2026 AHIP FINAL EXAM COMPREHENSIVE
QUESTION SET
◉ Mr. Moreno invited his neighbor, Agent Tom Smith, to discuss
Medicare Advantage (MA) and Part D plans that Agent Smith sells at
the regular Tuesday brunch the neighbors have for senior citizens.
What should Agent Tom Smith tell Mr. Moreno about the kinds of
food that can be provided to potential enrollees who attend the sales
presentation? Answer: A meal cannot be provided, but light snacks
would be permitted.
◉ 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:
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 coverage under Medicare. What should you tell him? Answer:
After receiving such disability payments for 24 months, he will be
automatically enrolled in Medicare, regardless of age.
◉ Mr. Schmidt would like to plan for retirement and has asked you
what is covered under Original Fee-for-Service (FFS) Medicare. What
QUESTION SET
◉ Mr. Moreno invited his neighbor, Agent Tom Smith, to discuss
Medicare Advantage (MA) and Part D plans that Agent Smith sells at
the regular Tuesday brunch the neighbors have for senior citizens.
What should Agent Tom Smith tell Mr. Moreno about the kinds of
food that can be provided to potential enrollees who attend the sales
presentation? Answer: A meal cannot be provided, but light snacks
would be permitted.
◉ 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:
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 coverage under Medicare. What should you tell him? Answer:
After receiving such disability payments for 24 months, he will be
automatically enrolled in Medicare, regardless of age.
◉ Mr. Schmidt would like to plan for retirement and has asked you
what is covered under Original Fee-for-Service (FFS) Medicare. What
