AHIP 2026 Certification
AHIP 2026 Certification
Study online at https://quizlet.com/_hi4oxb
1. 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 successfully
underwent transplant surgery 12 months
ago. Edward is now age 50 and asks you if
his Medicare coverage will continue, what
should you say?
2. Ms. Henderson believes that she will qualify To obtain Part B coverage, she must pay
for Medicare Coverage when she turns 65, a standard monthly premium, though it
without paying any premiums, because she is higher for individuals with higher in-
has been working for 40 years and paying comes.
Medicare taxes. What should you tell her?
3. Ms. Lewis has aggressive cancer and would Medicare covers hospice services under
like to know if Medicare will cover hos- Part A.
pice services in case she needs them. What
should you tell her?
4. Mr. Capadona would like to purchase a It is illegal for you to sell Mr. Capadona a
Medicare Advantage (MA) plan and a Medi- Medigap plan if he is enrolled in an MA
gap plan to pick up costs not covered by that plan, and besides, Medigap only works
plan. What should you tell him? with Original Medicare.
5. Mr. Vasquez is in good health and is prepar- Under Original Medicare, there is a single
ing a budget in anticipation of his retire- deductible amount due for the first 60
ment when he turns 66. He wants to un- days of any inpatient hospital stay, after
derstand the health care costs he might be which it converts into a per-day amount
exposed to under Medicare if he were to re- through day 90. After day 90, he would
quire hospitalization because of an illness. pay a daily amount up to 60 days over his
, AHIP 2026 Certification
AHIP 2026 Certification
Study online at https://quizlet.com/_hi4oxb
In general terms, what could you tell him lifetime, after which he would be respon-
about his costs for inpatient hospital ser- sible for all costs
vices under Original Medicare?
6. Mrs. Foster is covered by Original Medicare. Medicare will cover Mrs. Foster's skilled
She sustained a hip fracture and is be- nursing services provided during the first
ing successfully treated for that condition. 20 days of her stay, after which she would
However, she and her physicians feel that have a copay until she has been in the
after her lengthy hospital stay, she will need facility for 100 days.
a month or two of nursing and rehabilitative
care. What should you tell them about Orig-
inal Medicare's coverage of care in a skilled
nursing facility?
7. Mr. Wu is eligible for Medicare. He has lim- Mr. Wu may still qualify for help in paying
ited financial resources but failed to qualify Part D costs through his State Pharmaceu-
for the Part D low-income subsidy. Where tical Assistance Program (SPAP).
might he turn for help with his prescription
drug costs?
8. Mr. Singh would like drug coverage but does Mr. Singh can enroll in a stand-alone
not want to be enrolled in a Medicare Ad- prescription drug plan and continue to
vantage plan. What should you tell him? be covered for Part A and Part B ser-
vices through Original Fee-for-Service
Medicare.
9. Mr. Schmidt would like to plan for retire- Part A, which covers hospital, skilled nurs-
ment and has asked you what is covered un- ing facility, hospice, and home health ser-
der Original Fee-for-Service (FFS) Medicare. vices and Part B, which covers profes-
What could you tell him? sional services such as those provided
by a doctor are covered under Original
Medicare.
, AHIP 2026 Certification
AHIP 2026 Certification
Study online at https://quizlet.com/_hi4oxb
10. Anthony Boniface turned 65 in 2024. He was Anthony is eligible for a SEP of six months
not receiving Social Security or Railroad Re- after the end of the disaster declaration.
tirement Benefits on his 65th birthday. He Use of the SEP will allow Anthony to sign
was interested in obtaining Medicare cov- up for Part B without being subject to a
erage and is eligible for premium-free Part Part B late penalty. Anthony may enroll in
A. Before he could enroll in Medicare, his premium-free Part A at any time and his
entire area was impacted by a hurricane Part A coverage will be retroactive for up
causing massive flooding and severe wind to 6 months.
damage. The Federal government declared
this to be a natural disaster which has re-
cently ended. During this period Anthony's
initial enrollment period expired. Anthony
asks you how he can now obtain Medicare
coverage. What should you say?
11. Ms. Kumar plans to retire when she turns 65 Medicare is a program for people age 65
in a few months. She is in excellent health or older and those under age 65 with cer-
and will have considerable income when tain disabilities, end-stage renal disease,
she retires. She is concerned that her in- and Lou Gehrig's disease so she will be
come will make it impossible for her to qual- eligible for Medicare.
ify for Medicare. What could you tell her to
address her concern?
12. Juan Perez, who is turning age 65 next Juan is likely to be eligible for Medicare
month, intends to work for several more once he turns age 65 and if he en-
years at Smallcap, Incorporated. Smallcap rolls Medicare would become the primary
has a workforce of 15 employees and offers payor of his healthcare claims and Small-
employer-sponsored healthcare coverage. cap does not have to continue to offer him
Juan is a naturalized citizen and has con- coverage comparable to those under age
tributed to the Medicare system for over 20 65 under its employer-sponsored group
years. Juan asks you if he will be entitled health plan.
to Medicare and if he enrolls how that will
AHIP 2026 Certification
Study online at https://quizlet.com/_hi4oxb
1. 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 successfully
underwent transplant surgery 12 months
ago. Edward is now age 50 and asks you if
his Medicare coverage will continue, what
should you say?
