AHIP 2025/2026 Final Exam Questions and Answers Updated Latest
(Verified Answers)
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? - 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.
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? - ANSWER>>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? -
ANSWER>>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? - 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.
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? - 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.
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? -
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.
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? -
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.
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? - 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.
9. 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.
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? - 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.
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? - ANSWER>>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 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.
13. 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.
14. 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.
15. 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.
16. 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.
17. 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.
(Verified Answers)
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? - 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.
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? - ANSWER>>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? -
ANSWER>>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? - 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.
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? - 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.
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? -
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.
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? -
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.
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? - 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.
9. 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.
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? - 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.
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? - ANSWER>>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 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.
13. 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.
14. 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.
15. 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.
16. 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.
17. 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.
