AHIP - 2026 - Modules 1-5
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1. Mr. Capadona would like to purchase It is illegal for you to sell Mr.
a Medicare Advantage (MA) plan and a Capadona
Medigap plan a if he is enrolled in
Medigap plan to pick up costs not covered an MA
plan, and besides, Medigap only
by that plan. What should you tell him? works with
Original Medicare.
2. Agent John Miller is meeting with Jerry Tell prospect Jerry Smith that he
Smith, a new prospect. Jerry is currently shouldadding
sider con- a standalone Part D
enrolled in Medicare Parts A and B. Jer- tion drug coverage policy to his
prescrip-
ry has also purchased a Medicare Supple- present cov-
erage.
ment (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?
3. Mr. Wu is eligible for Medicare. He has Mr. Wu may still qualify for help
limited financial resources but failed to in paying
Part D costs through his State
qualify for the Part D low-income subsidy. Pharmaceuti-
cal Assistance Program (SPAP).
Where might he turn for help with his pre-
scription drug costs?
4. Mr. Vasquez is in good health and is Under Original Medicare, there is
preparing a budget in anticipation of his a single amount due for the first
deductible
retirement when he turns 66. He wants to 60 any
of daysinpatient hospital stay, after
understand the health care costs he might which it into a per-day
converts
be exposed to under Medicare if he were coinsurance
through day amount
90. After day 90, he
to require hospitalization because of an ill- wouldamount
daily pay a up to 60 days over
ness. In general terms, what could you tell his lifetime,
after which he would be
him about his costs for inpatient hospital responsible for all
costs.
services under Original Medicare?
5. Mr. Moy will soon turn age 65. He is slightly Medicare Supplemental Insurance
would
younger than his wife. Mr. Moy's wife has a help cover his Part A deductible
and Part
, AHIP - 2026 - Modules 1-5
Study online at https://quizlet.com/_hgxyw6
Medicare Advantage plan, but he wants to B coinsurance or copayments in
understand what coverage Medicare Sup- Original
Fee-for-Service (FFS) Medicare as
plemental Insurance provides since his well as some services that
possibly
health care needs are different from his Medicare
not cover.does
wife's needs. What could you tell Mr. Moy?
6. Juan Perez, who is turning age 65 next Juan is likely to be eligible for
month, intends to work for several more Medicare
once he turns age 65 and if he
years at Smallcap, Incorporated. Smallcap enrolls, would become the
Medicare
has a workforce of 15 employees and of- primary
of his healthcare
payor claims and
fers employer-sponsored healthcare cov- Smallcap
not have todoes
continue to offer him
erage. Juan is a naturalized citizen and has coverage to those under age 65
comparable
contributed to the Medicare system for under
its employer-sponsored group
over 20 years. Juan asks you if he will be healthisplan.
Juan likely to be eligible for
entitled to Medicare and if he enrolls how Medicare
once he turns age 65 and if he
that will impact his employer- sponsored enrolls, would become the
Medicare
healthcare coverage. How would you re- primary
of his healthcare
payor claims but
spond? Smallcapto
continue must
offer him coverage
under its
employer-sponsored group health
would
plan and become a secondary payor.
7. Ms. Kumar plans to retire when she turns Medicare is a program for people
65 in a few months. She is in excellent age 65and
older or those under age 65 with
health and will have considerable income certain
disabilities, end-stage renal
when she retires. She is concerned that disease,
Lou Gehrig's
and disease so she will be
her income will make it impossible for her eligible
for Medicare.
to qualify for Medicare. What could you tell
her to address her concern?
8. Mrs. Ellis recently turned 66 and decided Part B primarily covers physician
after many years of work to retire and services.
She will be paying a monthly
begin receiving Social Security benefits. premium
except forand,
many preventive and
screening
, AHIP - 2026 - Modules 1-5
Study online at https://quizlet.com/_hgxyw6
Shortly thereafter Mrs. Ellis received a let- tests, generally will have 20% co-
ter informing her that she had been au- payments
for these services, in addition to an
tomatically enrolled in Medicare Part B. annual
deductible.
She wants to understand what this means.
What should you tell Mrs. Ellis?
9. Mr. Singh would like drug coverage but Mr. Singh can enroll in a stand-
does not want to be enrolled in a Medicare alone pre-drug plan and continue to
scription
Advantage plan. What should you tell him? be cov-
ered for Part A and Part B services
Original Fee-for-Service
through
Medicare.
10. Mrs. Cook is an elderly retiree. Mrs. Cook She should contact her state
has a low fixed income. What could you tell Medicaid
agency to see if she qualifies for
Mrs. Cook that might be of assistance? one of
eral programs
sev- that can help with
costs for which she is responsible.
Medicare
11. Ms. Henderson believes that she will qual- To obtain Part B coverage, she
ify for Medicare Coverage when she turns amust pay monthly premium,
standard
65, without paying any premiums, be- thoughfor
higher it isindividuals with higher
cause she has been working for 40 years incomes.
and paying Medicare taxes. What should
you tell her?
