AHIP 2026 Modules 1-5: Questions & Complete
Solutions
Save
Terms in this set (105)
Mr. Capadona would like It is illegal for you to sell Mr. Capadona a Medigap
to purchase a Medicare plan if he is enrolled in an MA plan, and besides,
Advantage (MA) plan Medigap only works with Original Medicare.
and a Medigap plan to
pick up costs not
covered by that plan.
What should you tell
him?
Agent John Miller is Tell prospect Jerry Smith that he should consider
meeting with Jerry Smith, adding a standalone Part D prescription drug
a new prospect. Jerry is coverage policy to his present coverage.
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?
,Mr. Wu is eligible for Mr. Wu may still qualify for help in paying Part D
Medicare. He has limited costs through his State Pharmaceutical Assistance
financial resources but Program (SPAP).
failed to qualify for the
Part D low-income
subsidy. Where might he
turn for help with his
prescription drug costs?
Mr. Vasquez is in good Under Original Medicare, there is a single
health and is preparing a deductible amount due for the first 60 days of any
budget in anticipation of inpatient hospital stay, after which it converts into a
his retirement when he per-day coinsurance amount through day 90. After
turns 66. He wants to day 90, he would pay a daily amount up to 60 days
understand the health over his lifetime, after which he would be
care costs he might be responsible for all costs.
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?
Mr. Moy will soon turn Medicare Supplemental Insurance would help cover
age 65. He is slightly his Part A deductible and Part B coinsurance or
younger than his wife. Mr. copayments in Original Fee-for-Service (FFS)
Moy's wife has a Medicare as well as possibly some services that
Medicare Advantage Medicare does not cover.
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?
,Juan Perez, who is turning Juan is likely to be eligible for Medicare once he
age 65 next month, turns age 65 and if he enrolls, Medicare would
intends to work for become the primary payor of his healthcare claims
several more years at and Smallcap does not have to continue to offer
Smallcap, Incorporated. him coverage comparable to those under age 65
Smallcap has a workforce under its employer-sponsored group health plan.
of 15 employees and Juan is likely to be eligible for Medicare once he
offers employer- turns age 65 and if he enrolls, Medicare would
sponsored healthcare become the primary payor of his healthcare claims
coverage. Juan is a but Smallcap must continue to offer him coverage
naturalized citizen and under its employer-sponsored group health plan
has contributed to the and would become a secondary payor.
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?
Ms. Kumar plans to retire Medicare is a program for people age 65 or older
when she turns 65 in a and those under age 65 with certain disabilities,
few months. She is in end-stage renal disease, and Lou Gehrig's disease
excellent health and will so she will be eligible for Medicare.
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?
, Mrs. Ellis recently turned Part B primarily covers physician services. She will
66 and decided after be paying a monthly premium and, except for many
many years of work to preventive and screening tests, generally will have
retire and begin 20% co-payments for these services, in addition to
receiving Social Security an annual deductible.
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?
Mr. Singh would like drug Mr. Singh can enroll in a stand-alone prescription
coverage but does not drug plan and continue to be covered for Part A
want to be enrolled in a and Part B services through Original Fee-for-Service
Medicare Advantage Medicare.
plan. What should you
tell him?
Mrs. Cook is an elderly She should contact her state Medicaid agency to
retiree. Mrs. Cook has a see if she qualifies for one of several programs that
low fixed income. What can help with Medicare costs for which she is
could you tell Mrs. Cook responsible.
that might be of
assistance?
Ms. Henderson believes To obtain Part B coverage, she must pay a standard
that she will qualify for monthly premium, though it is higher for individuals
Medicare Coverage with higher incomes.
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?
Solutions
Save
Terms in this set (105)
Mr. Capadona would like It is illegal for you to sell Mr. Capadona a Medigap
to purchase a Medicare plan if he is enrolled in an MA plan, and besides,
Advantage (MA) plan Medigap only works with Original Medicare.
and a Medigap plan to
pick up costs not
covered by that plan.
What should you tell
him?
Agent John Miller is Tell prospect Jerry Smith that he should consider
meeting with Jerry Smith, adding a standalone Part D prescription drug
a new prospect. Jerry is coverage policy to his present coverage.
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?
,Mr. Wu is eligible for Mr. Wu may still qualify for help in paying Part D
Medicare. He has limited costs through his State Pharmaceutical Assistance
financial resources but Program (SPAP).
failed to qualify for the
Part D low-income
subsidy. Where might he
turn for help with his
prescription drug costs?
Mr. Vasquez is in good Under Original Medicare, there is a single
health and is preparing a deductible amount due for the first 60 days of any
budget in anticipation of inpatient hospital stay, after which it converts into a
his retirement when he per-day coinsurance amount through day 90. After
turns 66. He wants to day 90, he would pay a daily amount up to 60 days
understand the health over his lifetime, after which he would be
care costs he might be responsible for all costs.
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?
Mr. Moy will soon turn Medicare Supplemental Insurance would help cover
age 65. He is slightly his Part A deductible and Part B coinsurance or
younger than his wife. Mr. copayments in Original Fee-for-Service (FFS)
Moy's wife has a Medicare as well as possibly some services that
Medicare Advantage Medicare does not cover.
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?
,Juan Perez, who is turning Juan is likely to be eligible for Medicare once he
age 65 next month, turns age 65 and if he enrolls, Medicare would
intends to work for become the primary payor of his healthcare claims
several more years at and Smallcap does not have to continue to offer
Smallcap, Incorporated. him coverage comparable to those under age 65
Smallcap has a workforce under its employer-sponsored group health plan.
of 15 employees and Juan is likely to be eligible for Medicare once he
offers employer- turns age 65 and if he enrolls, Medicare would
sponsored healthcare become the primary payor of his healthcare claims
coverage. Juan is a but Smallcap must continue to offer him coverage
naturalized citizen and under its employer-sponsored group health plan
has contributed to the and would become a secondary payor.
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?
Ms. Kumar plans to retire Medicare is a program for people age 65 or older
when she turns 65 in a and those under age 65 with certain disabilities,
few months. She is in end-stage renal disease, and Lou Gehrig's disease
excellent health and will so she will be eligible for Medicare.
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?
, Mrs. Ellis recently turned Part B primarily covers physician services. She will
66 and decided after be paying a monthly premium and, except for many
many years of work to preventive and screening tests, generally will have
retire and begin 20% co-payments for these services, in addition to
receiving Social Security an annual deductible.
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?
Mr. Singh would like drug Mr. Singh can enroll in a stand-alone prescription
coverage but does not drug plan and continue to be covered for Part A
want to be enrolled in a and Part B services through Original Fee-for-Service
Medicare Advantage Medicare.
plan. What should you
tell him?
Mrs. Cook is an elderly She should contact her state Medicaid agency to
retiree. Mrs. Cook has a see if she qualifies for one of several programs that
low fixed income. What can help with Medicare costs for which she is
could you tell Mrs. Cook responsible.
that might be of
assistance?
Ms. Henderson believes To obtain Part B coverage, she must pay a standard
that she will qualify for monthly premium, though it is higher for individuals
Medicare Coverage with higher incomes.
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?
