AHIP Final Exam 2026 Exam
Questions and Answers | 100%
Solved
Mrs. Shields 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. Shield'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.
Mrs. West wears glasses and dentures and has enjoyed considerable pain
relief from arthritis through massage therapy. She is concerned about
whether or not Medicare will cover these items and services. What should
you tell her? - 🧠 ANSWER ✔✔Medicare does not cover massage therapy,
or, in general, glasses or dentures.
Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What
could you tell Mrs. Park 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.
Mr. Alonso receives some help paying for his two generic prescription
drugs from his employer's retiree coverage, but he wants to compare it to a
Part D prescription drug plan. He asks you what costs he would generally
expect to encounter when enrolling into a standard Medicare Part D
prescription drug plan. What should you tell him? - 🧠 ANSWER ✔✔He
generally would pay a monthly premium, annual deductible, and per-
prescription cost-sharing.
,Mrs. Gonzalez is enrolled in Original Medicare and has a Medigap policy as
well, but it provides no drug coverage. She would like to keep the coverage
she has but replace her existing Medigap plan with one that provides drug
coverage. What should you tell her? - 🧠 ANSWER ✔✔Mrs. Gonzalez
cannot purchase a Medigap plan that covers drugs, but she could keep her
Medigap policy and enroll in a Part D prescription drug plan.
Mr. Davis is 52 years old and has recently been diagnosed with end-stage
renal disease (ESRD) and will soon begin dialysis. He is wondering if he
can obtain coverage under Medicare. What should you tell him? - 🧠
ANSWER ✔✔He may sign-up for Medicare at any time however coverage
usually begins on the fourth month after dialysis treatments start.
Mrs. Duarte is enrolled in Original Medicare Parts A and B. She has
recently reviewed her Medicare Summary Notice (MSN) and disagrees with
a determination that partially denied one of her claims for services. What
advice would you give her? - 🧠 ANSWER ✔✔Mrs. Duarte should file an
appeal of this initial determination within 120 days of the date she received
the MSN in the mail.
Mrs. Geisler's neighbor told her she should look at her Part D options
during the annual Medicare enrollment period because the features of Part
COPYRIGHT©PROFFKERRYMARTIN 2025/2026. YEAR PUBLISHED 2026. COMPANY REGISTRATION NUMBER: 619652435. TERMS OF USE.
PRIVACY STATEMENT. ALL RIGHTS RESERVED
, D might have changed. Mrs. Geisler can't remember what Part D is so she
called you to ask what her neighbor was talking about. What could you tell
her? - 🧠 ANSWER ✔✔Part D covers prescription drugs and she should look
at her premiums, formulary, and cost-sharing among other factors to see if
they have changed.
Mr. Rainey is experiencing paranoid delusions and his physician feels that
he should be hospitalized. What should you tell Mr. Rainey (or his
representative) about the length of an inpatient psychiatric hospital stay
that Medicare will cover? - 🧠 ANSWER ✔✔Medicare will cover a total of
190 days of inpatient psychiatric care during Mr. Rainey's entire lifetime.
Mr. Xi will soon turn age 65 and has come to you for advice as to what
services are provided under Original Medicare. What should you tell Mr. Xi
that best describes the health coverage provided to Medicare
beneficiaries? - 🧠 ANSWER ✔✔Beneficiaries under Original Medicare have
no cost-sharing for most preventive services.
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
Questions and Answers | 100%
Solved
Mrs. Shields 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. Shield'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.
Mrs. West wears glasses and dentures and has enjoyed considerable pain
relief from arthritis through massage therapy. She is concerned about
whether or not Medicare will cover these items and services. What should
you tell her? - 🧠 ANSWER ✔✔Medicare does not cover massage therapy,
or, in general, glasses or dentures.
Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What
could you tell Mrs. Park 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.
Mr. Alonso receives some help paying for his two generic prescription
drugs from his employer's retiree coverage, but he wants to compare it to a
Part D prescription drug plan. He asks you what costs he would generally
expect to encounter when enrolling into a standard Medicare Part D
prescription drug plan. What should you tell him? - 🧠 ANSWER ✔✔He
generally would pay a monthly premium, annual deductible, and per-
prescription cost-sharing.
,Mrs. Gonzalez is enrolled in Original Medicare and has a Medigap policy as
well, but it provides no drug coverage. She would like to keep the coverage
she has but replace her existing Medigap plan with one that provides drug
coverage. What should you tell her? - 🧠 ANSWER ✔✔Mrs. Gonzalez
cannot purchase a Medigap plan that covers drugs, but she could keep her
Medigap policy and enroll in a Part D prescription drug plan.
Mr. Davis is 52 years old and has recently been diagnosed with end-stage
renal disease (ESRD) and will soon begin dialysis. He is wondering if he
can obtain coverage under Medicare. What should you tell him? - 🧠
ANSWER ✔✔He may sign-up for Medicare at any time however coverage
usually begins on the fourth month after dialysis treatments start.
Mrs. Duarte is enrolled in Original Medicare Parts A and B. She has
recently reviewed her Medicare Summary Notice (MSN) and disagrees with
a determination that partially denied one of her claims for services. What
advice would you give her? - 🧠 ANSWER ✔✔Mrs. Duarte should file an
appeal of this initial determination within 120 days of the date she received
the MSN in the mail.
Mrs. Geisler's neighbor told her she should look at her Part D options
during the annual Medicare enrollment period because the features of Part
COPYRIGHT©PROFFKERRYMARTIN 2025/2026. YEAR PUBLISHED 2026. COMPANY REGISTRATION NUMBER: 619652435. TERMS OF USE.
PRIVACY STATEMENT. ALL RIGHTS RESERVED
, D might have changed. Mrs. Geisler can't remember what Part D is so she
called you to ask what her neighbor was talking about. What could you tell
her? - 🧠 ANSWER ✔✔Part D covers prescription drugs and she should look
at her premiums, formulary, and cost-sharing among other factors to see if
they have changed.
Mr. Rainey is experiencing paranoid delusions and his physician feels that
he should be hospitalized. What should you tell Mr. Rainey (or his
representative) about the length of an inpatient psychiatric hospital stay
that Medicare will cover? - 🧠 ANSWER ✔✔Medicare will cover a total of
190 days of inpatient psychiatric care during Mr. Rainey's entire lifetime.
Mr. Xi will soon turn age 65 and has come to you for advice as to what
services are provided under Original Medicare. What should you tell Mr. Xi
that best describes the health coverage provided to Medicare
beneficiaries? - 🧠 ANSWER ✔✔Beneficiaries under Original Medicare have
no cost-sharing for most preventive services.
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
