AHIP 2026 FINAL
EXAM
Ms. Galindo will turn 65 on June 10th. She has never previously qualified for Medicare. She is entitled to
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Medicare Part A and intends to enroll in Part B. She wants to know if she is eligible to enroll in a Medicare
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Advantage plan that includes prescription drug coverage. What do you tell her? - correct answers a. Ms.
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Galindo can enroll in an MA-PD plan now since her initial election period (IEP) for Part D prescription drug
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coverage and initial coverage election period (ICEP) are occurring together beginning March 1st and ending
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September 30th. P
Mr. Moreno invited his neighbor, Agent Tom Smith, to discuss Medicare Advantage (MA) and Part D plans that
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Agent Smith sells at the regular Tuesday brunch the neighbors have for senior citizens. What should Agent
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Tom Smith tell Mr. Moreno about the kinds of food that can be provided to potential enrollees who attend the
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sales presentation? - correct answers A meal cannot be provided, but light snacks would be permitted.
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Mr. Capadona would like to purchase a Medicare Advantage (MA) plan and a Medigap plan to pick up costs not
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covered by that plan. What should you tell him? - correct answers It is illegal for you to sell Mr. Capadona a
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Medigap plan if he is enrolled in an MA plan, and besides, Medigap only works with Original Medicare.
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Agent John Miller is meeting with Jerry Smith, a new prospect. Jerry is currently enrolled in Medicare Parts A
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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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correct answers Tell prospect Jerry Smith that he should consider adding a standalone Part D prescription
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drug coverage policy to his present coverage.
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Mr. Wu is eligible for Medicare. He has limited financial resources but failed to qualify for the Part D low-
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income subsidy. Where might he turn for help with his prescription drug costs? - correct answers Mr. Wu may
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still qualify for help in paying Part D costs through his State Pharmaceutical Assistance Program (SPAP).
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Mr. Vasquez is in good health and is preparing a budget in anticipation of his retirement when he turns 66. He
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wants to understand the health care costs he might be exposed to under Medicare if he were to require
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hospitalization because of an illness. In general terms, what could you tell him about his costs for inpatient P P P P P P P P P P P P P P P P P P
hospital services under Original Medicare? - correct answers Under Original Medicare, there is a single
P P P P P P P P P P P P P P P
deductible amount due for the first 60 days of any inpatient hospital stay, after which it converts into a per-day
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coinsurance amount through day 90. After day 90, he would pay a daily amount up to 60 days over his lifetime, P P P P P P P P P P P P P P P P P P P P P
after which he would be responsible for all costs.
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Mr. Moy will soon turn age 65. He is slightly younger than his wife. Mr. Moy's wife has a Medicare Advantage
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plan, but he wants to understand what coverage Medicare Supplemental Insurance provides since his health
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care needs are different from his wife's needs. What could you tell Mr. Moy? - correct answers Medicare
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Supplemental Insurance would help cover his Part A deductible and Part B coinsurance or copayments in P P P P P P P P P P P P P P P P
Original Fee-for-Service (FFS) Medicare as well as possibly some services that Medicare does not cover.
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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 employees and offers employer-sponsored healthcare P P P P P P P P P P P P
coverage. Juan is a naturalized citizen and has contributed to the Medicare system for over 20 years. Juan asks
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you if he 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? - correct answers Juan is likely to be eligible for Medicare once he turns
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age 65 and if he enrolls, Medicare would become the primary payor of his healthcare claims and Smallcap
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does not have to continue to offer him coverage comparable to those under age 65 under its employer-
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sponsored group health plan. Juan is likely to be eligible for Medicare once he turns age 65 and if he enrolls,
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Medicare would become the primary payor of his healthcare claims but Smallcap must continue to offer him
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coverage under its employer-sponsored group health plan and would become a secondary payor.
