2026 AHIP – Module 1 Final Review

Question 1

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?

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.

Part C, which always covers dental and vision services, is covered under Original Medicare.

Part A, which covers long-term custodial care services, is covered under Original Medicare.

Part D, which covers prescription drug services, is covered under Original Medicare.

Question 2

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?

She is correct because she will be covered under Part A, without paying premiums and she has worked for 40 years so she will not have to pay Part B premiums.

Medicare beneficiaries only pay a Part B premium if they are enrolled in a Medicare Advantage plan.

She is correct that she will not have to pay a premium because State programs cover the cost of Part B premiums for all Medicare beneficiaries.

To obtain Part B coverage, she must pay a standard monthly premium, though it is higher for individuals with higher incomes.

Question 3

Mrs. Cook is an elderly retiree. Mrs. Cook has a low fixed income. What could you tell Mrs. Cook that might be of assistance?

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.

She should only seek help from private organizations to cover her Medicare costs.

She should not sign up for a Medicare Advantage plan.

She can apply to the Medicare agency for lower premiums and cost-sharing.

Question 4

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?

Medigap policies designed to cover costs not paid for by an MA plan can be purchased, but only if the MA plan’s design is considered to be the “defined standard benefit.”

Medigap plans that cover costs not paid for by an MA plan are available only in Massachusetts, Minnesota, and Wisconsin.

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.

You will help Mr. Capadona to select a Medigap plan that is designed to cover gaps in Medicare Advantage.

Question 5

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?

After receiving such disability payments for 24 months, he will be automatically enrolled in Medicare, regardless of age.

Individuals who become eligible for such disability payments only have to wait 12 months before they can apply for coverage under Medicare.

Individuals receiving such disability payments from the Social Security Administration continue to receive those payments but only become eligible for Medicare upon reaching age 65.

He became eligible for Medicare when his disability eligibility determination was first made.

Question 6

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?

Part B will cover her routine dental and vision needs.

She will need to pay no premiums for Part B as she qualifies for premium-free coverage due to the number of quarters she has worked.

She should disenroll if she does not want to pay the monthly premiums. There is no disadvantage in doing so.

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.

Question 7

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?

You should tell Madeline that she will be able to enroll in both Medicare Part A and Part B without paying monthly premiums due to her husband’s long work record and participation in the Medicare system.

You should tell Madeline that she will be able to enroll in Medicare Part A without paying monthly premiums due to her husband’s long work record and participation in the Medicare system. You should also tell Madeline that she will pay Part B premiums at the highest rate because her income over the last several years has exceeded $100,000.

You should tell Madeline that she will need to pay premiums for Part A because of her short work history. You should also tell Madeline that she will pay Part B premiums at the highest rate because her income over the last several years has exceeded $100,000.

You should tell Madeline that she will be able to enroll in Medicare Part A without paying monthly premiums due to her husband’s long work record and participation in the Medicare system. You should also tell Madeline that she will pay Part B premiums at more than the standard lowest rate but less than the highest rate due her substantial income.

Question 8

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?

Anthony will have a special enrollment period (SEP) of 3 months beginning after the end of the emergency declaration, but he will be subject to a late enrollment penalty if he chooses Part B coverage.

Anthony will be automatically enrolled in Medicare Part A within one month from the date the Federal government declared the disaster ended. If he wishes Part B coverage he must wait until the next General Enrollment Period.

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.

Anthony must wait until the next General Enrollment Period (GEP) which runs from January 1 through March 31.

Question 9

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?

Mr. Wu may still qualify for help in paying for Part D costs through the local Office of the Aging.

Mr. Wu may still qualify for help in paying Part D costs through his State Pharmaceutical Assistance Program (SPAP).

Mr. Wu may still qualify for help in paying for Part D costs through the Federal Pharmaceutical Assistance Program.

Mr. Wu has no alternative but to liquidate his remaining assets and apply for coverage through his state’s Medicaid program.

Question 10

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?

Medicare will cover an unlimited number of days in a skilled nursing facility, as long as a physician certifies that such care is needed.

Once she has expended her liquid assets, Medicare will cover 80% of Mrs. Foster’s long-term care costs.

Mrs. Foster will have to apply for Medicaid to have her skilled nursing services covered because Medicare does not provide such a benefit.

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.

Question 11

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?

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 should apply for Medicaid if he has no other health care coverage that would cover the drugs regardless of his income level or assets.

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.

Individuals eligible for Medicare based on ESRD generally lose eligibility 24 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 A but solely for coverage of immunosuppressive drugs if he has no other health care coverage that would cover the drugs.

Individuals eligible for Medicare based on ESRD generally lose eligibility 48 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 E (Medigap) but solely for coverage of immunosuppressive drugs if he has no other health care coverage that would cover the drugs.

