AHIP -2026-MODULES 1-5 (EXAM QUESTIONS WITH ONLY THE
CORRECT ANSWERS)
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.
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? - ✔✔ANSWER Tell Prospect Jerry Smith That He Should Consider Adding A
Standalone Part D Prescription Drug Coverage Policy To His Present Coverage.
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? -
✔✔ANSWER Mr. Wu May Still Qualify For Help In Paying Part D Costs Through His State
Pharmaceutical Assistance Program (Spap).
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? - ✔✔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.
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 Supplemental 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.
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 Employer-
Sponsored Healthcare Coverage. How Would You Respond? - ✔✔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.
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.
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? - ✔✔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.
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 Prescription Drug
Plan And Continue To Be Covered For Part A And Part B Services Through Original Fee-For-Service
Medicare.
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 Several Programs That Can Help With Medicare Costs For Which She Is
Responsible.
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? - ✔✔ANSWER To Obtain Part B Coverage, She Must Pay A Standard Monthly
Premium, Though It Is Higher For Individuals With Higher Incomes.
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
CORRECT ANSWERS)
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.
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? - ✔✔ANSWER Tell Prospect Jerry Smith That He Should Consider Adding A
Standalone Part D Prescription Drug Coverage Policy To His Present Coverage.
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? -
✔✔ANSWER Mr. Wu May Still Qualify For Help In Paying Part D Costs Through His State
Pharmaceutical Assistance Program (Spap).
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? - ✔✔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.
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 Supplemental 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.
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 Employer-
Sponsored Healthcare Coverage. How Would You Respond? - ✔✔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.
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.
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? - ✔✔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.
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 Prescription Drug
Plan And Continue To Be Covered For Part A And Part B Services Through Original Fee-For-Service
Medicare.
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 Several Programs That Can Help With Medicare Costs For Which She Is
Responsible.
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? - ✔✔ANSWER To Obtain Part B Coverage, She Must Pay A Standard Monthly
Premium, Though It Is Higher For Individuals With Higher Incomes.
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