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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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considerable income when she retires. She is concerned that her income will make it impossible for her to P P P P P P P P P P P P P P P P P P
qualify for Medicare. What could you tell her to address her concern? - correct answers Medicare is a program
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for people age 65 or older and those under age 65 with certain disabilities, end-stage renal disease, and Lou
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Gehrig's disease so she will be eligible for Medicare. P P P P P P P P
, Mrs. Ellis recently turned 66 and decided after many years of work to retire and begin receiving Social Security
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benefits. Shortly thereafter Mrs. Ellis received a letter informing her that she had been automatically enrolled
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in Medicare Part B. She wants to understand what this means. What should you tell Mrs. Ellis? - correct
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answers Part B primarily covers physician services. She will be paying a monthly premium and, except for
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many preventive and screening tests, generally will have 20% co-payments for these services, in addition to
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an annual deductible.
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Mr. Singh would like drug coverage but does not want to be enrolled in a Medicare Advantage plan. What
P P P P P P P P P P P P P P P P P P P
should you tell him? - correct answers Mr. Singh can enroll in a stand-alone prescription drug plan and
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continue to be covered for Part A and Part B services through Original Fee-for-Service Medicare.
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Mrs. Cook is an elderly retiree. Mrs. Cook has a low fixed income. What could you tell Mrs. Cook that might be
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of assistance? - correct answers To obtain Part B coverage, she must pay a standard monthly premium,
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though it is higher for individuals with higher incomes.
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Mr. Bauer is 49 years old, but eighteen months ago he was declared disabled by the Social Security
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Administration and has been receiving disability payments. He is wondering whether he can obtain coverage P P P P P P P P P P P P P P P
under Medicare. What should you tell him? - correct answers After receiving such disability payments for 24
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months, he will be automatically enrolled in Medicare, regardless of age.
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Mr. Schmidt would like to plan for retirement and has asked you what is covered under Original Fee-for-
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Service (FFS) Medicare. What could you tell him? - correct answers Part A, which covers hospital, skilled
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nursing facility, hospice, and home health services and Part B, which covers professional services such as
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those provided by a doctor are covered under Original Medicare.
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Anthony Boniface turned 65 in 2024. He was not receiving Social Security or Railroad Retirement Benefits on
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his 65th birthday. He was interested in obtaining Medicare coverage and is eligible for premium-free Part A.
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Before he could enroll in Medicare, his entire area was impacted by a hurricane causing massive flooding and
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severe wind damage. The Federal government declared this to be a natural disaster which has recently ended.
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During this period Anthony's initial enrollment period expired. Anthony asks you how he can now obtain
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Medicare coverage. What should you say? - correct answers Anthony is eligible for a special enrollment
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period (SEP) because he missed an enrollment period due to the impact of the Federally declared disaster.
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This SEP will allow Anthony to enroll in Part B up to six months after the end of the emergency declaration.
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Anthony may enroll in premium-free Part A at any time and his Part A coverage will be retroactive for up to 6
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months.
EXAM
Ms. Galindo will turn 65 on June 10th. She has never previously qualified for Medicare. She is entitled to
P P P P P P P P P P P P P P P P P P P
Medicare Part A and intends to enroll in Part B. She wants to know if she is eligible to enroll in a Medicare
P P P P P P P P P P P P P P P P P P P P P P P
Advantage plan that includes prescription drug coverage. What do you tell her? - correct answers a. Ms.
P P P P P P P P P P P P P P P P P
Galindo can enroll in an MA-PD plan now since her initial election period (IEP) for Part D prescription drug
P P P P P P P P P P P P P P P P P P P
coverage and initial coverage election period (ICEP) are occurring together beginning March 1st and ending
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September 30th. P
Mr. Moreno invited his neighbor, Agent Tom Smith, to discuss Medicare Advantage (MA) and Part D plans that
P P P P P P P P P P P P P P P P P
Agent Smith sells at the regular Tuesday brunch the neighbors have for senior citizens. What should Agent
P P P P P P P P P P P P P P P P P P
Tom Smith tell Mr. Moreno about the kinds of food that can be provided to potential enrollees who attend the
P P P P P P P P P P P P P P P P P P P P
sales presentation? - correct answers A meal cannot be provided, but light snacks would be permitted.
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Mr. Capadona would like to purchase a Medicare Advantage (MA) plan and a Medigap plan to pick up costs not
P P P P P P P P P P P P P P P P P P P
covered by that plan. What should you tell him? - correct answers It is illegal for you to sell Mr. Capadona a
P P P P P P P P P P P P P P P P P P P P P P P
Medigap plan if he is enrolled in an MA plan, and besides, Medigap only works with Original Medicare.
