2026 AHIP FINAL EXAM QUESTIONS
WITH VERIFIED ANSWERS
Mrs. Shields is covered by Original Medicare. She sustained a hip fracture and is being successfully treate
d for that condition. However, she and her physicians feel that aſter her lengthy hospital stay, she will nee
d 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? - correct answer-
Medicare will cover Mrs. Shield's skilled nursing services provided during the first 20 days of her stay, aſte
r 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 ma
ssage therapy. She is concerned about whether or not Medicare will cover these items and services. Wha
t should you tell her? - correct 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? - correct 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 c
overage, but he wants to compare it to a Part D prescription drug plan. He asks you what costs he would g
enerally expect to encounter when enrolling into a standard Medicare Part D prescription drug plan. Wha
t should you tell him? - correct 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 c
overage. 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? - correct 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? - correct answer-He may sign-
up for Medicare at any time however coverage usually begins on the fourth month aſter dialysis treatmen
ts start.
,Mrs. Duarte is enrolled in Original Medicare Parts A and B. She has recently reviewed her Medicare Sum
mary Notice (MSN) and disagrees with a determination that partially denied one of her claims for service
s. What advice would you give her? - correct answer-
Mrs. Duarte should file an appeal of this initial determination within 120 days of the date she received th
e MSN in the mail.
Mrs. Geisler's neighbor told her she should look at her Part D options during the annual Medicare enrollm
ent period because the features of Part D might have changed. Mrs. Geisler can't remember what Part D i
s so she called you to ask what her neighbor was talking about. What could you tell her? - correct 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 delusionsxandxhisxphysicianxfeelsxthatxhexshouldxbexhospitalized.xWha
txshouldxyouxtellxMr.xRaineyx(orxhisxrepresentative)xaboutxthexlengthxofxanxinpatientxpsychiatricxhospitalx
sta
yxthatxMedicare
Medicare xwillxxacover?
xwillxcover -xxcorrect
xtotalxxof xanswer-
190xdays xofxinpatientxpsychiatricxcarexduringxMr.xRainey'sxentirexlifetim
e.
Mr.xXixwillxsoonxturnxagex65xandxhasxcomextoxyouxforxadvicexasxtoxwhatxservicesxarexprovidedxunderxOri
gin
alxMedicare.xWhatxshouldxyouxtellxMr.xXixthatxbestxdescribesxthexhealthxcoveragexprovidedxtoxMedicarex
be
neficiaries?x-xcorrectxanswer-BeneficiariesxunderxOriginalxMedicarexhavexnoxcost-
sharingxforxmostxpreventivexservices.
Mr.xSinghxwouldxlikexdrugxcoveragexbutxdoesxnotxwantxtoxbexenrolledxinxaxMedicarexAdvantagexplan.xW
hat
shouldxyouxtellxhim?x-xcorrectxanswer-Mr.xSinghxcanxenrollxinxaxstand-
alonexprescriptionxdrugxplanxandxcontinuextoxbexcoveredxforxPartxAxandxPartxBxservicesxthroughxOriginalx
Fe
e-for-ServicexMedicare.
Mrs.xChenxwillxbex65xsoon,xhasxbeenxaxcitizenxforxtwelvexyears,xhasxbeenxemployedxfullxtime,xandxpaidxt
axe
sxduringxthatxentirexperiod.xShexisxconcernedxthatxshexwillxnotxqualifyxforxcoveragexunderxpartxAxbecause
xs
hexwasxnotxbornxinxthexUnitedxStates.xWhatxshouldxyouxtellxher?x-xcorrectxanswer-
Mostxindividualsxwhoxarexcitizensxandxagex65xorxoverxarexcoveredxunderxPartxAxbyxvirtuexofxhavingxpaidx
Me
dicare xtaxesxwhilexworking,xthoughxsomexmayxbexcoveredxasxaxresultxofxpayingxmonthlyxpremiums.
