Master the AHIP 2027-2028 Final
Exam: Complete -Question Bank with
Verified Answers & In-Depth
Rationales/Instant Download pdf
Question 1
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?
A) You can sell him a Medigap plan to help with costs not covered
under Medicare Advantage.
B) 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.
C) Medigap plans are available to all Medicare beneficiaries regardless
of their primary coverage.
D) He can purchase both, but the Medigap plan will only cover costs
after the MA plan pays.
Correct Answer: B
Rationale: It is illegal to sell a Medigap plan to someone enrolled in a
Medicare Advantage plan. Medigap plans only coordinate with Original
Medicare (Parts A and B) and cannot be used to supplement MA plan cost-
sharing. Selling a Medigap policy to an MA enrollee is a prohibited
marketing practice under CMS guidelines.
,Question 2
Mr. Davis is 52 years old and has recently been diagnosed with end-stage
renal disease (ESRD) and will soon begin dialysis. He is wondering if he can
obtain coverage under Medicare. What should you tell him?
A) He is not eligible for Medicare until age 65.
B) He may sign up for Medicare at any time; however, coverage
usually begins on the fourth month after dialysis treatments start.
C) He must wait until he has been on dialysis for 12 months.
D) ESRD patients are only eligible for Medicaid, not Medicare.
Correct Answer: B
Rationale: Individuals with ESRD are eligible for Medicare regardless of
age. Coverage typically begins the fourth month after dialysis treatments
commence, though there are exceptions for certain training programs and
home dialysis.
Question 3
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 how enrollment
will impact his employer-sponsored coverage. How would you respond?
A) Juan is not eligible for Medicare because he is still working.
, B) 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.
C) Juan should delay enrollment until he retires to avoid penalties.
D) Smallcap must continue to offer him the same coverage as
younger employees regardless of Medicare enrollment.
Correct Answer: B
Rationale: Individuals aged 65 or older who have paid into Medicare for at
least 10 years (40 quarters) are eligible for premium-free Part A. For
employers with fewer than 20 employees, Medicare becomes the primary
payor when the employee enrolls. Employers with fewer than 20 employees
are not required to offer coverage comparable to that provided to younger
employees.
Question 4
Mrs. Peña is 66 years old, has coverage under an employer plan, and will
retire next year. She heard she must enroll in Part B at the beginning of the
year to ensure no gap in coverage. What can you tell her?
A) She must enroll in Part B during the General Enrollment Period
(January 1–March 31) to avoid a gap.
B) She may enroll at any time while she is covered under her
employer plan, and she has a Special Enrollment Period (SEP) of 8
months after her employment or coverage ends.
C) She must enroll in Part B within 30 days of turning 65.
, D) She cannot delay Part B enrollment without incurring permanent
penalties.
Correct Answer: B
Rationale: Individuals who are covered under an employer group health
plan based on current employment (their own or a spouse's) have a Special
Enrollment Period (SEP) to enroll in Part B without penalty. The SEP lasts for
8 months after employment ends or the employer coverage terminates,
whichever comes first.
Question 5
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?
A) Medicare Supplemental Insurance works the same as Medicare
Advantage.
B) Medicare Supplemental Insurance would help cover his Part A and
Part B deductibles or coinsurance in Original Fee-for-Service (FFS)
Medicare as well as possibly some services that Medicare does not
cover.
C) Medigap plans cover all out-of-pocket costs with no exceptions.
D) Medicare Supplemental Insurance is only available to low-income
beneficiaries.
Correct Answer: B
Exam: Complete -Question Bank with
Verified Answers & In-Depth
Rationales/Instant Download pdf
Question 1
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?
A) You can sell him a Medigap plan to help with costs not covered
under Medicare Advantage.
B) 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.
C) Medigap plans are available to all Medicare beneficiaries regardless
of their primary coverage.
D) He can purchase both, but the Medigap plan will only cover costs
after the MA plan pays.
Correct Answer: B
Rationale: It is illegal to sell a Medigap plan to someone enrolled in a
Medicare Advantage plan. Medigap plans only coordinate with Original
Medicare (Parts A and B) and cannot be used to supplement MA plan cost-
sharing. Selling a Medigap policy to an MA enrollee is a prohibited
marketing practice under CMS guidelines.
,Question 2
Mr. Davis is 52 years old and has recently been diagnosed with end-stage
renal disease (ESRD) and will soon begin dialysis. He is wondering if he can
obtain coverage under Medicare. What should you tell him?
A) He is not eligible for Medicare until age 65.
B) He may sign up for Medicare at any time; however, coverage
usually begins on the fourth month after dialysis treatments start.
C) He must wait until he has been on dialysis for 12 months.
D) ESRD patients are only eligible for Medicaid, not Medicare.
Correct Answer: B
Rationale: Individuals with ESRD are eligible for Medicare regardless of
age. Coverage typically begins the fourth month after dialysis treatments
commence, though there are exceptions for certain training programs and
home dialysis.
Question 3
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 how enrollment
will impact his employer-sponsored coverage. How would you respond?
A) Juan is not eligible for Medicare because he is still working.
, B) 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.
C) Juan should delay enrollment until he retires to avoid penalties.
D) Smallcap must continue to offer him the same coverage as
younger employees regardless of Medicare enrollment.
Correct Answer: B
Rationale: Individuals aged 65 or older who have paid into Medicare for at
least 10 years (40 quarters) are eligible for premium-free Part A. For
employers with fewer than 20 employees, Medicare becomes the primary
payor when the employee enrolls. Employers with fewer than 20 employees
are not required to offer coverage comparable to that provided to younger
employees.
Question 4
Mrs. Peña is 66 years old, has coverage under an employer plan, and will
retire next year. She heard she must enroll in Part B at the beginning of the
year to ensure no gap in coverage. What can you tell her?
A) She must enroll in Part B during the General Enrollment Period
(January 1–March 31) to avoid a gap.
B) She may enroll at any time while she is covered under her
employer plan, and she has a Special Enrollment Period (SEP) of 8
months after her employment or coverage ends.
C) She must enroll in Part B within 30 days of turning 65.
, D) She cannot delay Part B enrollment without incurring permanent
penalties.
Correct Answer: B
Rationale: Individuals who are covered under an employer group health
plan based on current employment (their own or a spouse's) have a Special
Enrollment Period (SEP) to enroll in Part B without penalty. The SEP lasts for
8 months after employment ends or the employer coverage terminates,
whichever comes first.
Question 5
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?
A) Medicare Supplemental Insurance works the same as Medicare
Advantage.
B) Medicare Supplemental Insurance would help cover his Part A and
Part B deductibles or coinsurance in Original Fee-for-Service (FFS)
Medicare as well as possibly some services that Medicare does not
cover.
C) Medigap plans cover all out-of-pocket costs with no exceptions.
D) Medicare Supplemental Insurance is only available to low-income
beneficiaries.
Correct Answer: B