P P P P P P P P P P P P P P P P P
Agent John Miller is meeting with Jerry Smith, a new prospect. Jerry is currently enrolled in Medicare Parts A
P P P P P P P P P P P P P P P P P P P
and B. Jerry has also purchased a Medicare Supplement (Medigap) plan which he has had for several years.
P P P P P P P P P P P P P P P P P P
,However, the plan does not provide drug benefits. How would you advise Agent John Miller to proceed? -
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correct answers Tell prospect Jerry Smith that he should consider adding a standalone Part D prescription
P P P P P P P P P P P P P P P P
drug coverage policy to his present coverage.
P P P P P P
Mr. Wu is eligible for Medicare. He has limited financial resources but failed to qualify for the Part D low-
P P P P P P P P P P P P P P P P P P P
income subsidy. Where might he turn for help with his prescription drug costs? - correct answers Mr. Wu may
P P P P P P P P P P P P P P P P P P P
still qualify for help in paying Part D costs through his State Pharmaceutical Assistance Program (SPAP).
P P P P P P P P P P P P P P P
Mr. Vasquez is in good health and is preparing a budget in anticipation of his retirement when he turns 66. He
P P P P P P P P P P P P P P P P P P P P P
wants to understand the health care costs he might be exposed to under Medicare if he were to require
P P P P P P P P P P P P P P P P P P P
hospitalization because of an illness. In general terms, what could you tell him about his costs for inpatient P P P P P P P P P P P P P P P P P P
hospital services under Original Medicare? - correct answers Under Original Medicare, there is a single
P P P P P P P P P P P P P P P
deductible amount due for the first 60 days of any inpatient hospital stay, after which it converts into a per-day
P P P P P P P P P P P P P P P P P P P P
coinsurance amount through day 90. After day 90, he would pay a daily amount up to 60 days over his lifetime, P P P P P P P P P P P P P P P P P P P P P
after which he would be responsible for all costs.
P P P P P P P P
Mr. Moy will soon turn age 65. He is slightly younger than his wife. Mr. Moy's wife has a Medicare Advantage
P P P P P P P P P P P P P P P P P P P P P
plan, but he wants to understand what coverage Medicare Supplemental Insurance provides since his health
P P P P P P P P P P P P P P P
care needs are different from his wife's needs. What could you tell Mr. Moy? - correct answers Medicare
P P P P P P P P P P P P P P P P P P
Supplemental Insurance would help cover his Part A deductible and Part B coinsurance or copayments in P P P P P P P P P P P P P P P P
Original Fee-for-Service (FFS) Medicare as well as possibly some services that Medicare does not cover.
P P P P P P P P P P P P P P
Juan Perez, who is turning age 65 next month, intends to work for several more years at Smallcap,
P P P P P P P P P P P P P P P P P P
Incorporated. Smallcap has a workforce of 15 employees and offers employer-sponsored healthcare P P P P P P P P P P P P
coverage. Juan is a naturalized citizen and has contributed to the Medicare system for over 20 years. Juan asks
P P P P P P P P P P P P P P P P P P P
you if he will be entitled to Medicare and if he enrolls how that will impact his employer- sponsored healthcare
P P P P P P P P P P P P P P P P P P P P
coverage. How would you respond? - correct answers Juan is likely to be eligible for Medicare once he turns
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age 65 and if he enrolls, Medicare would become the primary payor of his healthcare claims and Smallcap
P P P P P P P P P P P P P P P P P P
does not have to continue to offer him coverage comparable to those under age 65 under its employer-
P P P P P P P P P P P P P P P P P
sponsored group health plan. Juan is likely to be eligible for Medicare once he turns age 65 and if he enrolls,
P P P P P P P P P P P P P P P P P P P P P
Medicare would become the primary payor of his healthcare claims but Smallcap must continue to offer him
P P P P P P P P P P P P P P P P P
coverage under its employer-sponsored group health plan and would become a secondary payor.
