AHIP - 2026 - Modules 1-5
Test Question And Correct
Answers 2025-2026
GRADED A +
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.
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.
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).
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.
,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.
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.
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.
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.
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.
, 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.
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.
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? - ANS-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? - ANS-
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? - ANS-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? - ANS-
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
Test Question And Correct
Answers 2025-2026
GRADED A +
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.
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.
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).
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.
,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.
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.
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.
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.
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.
, 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.
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.
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? - ANS-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? - ANS-
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? - ANS-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? - ANS-
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
