AHIP - 2026 - Modules 1-5 EXAMS
QUESTIONS WITH CORRECT SOLUTIONS
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? - -ANS☑☑-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.
2. 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? - -ANS☑☑-Tell
prospect Jerry Smith that he should consider adding a standalone
Part D prescription drug coverage policy to his present coverage.
3. 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? - -ANS☑☑-Mr. Wu
may still qualify for help in paying Part D costs through his State
Pharmaceutical Assistance Program (SPAP).
4. 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? - -ANS☑☑-
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.
5. 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? - -ANS☑☑-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.
6. 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? -
-ANS☑☑-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.
7. 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? - -ANS☑☑-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.
8. 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? - -ANS☑☑-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.
9. Mr. Singh would like drug coverage but does not want to be enrolled
in a Medicare Advantage plan. What should you tell him? - -ANS☑☑-
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.
10. Mrs. Cook is an elderly retiree. Mrs. Cook has a low fixed
income. What could you tell Mrs. Cook that might be of assistance? - -
ANS☑☑-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.
11. 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? - -ANS☑☑-To obtain Part B coverage, she must
pay a standard monthly premium, though it is higher for individuals
with higher incomes.
12. Mr. Bauer is 49 years old, but eighteen months ago he was
declared disabled by the Social Security Administration and has been
QUESTIONS WITH CORRECT SOLUTIONS
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? - -ANS☑☑-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.
2. 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? - -ANS☑☑-Tell
prospect Jerry Smith that he should consider adding a standalone
Part D prescription drug coverage policy to his present coverage.
3. 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? - -ANS☑☑-Mr. Wu
may still qualify for help in paying Part D costs through his State
Pharmaceutical Assistance Program (SPAP).
4. 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? - -ANS☑☑-
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.
5. 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? - -ANS☑☑-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.
6. 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? -
-ANS☑☑-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.
7. 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? - -ANS☑☑-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.
8. 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? - -ANS☑☑-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.
9. Mr. Singh would like drug coverage but does not want to be enrolled
in a Medicare Advantage plan. What should you tell him? - -ANS☑☑-
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.
10. Mrs. Cook is an elderly retiree. Mrs. Cook has a low fixed
income. What could you tell Mrs. Cook that might be of assistance? - -
ANS☑☑-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.
11. 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? - -ANS☑☑-To obtain Part B coverage, she must
pay a standard monthly premium, though it is higher for individuals
with higher incomes.
12. Mr. Bauer is 49 years old, but eighteen months ago he was
declared disabled by the Social Security Administration and has been