P P P P P P P P P P P P
Ms. Kumar plans to retire when she turns 65 in a few months. She is in excellent health and will have
P P P P P P P P P P P P P P P P P P P P P
considerable income when she retires. She is concerned that her income will make it impossible for her to P P P P P P P P P P P P P P P P P P
qualify for Medicare. What could you tell her to address her concern? - correct answers Medicare is a program
P P P P P P P P P P P P P P P P P P P
for people age 65 or older and those under age 65 with certain disabilities, end-stage renal disease, and Lou
P P P P P P P P P P P P P P P P P P P
Gehrig's disease so she will be eligible for Medicare. P P P P P P P P
, Mrs. Ellis recently turned 66 and decided after many years of work to retire and begin receiving Social Security
P P P P P P P P P P P P P P P P P P P
benefits. Shortly thereafter Mrs. Ellis received a letter informing her that she had been automatically enrolled
P P P P P P P P P P P P P P P P
in Medicare Part B. She wants to understand what this means. What should you tell Mrs. Ellis? - correct
P P P P P P P P P P P P P P P P P P P
answers Part B primarily covers physician services. She will be paying a monthly premium and, except for
P P P P P P P P P P P P P P P P P
many preventive and screening tests, generally will have 20% co-payments for these services, in addition to
P P P P P P P P P P P P P P P P
an annual deductible.
P P
Mr. Singh would like drug coverage but does not want to be enrolled in a Medicare Advantage plan. What
P P P P P P P P P P P P P P P P P P P
should you tell him? - correct answers Mr. Singh can enroll in a stand-alone prescription drug plan and
P P P P P P P P P P P P P P P P P P
continue to be covered for Part A and Part B services through Original Fee-for-Service Medicare.
P P P P P P P P P P P P P P
Mrs. Cook is an elderly retiree. Mrs. Cook has a low fixed income. What could you tell Mrs. Cook that might be
P P P P P P P P P P P P P P P P P P P P P P
of assistance? - correct answers To obtain Part B coverage, she must pay a standard monthly premium,
P P P P P P P P P P P P P P P P P
though it is higher for individuals with higher incomes.
P P P P P P P P
Mr. Bauer is 49 years old, but eighteen months ago he was declared disabled by the Social Security
P P P P P P P P P P P P P P P P P P
Administration and has been receiving disability payments. He is wondering whether he can obtain coverage P P P P P P P P P P P P P P P
under Medicare. What should you tell him? - correct answers After receiving such disability payments for 24
P P P P P P P P P P P P P P P P P
months, he will be automatically enrolled in Medicare, regardless of age.
P P P P P P P P P P
Mr. Schmidt would like to plan for retirement and has asked you what is covered under Original Fee-for-
P P P P P P P P P P P P P P P P P
Service (FFS) Medicare. What could you tell him? - correct answers Part A, which covers hospital, skilled
P P P P P P P P P P P P P P P P P
nursing facility, hospice, and home health services and Part B, which covers professional services such as
P P P P P P P P P P P P P P P P
those provided by a doctor are covered under Original Medicare.
P P P P P P P P P
Anthony Boniface turned 65 in 2024. He was not receiving Social Security or Railroad Retirement Benefits on
P P P P P P P P P P P P P P P P P
his 65th birthday. He was interested in obtaining Medicare coverage and is eligible for premium-free Part A.
P P P P P P P P P P P P P P P P P
Before he could enroll in Medicare, his entire area was impacted by a hurricane causing massive flooding and
P P P P P P P P P P P P P P P P P P
severe wind damage. The Federal government declared this to be a natural disaster which has recently ended.
P P P P P P P P P P P P P P P P
During this period Anthony's initial enrollment period expired. Anthony asks you how he can now obtain
P P P P P P P P P P P P P P P P P
Medicare coverage. What should you say? - correct answers Anthony is eligible for a special enrollment
P P P P P P P P P P P P P P P P
period (SEP) because he missed an enrollment period due to the impact of the Federally declared disaster.
P P P P P P P P P P P P P P P P P
This SEP will allow Anthony to enroll in Part B up to six months after the end of the emergency declaration.
P P P P P P P P P P P P P P P P P P P P P
Anthony may enroll in premium-free Part A at any time and his Part A coverage will be retroactive for up to 6
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months.
