AHIP - 2026 - Modules 1-5
QUESTION
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.
QUESTION
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.
QUESTION
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).
QUESTION
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.
QUESTION
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.
QUESTION
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.
, QUESTION
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.
QUESTION
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.
QUESTION
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.
QUESTION
Mrs. Cook is an elderly retiree. Mrs. Cook has a low fixed income. What could you tell Mrs.
Cook that might be of assistance?
QUESTION
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.
QUESTION
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.
QUESTION
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).
QUESTION
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.
QUESTION
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.
QUESTION
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.
, QUESTION
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.
QUESTION
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.
QUESTION
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.
QUESTION
Mrs. Cook is an elderly retiree. Mrs. Cook has a low fixed income. What could you tell Mrs.
Cook that might be of assistance?
