Download AHIP Modules 1–5 Exam (2026 / 2027) | Medicare Certification | AHIP (PDF) and more Exams Medical Sciences in PDF only on Docsity!
2026 AHIP
MODULES 1 - 5 EXAM
Actual Questions and Answers
What’s Inside?
- Actual AHIP 2 026 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
** 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 daily
Service (FFS) Medicare as well as possibly some services that Medicare does not cover.
D) It is only available for Medicare Advantage enrollees.
Correct Answer:
C) 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.
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.
Correct Answer:
B) 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.
Expert Rationale:
Medicare Part B covers outpatient services including doctor visits, preventive care, and durable medical equipment. Beneficiaries pay a monthly premium and a 20% coinsurance, with an annual deductible, except for certain preventive services which are fully covered.
** 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:
** 12. Mr. Bauer is 49 , recently declared disabled by SSA, and receives disability payments. Is he eligible for Medicare?**
A) He cannot get Medicare until age 65.
B) Anyone on SSA disability is immediately eligible for Medicare.
C) After receiving such disability payments for 24 months, he will be automatically enrolled in Medicare, regardless of age.
D) He must apply separately for Medicare after two years of disability.
Correct Answer:
C) After receiving such disability payments for 24 months, he will be automatically enrolled in Medicare, regardless of age.
Expert Rationale:
Individuals receiving SSA disability for 24 months become eligible for Medicare regardless of age, with automatic enrollment helping to ensure coverage continuity for those with disabilities.
** 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 65 th 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?**
** 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?**
A. Medicare does not cover hospice services.
B. Hospice services are only covered if Ms. Lewis is enrolled in a Medicare Advantage plan.
C. Medicare covers hospice services; they will be available to her if she qualifies.
D. Medicare only covers hospice services for those under 65.
Correct Answer:
C. Medicare covers hospice services; they will be available to her if she qualifies.
Expert Rationale:
Medicare Part A provides coverage for hospice care for beneficiaries who are terminally ill and elect hospice. Eligibility hinges on certification of the terminal illness and an election of hospice benefits.
** 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?**
A. Edward’s Medicare coverage continues for life regardless of age or disability status.
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?**
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:
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.
Expert Rationale:
Individuals aged 65+ qualify for premium-free Part A due to a spouse’s qualifying work record. Part B premiums are income-adjusted via IRMAA for higher-income enrollees.
** 19. 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?**
A. Mrs. Thomas must enroll in Part B as soon as she retires, or she will lose all coverage permanently.
B. She can enroll in Part B at any time while covered by the employer plan, and has an 8-month Special Enrollment Period after her employer coverage ends to enroll without late penalty.
C. She may never enroll in Part B after retirement.
D. She must enroll during General Enrollment Period only.
Correct Answer:
B. She can enroll in Part B at any time while covered by the employer plan, and has an 8 - month Special Enrollment Period after her employer coverage ends to enroll without late penalty.
Expert Rationale:
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.
