2026 AHIP Final Exam – Actual Questions & Verified
Answers (CMS-Aligned Study Guide)
What’s Inside?
• Actual AHIP 2026 Final Exam questions with verified and
explained answers
• Fully aligned with the latest CMS & AHIP training modules
• Detailed coverage of all exam sections,
• Each question includes rationales and key references to
reinforce understanding
• Content designed to mirror the official AHIP testing
environment
**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 designed to work alongside Medicare Advantage
plans.
D) He must disenroll from his MA plan before buying a Medigap plan.
**Correct Answer:**
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.
**Expert Rationale:**
Medigap plans are supplemental policies that fill gaps in Original Medicare
(Parts A and B) coverage. Federal law prohibits issuance of a Medigap policy
to anyone currently enrolled in a Medicare Advantage plan; Medigap cannot
pay costs associated with MA. This ensures coordination of benefits and
prevents duplicate coverage.
---
**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?**
,A) Advise Jerry to switch to a Medicare Advantage plan for drug coverage.
B) Tell prospect Jerry Smith that he should consider adding a standalone
Part D prescription drug coverage policy to his present coverage.
C) Inform Jerry that Medigap automatically covers prescription drugs.
D) Recommend canceling the Medigap plan.
**Correct Answer:**
B) Tell prospect Jerry Smith that he should consider adding a standalone
Part D prescription drug coverage policy to his present coverage.
**Expert Rationale:**
Medigap plans sold after 2006 do not include prescription drug coverage.
Beneficiaries needing drug coverage must enroll in a standalone Medicare
Part D plan. This allows individuals to retain their Medigap coverage while
accessing necessary medications through an appropriate channel.
---
**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?**
A) Apply for Medicaid to cover prescription costs.
B) Seek assistance from pharmaceutical company discount programs.
, C) Mr. Wu may still qualify for help in paying Part D costs through his State
Pharmaceutical Assistance Program (SPAP).
D) Try to enroll in a Medigap plan with drug coverage.
**Correct Answer:**
C) Mr. Wu may still qualify for help in paying Part D costs through his State
Pharmaceutical Assistance Program (SPAP).
**Expert Rationale:**
States may offer SPAPs to assist residents who do not qualify for the federal
Low Income Subsidy but still need help with Part D drug costs. Eligibility
and benefits vary by state, but these programs can provide meaningful
financial support when other federal options aren’t available.
---
**4. Mr. Vasquez is in good health and wants to understand the health
care costs for inpatient hospital services under Original Medicare.
What could you tell him?**
A) He pays no deductible if admitted to a hospital.
B) He is responsible for a copayment every day in the hospital.
C) 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
Answers (CMS-Aligned Study Guide)
What’s Inside?
• Actual AHIP 2026 Final Exam questions with verified and
explained answers
• Fully aligned with the latest CMS & AHIP training modules
• Detailed coverage of all exam sections,
• Each question includes rationales and key references to
reinforce understanding
• Content designed to mirror the official AHIP testing
environment
**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 designed to work alongside Medicare Advantage
plans.
D) He must disenroll from his MA plan before buying a Medigap plan.
**Correct Answer:**
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.
**Expert Rationale:**
Medigap plans are supplemental policies that fill gaps in Original Medicare
(Parts A and B) coverage. Federal law prohibits issuance of a Medigap policy
to anyone currently enrolled in a Medicare Advantage plan; Medigap cannot
pay costs associated with MA. This ensures coordination of benefits and
prevents duplicate coverage.
---
**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?**
,A) Advise Jerry to switch to a Medicare Advantage plan for drug coverage.
B) Tell prospect Jerry Smith that he should consider adding a standalone
Part D prescription drug coverage policy to his present coverage.
C) Inform Jerry that Medigap automatically covers prescription drugs.
D) Recommend canceling the Medigap plan.
**Correct Answer:**
B) Tell prospect Jerry Smith that he should consider adding a standalone
Part D prescription drug coverage policy to his present coverage.
**Expert Rationale:**
Medigap plans sold after 2006 do not include prescription drug coverage.
Beneficiaries needing drug coverage must enroll in a standalone Medicare
Part D plan. This allows individuals to retain their Medigap coverage while
accessing necessary medications through an appropriate channel.
---
**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?**
A) Apply for Medicaid to cover prescription costs.
B) Seek assistance from pharmaceutical company discount programs.
, C) Mr. Wu may still qualify for help in paying Part D costs through his State
Pharmaceutical Assistance Program (SPAP).
D) Try to enroll in a Medigap plan with drug coverage.
**Correct Answer:**
C) Mr. Wu may still qualify for help in paying Part D costs through his State
Pharmaceutical Assistance Program (SPAP).
**Expert Rationale:**
States may offer SPAPs to assist residents who do not qualify for the federal
Low Income Subsidy but still need help with Part D drug costs. Eligibility
and benefits vary by state, but these programs can provide meaningful
financial support when other federal options aren’t available.
---
**4. Mr. Vasquez is in good health and wants to understand the health
care costs for inpatient hospital services under Original Medicare.
What could you tell him?**
A) He pays no deductible if admitted to a hospital.
B) He is responsible for a copayment every day in the hospital.
C) 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
