AHIP - 2026 - Modules 1-5 / Comprehensive Study Guide Questions Bank / Actual Questions and Correct Detailed Answers

AHIP - 2026 - MODULES 1-5 / COMPREHENSIVE STUDY GUIDE
QUESTIONS BANK


1. Mr. Capadona would like to purchase a Medicare Advantage (MA) plan and a Medigap plan to pick up
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costs not covered by that plan. What should you tell him?
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..ANS>> It is illegal for you to sell Mr. Capadona a Medigap plan if he is enrolled in an MA plan, and besides,
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v Medigap only works with Original Medicare.
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2. Agent John Miller is meeting with Jerry Smith, a new prospect. Jerry is cur- rently enrolled in Medicare Parts
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A and B. Jerry has also purchased a Medicare Supplement (Medigap) plan which he has had for several years.
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However, the plan does not provide drug benefits. How would you advise Agent John Miller to proceed?
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v ..ANS>> Tell prospect Jerry Smith that he should consider adding a standalone Part D prescription drug coverage
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v policy to his present coverage.
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3. Mr.Wu is eligible for Medicare. He has limited financial resources but failed to qualify for the PartD low-
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income subsidy.Where might he turn for help with his prescription drug costs?
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v ..ANS>> Mr.Wu may still qualify for help in paying Part D costs through his State Pharmaceutical Assistance
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v Program (SPAP). v

,4. Mr.Vasquez is in good health and is preparing a budget in anticipation of his retirement when he turns 66.
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He wants to understand the health care costs he might be exposed to under Medicare if he were to require
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v hospitalization because of an illness. In general terms, what could you tell him about his costs for inpatient
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hospital services under Original Medicare?
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v ..ANS>> Under Original Medicare, there is a single deductible amount due for the first 60 days of any inpatient
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hospital stay, after which it converts into a per-day coinsurance amount through day
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90. After day 90, he would pay a daily amount up to 60 days over his lifetime, after which he would be
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v responsible for all costs. v v v




5. Mr. Moy will soon turn age 65. He is slightly younger than his wife. Mr. Moy's wife has a Medicare
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v Advantage plan, but he wants to understand what coverage Medicare Supplemental Insurance provides
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v since his health care needs are different from his wife's needs.What could you tell Mr. Moy?
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v ..ANS>> - Medicare Supplemental Insurance would help cover his Part A deductible and Part B coinsurance or
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copayments in Original Fee-for-Service (FFS) Medicare as well as possibly some services that Medicare does not
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v cover.




6. Juan Perez, who is turning age 65 next month, intends to work for several more years at Smallcap,
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Incorporated.Smallcap has a workforce of 15 employ- ees and offers employer-sponsored healthcare coverage.
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Juan is a naturalized citizen and has contributed to the Medicare system for over 20 years. Juan asks you if he
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will be entitled to Medicare and if he enrolls how that will impact his employer- sponsored healthcare
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coverage.How would you respond?
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v ..ANS>> Juan is likely to be eligible for Medicare once he turns age 65 and if he enrolls, Medicare would become
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,the primary payor of his healthcare claims and Smallcap does not have to continue to offer him coverage
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comparable to those under age 65 under
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, its employer-sponsored group health plan. Juan is likely to be eligible for Medicare once he turns age 65 and if
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v he enrolls, Medicare would become the primary payor of his healthcare claims but Smallcap must continue to
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v offer him coverage under its employer-sponsored group health plan and would become a secondary payor.
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7. Ms. Kumar plans to retire when she turns 65 in a few months. She is in excellent health and will have
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v considerable income when she retires. She is concerned that her income will make it impossible for her
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v to qualify for Medicare.What could you tell her to address her concern?
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v ..ANS>> Medicare is a vv v v




program for people age 65 or older and those under age 65 with certain disabilities, end-stage renal disease, and
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v Lou Gehrig's disease so she will be eligible for Medicare.
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8. Mrs. Ellis recently turned 66 and decided after many years of work to retire and begin receiving Social
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v Security benefits. Shortly thereafter Mrs. Ellis received a letter informing her that she had been
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v automatically enrolled in Medicare Part B. She wants to understand what this means.What should you tell
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v Mrs. Ellis? v




v ..ANS>> Part B primarily covers physician services. She will be paying a monthly premium and, except for
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v many preventive and screening tests, generally will have 20% co-payments for these services, in addition to an
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v annual deductible. v