AHIP Medicare Certification Complete
Exam Practice Questions With 100%
Verified Answers 2026/2027
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-She should contact her state
Medicaid agency to see if she qualifies for one of several programs that can help with
Medicare costs for which she is responsible.
Ms. Henderson believes that she will qualify for Medicare Coverage when she turns 65,
without paying any premiums, because she has been working for 40 years and paying
Medicare taxes. What should you tell her? - 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 could you tell him? - ANSWER-Part A,
which covers hospital, skilled nursing facility, hospice, and home health services and
Part B, which covers professional services such as those provided by a doctor are
covered under Original Medicare.
Anthony Boniface turned 65 in 2024. He was not receiving Social Security or Railroad
Retirement Benefits on his 65th birthday. He was interested in obtaining Medicare
coverage and is eligible for premium-free Part A. Before he could enroll in Medicare, his
entire area was impacted by a hurricane causing massive flooding and severe wind
damage. The Federal 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? -
ANSWER-Anthony is eligible for a special enrollment period (SEP) because he missed
an enrollment period due to the impact of the Federally declared disaster. This SEP will
allow Anthony to enroll in Part B up to six months after the end of the emergency
declaration. Anthony may enroll in premium-free Part A at any time and his Part A
coverage will be retroactive for up to 6 months.
Ms. Lewis has aggressive cancer and would like to know if Medicare will cover hospice
services in case she needs them. What should you tell her? - ANSWER-Medicare
covers hospice services, and they will be available for her.
Edward suffered from serious kidney disease. As a result, Edward became eligible for
Medicare coverage due to end-stage renal disease (ESRD). A close relative donated
their kidney and Edward successfully underwent transplant surgery 12 months ago.
Edward is now age 50 and asks you if his Medicare coverage will continue, what should
you say? - ANSWER-Individuals eligible for Medicare based on ESRD generally lose
eligibility 36 months after the month in which the individual receives a kidney transplant
unless they are eligible for Medicare on another basis such as age or disability. Edward
may, however, remain enrolled in Part B but solely for coverage of immunosuppressive
drugs if he has no other health care coverage that would cover the drugs.
Mrs. Foster is covered by Original Medicare. She sustained a hip fracture and is being
successfully treated for that condition. However, she and her physicians feel that after
her lengthy hospital stay, she will need a month or two of nursing and rehabilitative
care. What should you tell them about Original Medicare's coverage of care in a skilled
nursing facility? - ANSWER-Medicare will cover Mrs. Foster's skilled nursing services
provided during the first 20 days of her stay, after which she would have a copay until
she has been in the facility for 100 days.
Madeline Martinez was widowed several years ago. Her husband worked for many
years and contributed into the Medicare system. He also left a substantial estate which
provides Madeline with an annual income of approximately $130,000. Madeline, who
has only worked part-time for the last three years, will soon turn age 65 and hopes to
enroll in Original Medicare. She comes to you for advice. What should you tell her? -
Exam Practice Questions With 100%
Verified Answers 2026/2027
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-She should contact her state
Medicaid agency to see if she qualifies for one of several programs that can help with
Medicare costs for which she is responsible.
Ms. Henderson believes that she will qualify for Medicare Coverage when she turns 65,
without paying any premiums, because she has been working for 40 years and paying
Medicare taxes. What should you tell her? - 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 could you tell him? - ANSWER-Part A,
which covers hospital, skilled nursing facility, hospice, and home health services and
Part B, which covers professional services such as those provided by a doctor are
covered under Original Medicare.
Anthony Boniface turned 65 in 2024. He was not receiving Social Security or Railroad
Retirement Benefits on his 65th birthday. He was interested in obtaining Medicare
coverage and is eligible for premium-free Part A. Before he could enroll in Medicare, his
entire area was impacted by a hurricane causing massive flooding and severe wind
damage. The Federal 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? -
ANSWER-Anthony is eligible for a special enrollment period (SEP) because he missed
an enrollment period due to the impact of the Federally declared disaster. This SEP will
allow Anthony to enroll in Part B up to six months after the end of the emergency
declaration. Anthony may enroll in premium-free Part A at any time and his Part A
coverage will be retroactive for up to 6 months.
Ms. Lewis has aggressive cancer and would like to know if Medicare will cover hospice
services in case she needs them. What should you tell her? - ANSWER-Medicare
covers hospice services, and they will be available for her.
Edward suffered from serious kidney disease. As a result, Edward became eligible for
Medicare coverage due to end-stage renal disease (ESRD). A close relative donated
their kidney and Edward successfully underwent transplant surgery 12 months ago.
Edward is now age 50 and asks you if his Medicare coverage will continue, what should
you say? - ANSWER-Individuals eligible for Medicare based on ESRD generally lose
eligibility 36 months after the month in which the individual receives a kidney transplant
unless they are eligible for Medicare on another basis such as age or disability. Edward
may, however, remain enrolled in Part B but solely for coverage of immunosuppressive
drugs if he has no other health care coverage that would cover the drugs.
Mrs. Foster is covered by Original Medicare. She sustained a hip fracture and is being
successfully treated for that condition. However, she and her physicians feel that after
her lengthy hospital stay, she will need a month or two of nursing and rehabilitative
care. What should you tell them about Original Medicare's coverage of care in a skilled
nursing facility? - ANSWER-Medicare will cover Mrs. Foster's skilled nursing services
provided during the first 20 days of her stay, after which she would have a copay until
she has been in the facility for 100 days.
Madeline Martinez was widowed several years ago. Her husband worked for many
years and contributed into the Medicare system. He also left a substantial estate which
provides Madeline with an annual income of approximately $130,000. Madeline, who
has only worked part-time for the last three years, will soon turn age 65 and hopes to
enroll in Original Medicare. She comes to you for advice. What should you tell her? -