12. Mr. Bauer is 49 years old, but eighteen After receiving such disability
months ago he was declared disabled by payments
24 months,for
he will be
the Social Security Administration and has automatically
in Medicare, regardless
enrolled of age.
been receiving disability payments. He is
wondering whether he can obtain cover-
age under Medicare. What should you tell
him?
13. Mr. Schmidt would like to plan for re- Part A, which covers hospital,
tirement and has asked you what is cov- skilled nursing
facility, hospice, and home health
services
, AHIP - 2026 - Modules 1-5
Study online at https://quizlet.com/_hgxyw6
ered under Original Fee-for-Service (FFS) and Part B, which covers
Medicare. What could you tell him? professional
vices such asser-
those provided by a
doctor are
covered under Original Medicare.
14. Anthony Boniface turned 65 in 2024. He Anthony is eligible for a special
was not receiving Social Security or Rail- enrollment
period (SEP) because he missed an
road Retirement Benefits on his 65th enroll-period due to the impact of
ment
birthday. He was interested in obtaining erally
the Fed-declared disaster. This SEP
Medicare coverage and is eligible for pre- will allowto enroll in Part B up to
Anthony
mium-free Part A. Before he could enroll six months
after the end of the emergency
in Medicare, his entire area was impact- declaration.
Anthony may enroll in premium-
ed by a hurricane causing massive flood- free
at any
Part
time
A and his Part A
ing and severe wind damage. The Federal coverage will
retroactive forbe
up to 6 months.
government declared this to be a natural
disaster which has recently ended. During
this period Anthony's initial enrollment
period expired. Anthony asks you how he
can now obtain Medicare coverage. What
should you say?
15. Ms. Lewis has aggressive cancer and Medicare covers hospice services,
would like to know if Medicare will cover and they
will be available for her.
hospice services in case she needs them.
What should you tell her?
16. Edward suffered from serious kidney dis- Individuals eligible for Medicare
ease. As a result, Edward became eligible based on
ESRD generally lose eligibility 36
for Medicare coverage due to end-stage months
after the month in which the
renal disease (ESRD). A close relative do- individual
ceives a kidney
re- transplant unless
nated their kidney and Edward success- they are
igible forel-
Medicare on another
fully underwent transplant surgery 12 basisorsuch
age disability.
as Edward may,
months ago. Edward is now age 50 and however,
main enrolled
re- in Part B but solely
for cover-
Study online at https://quizlet.com/_hgxyw6
1. Mr. Capadona would like to purchase It is illegal for you to sell Mr.
a Medicare Advantage (MA) plan and a Capadona
Medigap plan a if he is enrolled in
Medigap plan to pick up costs not covered an MA
plan, and besides, Medigap only
by that plan. What should you tell him? works with
Original Medicare.
2. Agent John Miller is meeting with Jerry Tell prospect Jerry Smith that he
Smith, a new prospect. Jerry is currently shouldadding
sider con- a standalone Part D
enrolled in Medicare Parts A and B. Jer- tion drug coverage policy to his
prescrip-
ry has also purchased a Medicare Supple- present cov-
erage.
ment (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?
3. Mr. Wu is eligible for Medicare. He has Mr. Wu may still qualify for help
limited financial resources but failed to in paying
Part D costs through his State
qualify for the Part D low-income subsidy. Pharmaceuti-
cal Assistance Program (SPAP).
Where might he turn for help with his pre-
scription drug costs?
4. Mr. Vasquez is in good health and is Under Original Medicare, there is
preparing a budget in anticipation of his a single amount due for the first
deductible
retirement when he turns 66. He wants to 60 any
of daysinpatient hospital stay, after
understand the health care costs he might which it into a per-day
converts
be exposed to under Medicare if he were coinsurance
through day amount
90. After day 90, he
to require hospitalization because of an ill- wouldamount
daily pay a up to 60 days over
ness. In general terms, what could you tell his lifetime,
after which he would be
him about his costs for inpatient hospital responsible for all
costs.
services under Original Medicare?
5. Mr. Moy will soon turn age 65. He is slightly Medicare Supplemental Insurance
would
younger than his wife. Mr. Moy's wife has a help cover his Part A deductible
and Part
, AHIP - 2026 - Modules 1-5
Study online at https://quizlet.com/_hgxyw6
Medicare Advantage plan, but he wants to B coinsurance or copayments in
understand what coverage Medicare Sup- Original
Fee-for-Service (FFS) Medicare as
plemental Insurance provides since his well as some services that
possibly
health care needs are different from his Medicare
not cover.does
wife's needs. What could you tell Mr. Moy?
