AHIP Modules 1–5 Exam (2026 / 2027) | Health Insurance | AHIP (PDF), Exams of Health sciences

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2026 AHIP

MODULES 1-5 EXAM

Actual Questions and Answers

What’s Inside?

 Actual AHIP 2026 Module 1–5 Exam questions

with verified and correct answers

 Covers all five official AHIP course modules ,

including:

1. Medicare Basics

2. Medicare Advantage (Part C)

3. Medicare Part D Prescription Coverage

4. Marketing & Enrollment Guidelines

5. Fraud, Waste, and Abuse (FWA) Prevention

 All answers have been verified by industry experts for accuracy

 Exam questions formatted to mirror the actual AHIP online testing

interface

Table of Contents

• 2026 AHIP Module
• 2026 AHIP Module
• 2026 AHIP Module
• 2026 AHIP Module
• 2026 AHIP Module

(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 daily amount up to 60 days over his lifetime, after which he would be responsible for all costs.

D) Medicare covers 100% of inpatient hospitalization with no out-of-pocket expense.

****Expert Rationale:****

Medigap policies pay many out-of-pocket costs not covered by Original Medicare, such as deductibles, coinsurance, and copayments. Some plans cover foreign travel emergency care. Medigap does not cover services like long-term care, vision, dental, hearing aids, or private nursing.

****6. Juan Perez intends to work at Smallcap, Incorporated, which has 15 employees and offers employer-sponsored coverage. He asks about his Medicare eligibility and impact on employer coverage. How would you respond?*** *

A) Juan is likely to be eligible for Medicare once he turns 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.

B) Juan is not eligible for Medicare.

C) 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.

D) He must drop employer insurance if he enrolls in Medicare.

****Correct Answer:*** *

A) Juan is likely to be eligible for Medicare once he turns 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.

****Expert Rationale:*** *

For employers with fewer than 20 employees, Medicare becomes primary when an eligible employee enrolls. The employer can offer coverage, but is not required to coordinate benefits as a secondary payor for older employees, and coverage may not be comparable to that offered to younger workers.

****7. Ms. Kumar is concerned that her income will make her ineligible for Medicare at age 65. What could you tell her?*** *

A) High income makes one ineligible for Medicare.

B) Only low-income individuals qualify for Medicare.

C) Medicare is a program for people age 65 or older and those under age 65 with certain disabilities, ESRD, and ALS, so she will be eligible for Medicare.

D) She should apply for Medicaid instead.

****Correct Answer:*** *

C) Medicare is a program for people age 65 or older and those under age 65 with certain disabilities, ESRD, and ALS, so she will be eligible for Medicare.

****Expert Rationale:*** *

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

A) He must switch to a Medicare Advantage Prescription Drug plan for coverage.

B) 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.

C) Drug coverage is only available through Medigap.

D) He cannot get drug coverage under Original Medicare.

****Correct Answer:*** *

B) 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.

****Expert Rationale:*** *

Beneficiaries on Original Medicare who wish to obtain prescription coverage can do so through a stand-alone Part D plan, without needing to join an MA plan. This preserves choice and flexibility in coverage.

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

A) She should apply for a Medigap policy.

B) 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.

C) She is not eligible for financial assistance.

D) Only the federal government offers help.

****Correct Answer:*** *

B) 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.

****Expert Rationale:*** *

Most states offer Medicare Savings Programs and Medicaid, which can pay Medicare premiums, deductibles, coinsurance, and other out-of-pocket costs for low-income seniors. Eligibility varies, so it’s essential to check state-specific requirements.

****11. Ms. Henderson believes she will qualify for Medicare coverage at age 65 without paying any premiums because of her work history. What should you tell her?*** *

A) All Medicare coverage is premium-free after working for 40 years.

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

C) Both Part A and Part B will be premium-free.

D) She won’t qualify for any Medicare coverage.

****Correct Answer:*** *

****13. Mr. Schmidt asks what is covered under Original Fee-for-Service (FFS) Medicare. What could you tell him?*** *

A) Dental, vision, hearing, and hospital services.

B) 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.

C) Only doctor visits.

D) Prescription drugs and hospital care.

****Correct Answer:*** *

B) 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.

****Expert Rationale:*** *

Original Medicare Part A covers inpatient services, while Part B covers outpatient and physician services. Exclusions are dental, vision, and hearing, which must be covered through separate plans, emphasizing the need for clear consumer understanding.