Mrs.xQuinn xrecentlyxturnedx66xandxdecidedxaſterxmanyxyearsxofxworkxtoxretirexandxbeginxreceivingxSocia
lxS
ecurityxbenefits.xShortlyxthereaſterxMrs.xQuinnxreceivedxaxletterxinformingxherxthatxshexhadxbeenxautom
at
icallyxenrolledxinxMedicarexPartxB.xShexwantsxtoxunderstandxwhatxthisxmeans.xWhatxshouldxyouxtellxMrs.
xQ
,x
uinn?x-xcorrectxanswer-
PartxBxprimarilyxcoversxphysicianxservices.xShexwillxbexpayingxaxmonthlyxpremiumxand,xexceptxforxmanyx
pr
eventivexandxscreeningxtests,xgenerallyxwillxhavex20%xco-
paymentsxforxthesexservices,xinxadditionxtoxanxannualxdeductible.
Mr.xPatelxisxinxgoodxhealthxandxisxpreparingxaxbudgetxinxanticipationxofxhisxretirementxwhenxhexturnsx66.
xH
exwantsxtoxunderstandxthexhealthxcarexcostsxhexmightxbexexposedxtoxunderxMedicarexifxhexwerextoxrequ
ire
hospitalizationxbecausexofxanxillness.xInxgeneralxterms,xwhatxcouldxyouxtellxhimxaboutxhisxcostsxforxinpati
e
nt
day xhospital xservices
xcoinsurance xunder
xamount xOriginal
xthrough xMedicare?
xdayx90.xAſterx-xxday
correct
x90,xxanswer-
hexwouldxpayxaxdailyxamountxupxtox60xdaysxove
rUnder
xhi xOriginalxMedicare,xtherexisxaxsinglexdeductiblexamountxduexforxthexfirstx60xdaysxofxanyxinpatientxh
os
sxlifetime,xaſterxwhichxhexwouldxbexresponsiblexforxallxcosts.
pitalxstay,xaſterxwhichxitxconvertsxintoxaxper-
Whatximpact,xifxany,xhavexrecentxregulatoryxchangesxhadxonxMedigapxplans?x-xcorrectxanswer-
ThexPartxBxdeductiblexisxnoxlongerxcoveredxforxindividualsxnewlyxeligiblexforxMedicarexstartingxJanuaryx1,
x0220.
Mrs.xPatersonxisxconcernedxaboutxthexdeductiblesxandxco-
paymentsxassociatedxwithxOriginalxMedicare.xWhatxcanxyouxtellxherxaboutxMedigapxasxanxoptionxtoxaddr
es
sxthisxconcern?x-xcorrectxanswer-
MedigapxplansxdoxnotxcoverxOriginalxMedicarexbenefits,xbutxtheyxcoordinatexwithxOriginalxMedicarexcov
er
age.
Mrs.xTurnerxisxcomparingxherxemployer'sxretireexinsurancextoxOriginalxMedicarexandxwouldxlikextoxknow
xw
hichxofxthexfollowingxservicesxOriginalxMedicarexwillxcoverxifxthexappropriatexcriteriaxarexmet.xWhatxcoul
d
youxtellxher?x-xcorrectxanswer-OriginalxMedicarexcoversxambulancexservices.
Ms.xBrooksxhasxaggressivexcancerxandxwouldxlikextoxknowxifxMedicarexwillxcoverxhospicexservicesxinxcas
exs
hexneedsxthem.xWhatxshouldxyouxtellxher?x-xcorrectxanswer-
Medicarexcoversxhospicexservices,xandxtheyxwillxbexavailablexforxher.
Mr.xDiazxcontinuedxworkingxwithxhisxcompanyxandxwasxinsuredxunderxhisxemployer'sxgroupxplanxuntilxhe
xr
eachedxagex68.xHexhasxheardxthatxtherexisxaxpremiumxpenaltyxforxthosexwhoxdidxnotxsignxupxforxPartxBx
whe
n xfirst
Mr. xeligible
xDiaz xand
xwillxnot xwants
xpayxanyxxtoxknowxxbecause
penalty howxmuchxhexxhe
hadxwillxhavextoxxpay.
xcontinuous xWhatxxunder
coverage should xyou
xhis xtellxhim?xxpla
xemployer's -
correctxanswer-
n.