2. Ms. Henderson believes that she will qualify To obtain Part B coverage, she must pay
for Medicare Coverage when she turns 65, a standard monthly premium, though it
without paying any premiums, because she is higher for individuals with higher in-
has been working for 40 years and paying comes.
Medicare taxes. What should you tell her?
3. Ms. Lewis has aggressive cancer and would Medicare covers hospice services under
like to know if Medicare will cover hos- Part A.
pice services in case she needs them. What
should you tell her?
4. Mr. Capadona would like to purchase a It is illegal for you to sell Mr. Capadona a
Medicare Advantage (MA) plan and a Medi- Medigap plan if he is enrolled in an MA
gap plan to pick up costs not covered by that plan, and besides, Medigap only works
plan. What should you tell him? with Original Medicare.
5. Mr. Vasquez is in good health and is prepar- Under Original Medicare, there is a single
ing a budget in anticipation of his retire- deductible amount due for the first 60
ment when he turns 66. He wants to un- days of any inpatient hospital stay, after
derstand the health care costs he might be which it converts into a per-day amount
exposed to under Medicare if he were to re- through day 90. After day 90, he would
quire hospitalization because of an illness. pay a daily amount up to 60 days over his
, AHIP 2026 Certification
AHIP 2026 Certification
Study online at https://quizlet.com/_hi4oxb
In general terms, what could you tell him lifetime, after which he would be respon-
about his costs for inpatient hospital ser- sible for all costs
vices under Original Medicare?
6. Mrs. Foster is covered by Original Medicare. Medicare will cover Mrs. Foster's skilled
She sustained a hip fracture and is be- nursing services provided during the first
ing successfully treated for that condition. 20 days of her stay, after which she would
However, she and her physicians feel that have a copay until she has been in the
after her lengthy hospital stay, she will need facility for 100 days.
a month or two of nursing and rehabilitative
care. What should you tell them about Orig-
inal Medicare's coverage of care in a skilled
nursing facility?
7. Mr. Wu is eligible for Medicare. He has lim- Mr. Wu may still qualify for help in paying
ited financial resources but failed to qualify Part D costs through his State Pharmaceu-
for the Part D low-income subsidy. Where tical Assistance Program (SPAP).
might he turn for help with his prescription
drug costs?
8. Mr. Singh would like drug coverage but does Mr. Singh can enroll in a stand-alone
not want to be enrolled in a Medicare Ad- prescription drug plan and continue to
vantage plan. What should you tell him? be covered for Part A and Part B ser-
vices through Original Fee-for-Service
Medicare.
9. Mr. Schmidt would like to plan for retire- Part A, which covers hospital, skilled nurs-
ment and has asked you what is covered un- ing facility, hospice, and home health ser-
der Original Fee-for-Service (FFS) Medicare. vices and Part B, which covers profes-
What could you tell him? sional services such as those provided
by a doctor are covered under Original
Medicare.
, AHIP 2026 Certification
AHIP 2026 Certification
Study online at https://quizlet.com/_hi4oxb
10. Anthony Boniface turned 65 in 2024. He was Anthony is eligible for a SEP of six months
not receiving Social Security or Railroad Re- after the end of the disaster declaration.
tirement Benefits on his 65th birthday. He Use of the SEP will allow Anthony to sign
was interested in obtaining Medicare cov- up for Part B without being subject to a
erage and is eligible for premium-free Part Part B late penalty. Anthony may enroll in
A. Before he could enroll in Medicare, his premium-free Part A at any time and his
entire area was impacted by a hurricane Part A coverage will be retroactive for up
causing massive flooding and severe wind to 6 months.
damage. The Federal government declared
this to be a natural disaster which has re-
cently ended. During this period Anthony's
initial enrollment period expired. Anthony
asks you how he can now obtain Medicare
coverage. What should you say?
11. Ms. Kumar plans to retire when she turns 65 Medicare is a program for people age 65
in a few months. She is in excellent health or older and those under age 65 with cer-
and will have considerable income when tain disabilities, end-stage renal disease,
she retires. She is concerned that her in- and Lou Gehrig's disease so she will be
come will make it impossible for her to qual- eligible for Medicare.
ify for Medicare. What could you tell her to
address her concern?
12. Juan Perez, who is turning age 65 next Juan is likely to be eligible for Medicare
month, intends to work for several more once he turns age 65 and if he en-
years at Smallcap, Incorporated. Smallcap rolls Medicare would become the primary
has a workforce of 15 employees and offers payor of his healthcare claims and Small-
employer-sponsored healthcare coverage. cap does not have to continue to offer him
Juan is a naturalized citizen and has con- coverage comparable to those under age
tributed to the Medicare system for over 20 65 under its employer-sponsored group
years. Juan asks you if he will be entitled health plan.
to Medicare and if he enrolls how that will
