance through federal Medicaid programs
Correct Answer: B
Rationale:
Even if a beneficiary does not qualify for the federal Part D Low-Income Subsidy (LIS),
many states operate State Pharmaceutical Assistance Programs (SPAPs) that provide
additional cost-sharing or premium assistance.
5. Mr. Moy will soon turn age 65. He is slightly younger than his wife, who has a
Medicare Advantage plan, but he wants to understand what coverage Medicare
Supplemental Insurance provides since his health care needs differ. What could
you tell Mr. Moy?
A. Medicare Supplemental Insurance covers all prescription drug costs not covered by
his wife’s plan
B. Medicare Supplemental Insurance would help cover his Part A deductible and Part B
coinsurance or copayments in Original Fee-for-Service Medicare as well as possibly
some services that Medicare does not cover
C. It replaces his Medicare coverage entirely with private insurance
D. It only covers emergency services received outside the United States
Correct Answer: B
Rationale:
Medigap (Medicare Supplement) policies are standardized plans that fill gaps in Original
Medicare cost-sharing, such as deductibles, coinsurance, and copayments; some plans
also cover limited additional benefits not covered by Medicare.
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
offers employer-sponsored healthcare coverage. Juan is a naturalized citizen and
has contributed to Medicare for over 20 years. He asks if he will be entitled to
Medicare and how that will impact his employer coverage. How would you
respond?
A. Juan is not eligible for Medicare while he remains actively employed
B. Juan is likely to be eligible for Medicare once he turns age 65; 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
C. Juan must drop his employer coverage to enroll in Medicare
,D. Juan is eligible, but Smallcap must continue his employer coverage as the primary
payor and Medicare becomes secondary
Correct Answer: B
Rationale:
For employers with fewer than 20 employees, Medicare is the primary payer once the
employee enrolls. The employer is not required to maintain coverage comparable to
younger employees, though it may offer secondary coverage.
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?
A. Medicare eligibility is based on income, so she may not qualify
B. 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
C. She must spend down her assets to qualify for Medicare
D. She should enroll in Medicaid instead due to her income level
Correct Answer: B
Rationale:
Medicare eligibility is based primarily on age (65+), disability status, ESRD, or ALS—not
on income or assets. High-income beneficiaries may pay higher Part B and Part D
premiums (IRMAA), but they remain fully eligible.
8. Mrs. Ellis recently turned 66 and decided to retire and begin receiving Social
Security benefits. Shortly thereafter she 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. Part B is free and covers all medical services without any cost-sharing
B. 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%
copayments for these services, in addition to an annual deductible
C. Part B only covers inpatient hospital services
D. Part B enrollment is voluntary and she can decline without any future penalty
Correct Answer: B
Rationale:
, Individuals already receiving Social Security or Railroad Retirement benefits are
automatically enrolled in Part B at age 65. Part B covers outpatient and physician
services, subject to a monthly premium, an annual deductible, and 20% coinsurance for
most services.
9. Mr. Singh would like drug coverage but does not want to be enrolled in a
Medicare Advantage plan. What should you tell him?
A. He must enroll in an MA plan to obtain prescription drug coverage
B. Mr. Singh can enroll in a stand-alone prescription drug plan and continue to be
covered for Part A and Part B services through Original Fee-for-Service Medicare
C. He cannot obtain drug coverage without switching to Original Medicare
D. He should purchase a Medigap plan that includes drug coverage
Correct Answer: B
Rationale:
Beneficiaries who prefer Original Medicare may add drug coverage by enrolling in a
standalone Medicare Part D Prescription Drug Plan (PDP) without joining a Medicare
Advantage plan.
10. Mrs. Cook is an elderly retiree with a low fixed income. What could you tell
Mrs. Cook that might be of assistance?
A. She should sell assets to qualify for Medicare premium assistance
B. She should contact her state Medicaid agency to see if she qualifies for one of
several programs that can help with Medicare costs
C. She is not eligible for any assistance programs because she is on Medicare
D. She must enroll in a Medicare Advantage plan to receive financial help
Correct Answer: B
Rationale:
Low-income Medicare beneficiaries may qualify for Medicare Savings Programs (QMB,
SLMB, QI) administered through state Medicaid agencies. These programs help pay
premiums, deductibles, coinsurance, and copayments.
11. Ms. Henderson believes that she will qualify for Medicare Coverage when she
turns 65, without paying any premiums, because she has been working for 40
years and paying Medicare taxes. What should you tell her?