WITH VERIFIED ANSWERS
Mrs. Shields is covered by Original Medicare. She sustained a hip fracture and is being successfully treate
d for that condition. However, she and her physicians feel that aſter her lengthy hospital stay, she will nee
d 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? - correct answer-
Medicare will cover Mrs. Shield's skilled nursing services provided during the first 20 days of her stay, aſte
r 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 ma
ssage therapy. She is concerned about whether or not Medicare will cover these items and services. Wha
t should you tell her? - correct 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? - correct 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 c
overage, but he wants to compare it to a Part D prescription drug plan. He asks you what costs he would g
enerally expect to encounter when enrolling into a standard Medicare Part D prescription drug plan. Wha
t should you tell him? - correct 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 c
overage. 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? - correct 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? - correct answer-He may sign-
up for Medicare at any time however coverage usually begins on the fourth month aſter dialysis treatmen
ts start.
,Mrs. Duarte is enrolled in Original Medicare Parts A and B. She has recently reviewed her Medicare Sum
mary Notice (MSN) and disagrees with a determination that partially denied one of her claims for service
s. What advice would you give her? - correct answer-
Mrs. Duarte should file an appeal of this initial determination within 120 days of the date she received th
e MSN in the mail.
Mrs. Geisler's neighbor told her she should look at her Part D options during the annual Medicare enrollm
ent period because the features of Part D might have changed. Mrs. Geisler can't remember what Part D i
s so she called you to ask what her neighbor was talking about. What could you tell her? - correct 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 delusionsxandxhisxphysicianxfeelsxthatxhexshouldxbexhospitalized.xWha
txshouldxyouxtellxMr.xRaineyx(orxhisxrepresentative)xaboutxthexlengthxofxanxinpatientxpsychiatricxhospitalx
sta
yxthatxMedicare
Medicare xwillxxacover?
xwillxcover -xxcorrect
xtotalxxof xanswer-
190xdays xofxinpatientxpsychiatricxcarexduringxMr.xRainey'sxentirexlifetim
e.
Mr.xXixwillxsoonxturnxagex65xandxhasxcomextoxyouxforxadvicexasxtoxwhatxservicesxarexprovidedxunderxOri
gin
alxMedicare.xWhatxshouldxyouxtellxMr.xXixthatxbestxdescribesxthexhealthxcoveragexprovidedxtoxMedicarex
be
neficiaries?x-xcorrectxanswer-BeneficiariesxunderxOriginalxMedicarexhavexnoxcost-
sharingxforxmostxpreventivexservices.
Mr.xSinghxwouldxlikexdrugxcoveragexbutxdoesxnotxwantxtoxbexenrolledxinxaxMedicarexAdvantagexplan.xW
hat
shouldxyouxtellxhim?x-xcorrectxanswer-Mr.xSinghxcanxenrollxinxaxstand-
alonexprescriptionxdrugxplanxandxcontinuextoxbexcoveredxforxPartxAxandxPartxBxservicesxthroughxOriginalx
Fe
e-for-ServicexMedicare.
Mrs.xChenxwillxbex65xsoon,xhasxbeenxaxcitizenxforxtwelvexyears,xhasxbeenxemployedxfullxtime,xandxpaidxt
axe
sxduringxthatxentirexperiod.xShexisxconcernedxthatxshexwillxnotxqualifyxforxcoveragexunderxpartxAxbecause
xs
hexwasxnotxbornxinxthexUnitedxStates.xWhatxshouldxyouxtellxher?x-xcorrectxanswer-
Mostxindividualsxwhoxarexcitizensxandxagex65xorxoverxarexcoveredxunderxPartxAxbyxvirtuexofxhavingxpaidx
Me
dicare xtaxesxwhilexworking,xthoughxsomexmayxbexcoveredxasxaxresultxofxpayingxmonthlyxpremiums.