Question 12

Mr. Singh would like drug coverage but does not want to be enrolled in a Medicare Advantage plan. What should you tell him?

Part D prescription drug coverage can only be obtained by enrollment into a Medicare Advantage plan that also covers Part A and Part B services.

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.

Mr. Singh will have to enroll in Medicaid if he wishes to obtain prescription drug coverage through some means other than a Medicare Advantage plan.

Mr. Singh must leave Original Medicare to receive drug coverage.

Question 13

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?

Under Original Medicare, the inpatient hospital co-payment is a percentage of allowed charges. The percentage increases after 60 days and again after 90 days.

Under Original Medicare, if the inpatient hospital service is provided by a participating Medicare provider, the co-payment is waived. Co-payments are only charged when a beneficiary opts to receive care from a non-participating provider.

Under Original Medicare, the inpatient hospital co-payment is a flat per-day amount that remains the same throughout the first 60 days of a beneficiary’s stay. After day 60 the amount gradually increases until day 90. After 90 days he would pay the full amount of all costs.

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.

Question 14

Mrs. Thomas is 66 years old, has coverage under an employer plan, and will retire next year. She heard she must enroll in Part B at the beginning of the year to ensure no gap in coverage. What can you tell her?

She may only enroll in Part B during the general enrollment period whether she is retired or not.

She may not enroll in Part B while covered under an employer group health plan and must wait until the standard general enrollment period after she retires.

She must wait at least 30 days after her employment terminates before she may enroll in Medicare Part B.

She may enroll at any time while she is covered under her employer plan, but she will have a special eight-month enrollment period after the last month on her employer plan that differs from the standard general enrollment period, during which she may enroll in Medicare Part B.

Question 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?

Hospice services are currently only offered under a limited demonstration project. Whether they will eventually become available nationally depends on the outcome of the demonstration.

Medicare covers hospice services, and they will be available for her.

Medicare does not cover hospice services. Hospice services are only available through state Medicaid programs if the state offers such coverage.

The Federal government facilitates competition between hospice programs to lower the price of their services for Medicare beneficiaries but does not offer coverage for hospice services through the Medicare program.

Question 16

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?

Juan is likely to be eligible for Medicare once he turns age 65 and if he enrolls his employer-sponsored coverage would continue to be the primary payor while Medicare would be considered a secondary payor of his healthcare claims.

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.

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.

Juan is likely to be ineligible for Medicare since he was born outside the United States and has only contributed to the Medicare system for 20 years.

Question 17

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?

Medicare is a program for people who have incomes and assets below specific limits, so you will have to find out her exact financial situation before telling her whether she can obtain Medicare coverage.

Eligibility for Medicare is based on whether or not the federal government has ever employed a person. If the federal government ever employed her or her husband, she can enroll in Medicare.

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.

Medicare is a program for people of all ages with specific mental health disabilities. Since she is in excellent health, she would not qualify, but should instead look into her state’s Medicaid program if she wants further coverage.

Question 18

Mildred Savage enrolled in Allcare Medicare Advantage plan several years ago. Mildred recently learned that she is suffering from inoperable cancer and has just a few months to live. She would like to spend these final months in hospice care. Mildred’s family asks you whether hospice benefits will be paid for under the Allcare Medicare Advantage plan. What should you say?

Hospice benefits will be available to Mildred but they will be paid for by Original Medicare under Part B.

Mildred may remain enrolled in Allcare and make a hospice election. Hospice benefits will be paid for by Original Medicare under Part A and Allcare will continue to pay for any non-hospice services.

Hospice benefits will be paid for under Mildred’s Allcare Medicare Advantage plan which must cover all Medicare Part A and Part B benefits.

Hospice benefits are not covered under Medicare and must be paid for using private funds.

Question 19

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?

Tell prospect Jerry Smith that he should drop his Medigap coverage and put those premium dollars toward the purchase of a standalone Part D prescription drug plan because he can always reactivate his Medigap policy on a guaranteed issue basis. Furthermore, because he has had Medigap Jerry will not incur a Part D late enrollment penalty.

Tell prospect Jerry Smith that he should keep his Medigap plan but he should supplement his healthcare coverage by purchasing a Medicare Advantage plan that offers prescription drug coverage (MA-PD).

Tell prospect Jerry Smith that Medigap is simply a variation of a Medicare Advantage plan and the companies John represents offer more comprehensive coverage for a lower price.

Tell prospect Jerry Smith that he should consider adding a standalone Part D prescription drug coverage policy to his present coverage.

Question 20

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?

Medicare Supplemental Insurance would cover his dental, vision and hearing services only.

Medicare Supplemental Insurance would cover all of his IRS approved health care expenditures not covered under Original Fee-for-Service (FFS) Medicare.

Medicare Supplemental Insurance would cover his long-term care services.

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.

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