6. Juan Perez, who is turning age 65 next Juan is likely to be eligible for
month, intends to work for several more Medicare
once he turns age 65 and if he
years at Smallcap, Incorporated. Smallcap enrolls, would become the
Medicare
has a workforce of 15 employees and of- primary
of his healthcare
payor claims and
fers employer-sponsored healthcare cov- Smallcap
not have todoes
continue to offer him
erage. Juan is a naturalized citizen and has coverage to those under age 65
comparable
contributed to the Medicare system for under
its employer-sponsored group
over 20 years. Juan asks you if he will be healthisplan.
Juan likely to be eligible for
entitled to Medicare and if he enrolls how Medicare
once he turns age 65 and if he
that will impact his employer- sponsored enrolls, would become the
Medicare
healthcare coverage. How would you re- primary
of his healthcare
payor claims but
spond? Smallcapto
continue must
offer him coverage
under its
employer-sponsored group health
would
plan and become a secondary payor.
7. Ms. Kumar plans to retire when she turns Medicare is a program for people
65 in a few months. She is in excellent age 65and
older or those under age 65 with
health and will have considerable income certain
disabilities, end-stage renal
when she retires. She is concerned that disease,
Lou Gehrig's
and disease so she will be
her income will make it impossible for her eligible
for Medicare.
to qualify for Medicare. What could you tell
her to address her concern?
8. Mrs. Ellis recently turned 66 and decided Part B primarily covers physician
after many years of work to retire and services.
She will be paying a monthly
begin receiving Social Security benefits. premium
except forand,
many preventive and
screening
, AHIP - 2026 - Modules 1-5
Study online at https://quizlet.com/_hgxyw6
Shortly thereafter Mrs. Ellis received a let- tests, generally will have 20% co-
ter informing her that she had been au- payments
for these services, in addition to an
tomatically enrolled in Medicare Part B. annual
deductible.
She wants to understand what this means.
What should you tell Mrs. Ellis?
9. Mr. Singh would like drug coverage but Mr. Singh can enroll in a stand-
does not want to be enrolled in a Medicare alone pre-drug plan and continue to
scription
Advantage plan. What should you tell him? be cov-
ered for Part A and Part B services
Original Fee-for-Service
through
Medicare.
10. Mrs. Cook is an elderly retiree. Mrs. Cook She should contact her state
has a low fixed income. What could you tell Medicaid
agency to see if she qualifies for
Mrs. Cook that might be of assistance? one of
eral programs
sev- that can help with
costs for which she is responsible.
Medicare
11. Ms. Henderson believes that she will qual- To obtain Part B coverage, she
ify for Medicare Coverage when she turns amust pay monthly premium,
standard
65, without paying any premiums, be- thoughfor
higher it isindividuals with higher
cause she has been working for 40 years incomes.
and paying Medicare taxes. What should
you tell her?
12. Mr. Bauer is 49 years old, but eighteen After receiving such disability
months ago he was declared disabled by payments
24 months,for
he will be
the Social Security Administration and has automatically
in Medicare, regardless
enrolled of age.
been receiving disability payments. He is
wondering whether he can obtain cover-
age under Medicare. What should you tell
him?
13. Mr. Schmidt would like to plan for re- Part A, which covers hospital,
tirement and has asked you what is cov- skilled nursing
facility, hospice, and home health
services
, AHIP - 2026 - Modules 1-5
Study online at https://quizlet.com/_hgxyw6
ered under Original Fee-for-Service (FFS) and Part B, which covers
Medicare. What could you tell him? professional
vices such asser-
those provided by a
doctor are
covered under Original Medicare.
14. Anthony Boniface turned 65 in 2024. He Anthony is eligible for a special
was not receiving Social Security or Rail- enrollment
period (SEP) because he missed an
road Retirement Benefits on his 65th enroll-period due to the impact of
ment
birthday. He was interested in obtaining erally
the Fed-declared disaster. This SEP
Medicare coverage and is eligible for pre- will allowto enroll in Part B up to
Anthony
mium-free Part A. Before he could enroll six months
after the end of the emergency
in Medicare, his entire area was impact- declaration.
Anthony may enroll in premium-
ed by a hurricane causing massive flood- free
at any
Part
time
A and his Part A
ing and severe wind damage. The Federal coverage will
retroactive forbe
up to 6 months.
government declared this to be a natural
disaster which has recently ended. During
this period Anthony's initial enrollment
period expired. Anthony asks you how he
can now obtain Medicare coverage. What
should you say?
15. Ms. Lewis has aggressive cancer and Medicare covers hospice services,
would like to know if Medicare will cover and they
will be available for her.
hospice services in case she needs them.
What should you tell her?
16. Edward suffered from serious kidney dis- Individuals eligible for Medicare
ease. As a result, Edward became eligible based on
ESRD generally lose eligibility 36
for Medicare coverage due to end-stage months
after the month in which the
renal disease (ESRD). A close relative do- individual
ceives a kidney
re- transplant unless
nated their kidney and Edward success- they are
igible forel-
Medicare on another
fully underwent transplant surgery 12 basisorsuch
age disability.
as Edward may,
months ago. Edward is now age 50 and however,
main enrolled
re- in Part B but solely
for cover-