Mrs.xQuinn xrecentlyxturnedx66xandxdecidedxaſterxmanyxyearsxofxworkxtoxretirexandxbeginxreceivingxSocia
lxS
ecurityxbenefits.xShortlyxthereaſterxMrs.xQuinnxreceivedxaxletterxinformingxherxthatxshexhadxbeenxautom
at
icallyxenrolledxinxMedicarexPartxB.xShexwantsxtoxunderstandxwhatxthisxmeans.xWhatxshouldxyouxtellxMrs.
xQ
,x
uinn?x-xcorrectxanswer-
PartxBxprimarilyxcoversxphysicianxservices.xShexwillxbexpayingxaxmonthlyxpremiumxand,xexceptxforxmanyx
pr
eventivexandxscreeningxtests,xgenerallyxwillxhavex20%xco-
paymentsxforxthesexservices,xinxadditionxtoxanxannualxdeductible.
Mr.xPatelxisxinxgoodxhealthxandxisxpreparingxaxbudgetxinxanticipationxofxhisxretirementxwhenxhexturnsx66.
xH
exwantsxtoxunderstandxthexhealthxcarexcostsxhexmightxbexexposedxtoxunderxMedicarexifxhexwerextoxrequ
ire
hospitalizationxbecausexofxanxillness.xInxgeneralxterms,xwhatxcouldxyouxtellxhimxaboutxhisxcostsxforxinpati
e
nt
day xhospital xservices
xcoinsurance xunder
xamount xOriginal
xthrough xMedicare?
xdayx90.xAſterx-xxday
correct
x90,xxanswer-
hexwouldxpayxaxdailyxamountxupxtox60xdaysxove
rUnder
xhi xOriginalxMedicare,xtherexisxaxsinglexdeductiblexamountxduexforxthexfirstx60xdaysxofxanyxinpatientxh
os
sxlifetime,xaſterxwhichxhexwouldxbexresponsiblexforxallxcosts.
pitalxstay,xaſterxwhichxitxconvertsxintoxaxper-
Whatximpact,xifxany,xhavexrecentxregulatoryxchangesxhadxonxMedigapxplans?x-xcorrectxanswer-
ThexPartxBxdeductiblexisxnoxlongerxcoveredxforxindividualsxnewlyxeligiblexforxMedicarexstartingxJanuaryx1,
x0220.
Mrs.xPatersonxisxconcernedxaboutxthexdeductiblesxandxco-
paymentsxassociatedxwithxOriginalxMedicare.xWhatxcanxyouxtellxherxaboutxMedigapxasxanxoptionxtoxaddr
es
sxthisxconcern?x-xcorrectxanswer-
MedigapxplansxdoxnotxcoverxOriginalxMedicarexbenefits,xbutxtheyxcoordinatexwithxOriginalxMedicarexcov
er
age.
Mrs.xTurnerxisxcomparingxherxemployer'sxretireexinsurancextoxOriginalxMedicarexandxwouldxlikextoxknow
xw
hichxofxthexfollowingxservicesxOriginalxMedicarexwillxcoverxifxthexappropriatexcriteriaxarexmet.xWhatxcoul
d
youxtellxher?x-xcorrectxanswer-OriginalxMedicarexcoversxambulancexservices.
Ms.xBrooksxhasxaggressivexcancerxandxwouldxlikextoxknowxifxMedicarexwillxcoverxhospicexservicesxinxcas
exs
hexneedsxthem.xWhatxshouldxyouxtellxher?x-xcorrectxanswer-
Medicarexcoversxhospicexservices,xandxtheyxwillxbexavailablexforxher.
Mr.xDiazxcontinuedxworkingxwithxhisxcompanyxandxwasxinsuredxunderxhisxemployer'sxgroupxplanxuntilxhe
xr
eachedxagex68.xHexhasxheardxthatxtherexisxaxpremiumxpenaltyxforxthosexwhoxdidxnotxsignxupxforxPartxBx
whe
n xfirst
Mr. xeligible
xDiaz xand
xwillxnot xwants
xpayxanyxxtoxknowxxbecause
penalty howxmuchxhexxhe
hadxwillxhavextoxxpay.
xcontinuous xWhatxxunder
coverage should xyou
xhis xtellxhim?xxpla
xemployer's -
correctxanswer-
n.