****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?* *

A. Anthony is required to wait for the next General Enrollment Period to enroll in Medicare.

B. Anthony is eligible for a Special Enrollment Period (SEP) because he missed his Initial Enrollment Period due to the Federally declared disaster. He may enroll in Part B within six months of the end of the emergency declaration, and can enroll in premium-free Part A at any time, with retroactive coverage up to six months.

C. Anthony may never enroll in Medicare since he missed his Initial Enrollment Period.

D. Anthony must pay a penalty for late enrollment regardless of the disaster.

****Correct Answer:*** *

****B. Anthony is eligible for a Special Enrollment Period (SEP) because he missed his Initial Enrollment Period due to the Federally declared disaster. He may enroll in Part B within six months of the end of the emergency declaration, and can enroll in premium-free Part A at any time, with retroactive coverage up to six months.*** *

****Expert Rationale:*** *

Medicare provides a SEP for individuals who are unable to enroll during standard periods due to FEMA-declared disasters or other emergencies, allowing Anthony up to six months after the disaster's end to enroll in Part B without penalty. Part A enrollment remains flexible for those qualifying for premium-free coverage.

B. Edward will lose Medicare coverage 36 months after his transplant unless he qualifies for Medicare due to age or disability, though he may continue Part B solely for immunosuppressive drug coverage.

C. Edward must enroll in a Medicare Advantage plan to continue coverage.

D. His coverage ends immediately after the transplant.

****Correct Answer:*** *

****B. Edward will lose Medicare coverage 36 months after his transplant unless he qualifies for Medicare due to age or disability, though he may continue Part B solely for immunosuppressive drug coverage.*** *

****Expert Rationale:*** *

Medicare eligibility for ESRD ends 36 months after a successful transplantation unless another eligibility factor exists. Recent legislation allows continued Part B solely for immunosuppressive drugs in absence of other coverage.

****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?*** *

A. Medicare covers all skilled nursing facility care with no time limit or copay.

B. Medicare covers the first 20 days in a skilled nursing facility fully; after that, coinsurance applies until 100 days are reached per benefit period.

C. Medicare does not cover any skilled nursing facility care.

D. Medicare pays for skilled nursing facility care only if the patient is under age 65.

****Correct Answer:*** *

****B. Medicare covers the first 20 days in a skilled nursing facility fully; after that, coinsurance applies until 100 days are reached per benefit period.*** *

****Expert Rationale:*** *

Medicare Part A covers up to 100 days of SNF care per benefit period following a qualifying hospital stay; days 1-20 are fully covered, while days 21-100 require coinsurance.

****18. 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?*** *

A. Madeline must pay full premiums for both Part A and Part B due to her high income.

B. Madeline qualifies for premium-free Part A due to her husband’s work record, but her Part B premium will be higher than the base rate due to her income.

C. Madeline cannot enroll in Medicare unless she has a work record herself.

D. Madeline’s income will not affect any aspect of her Medicare premiums.

****Correct Answer:*** *

Medicare offers a SEP for those covered by active employer plans; the window extends 8 months from when employer coverage ends, allowing penalty-free Part B enrollment.

****20. 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?*** *

A. All hospice benefits are provided under the Medicare Advantage plan and not through Original Medicare.

B. Hospice benefits are provided by Original Medicare Part A, while Allcare continues to cover non-hospice services.

C. Hospice benefits are not covered by Medicare for Advantage plan enrollees.

D. Hospice care must be paid out-of-pocket.

****Correct Answer:*** *

****B. Hospice benefits are provided by Original Medicare Part A, while Allcare continues to cover non-hospice services.*** *

****Expert Rationale:*** *

When a Medicare Advantage enrollee elects hospice, Original Medicare assumes coverage for hospice while the MA plan continues coverage for supplemental, non-hospice services.

2026 AHIP Module 2

****21. Which of the following statement(s) is/are correct about Medicare Savings Account (MSA) Plans?**

I. MSAs may have either a partial network, full network, or no network of providers.

II. MSA plans cover Part A and Part B benefits but not Part D prescription drug benefits.

III. An individual who is enrolled in an MSA plan is responsible for a minimal deductible of $500 indexed for inflation.

IV. Non-network providers must accept the same amount that Original Medicare would pay them as payment in full.* *

A. I and II only

B. I, II, and III only

C. I, II, and IV only

D. III and IV only

****Correct Answer:*** *

****C. I, II, and IV only*** *