AHIP FINAL EXAM 200 LEARNING WORKBOOK
2026 MEDICARE ADVANTAGE AND PART D
PLAN BASICS
◉ 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 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 covered for Part A and Part B services through
Original Fee-for-Service Medicare.
, ◉ Mrs. Chen will be 65 soon, has been a citizen for twelve years, has
been employed full time, and paid taxes during that entire period.
She is concerned that she will not qualify for coverage under part A
because she was not born in the United States. What should you tell
her?
Answer: Most individuals who are citizens and age 65 or over are
covered under Part A by virtue of having paid Medicare taxes while
working, though some may be covered as a result of paying monthly
premiums.
◉ Mrs. Quinn recently turned 66 and decided after many years of
work to retire and begin receiving Social Security benefits. Shortly
thereafter Mrs. Quinn 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. Quinn?
Answer: 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.
◉ Mr. Patel 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?
2026 MEDICARE ADVANTAGE AND PART D
PLAN BASICS
◉ 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 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 covered for Part A and Part B services through
Original Fee-for-Service Medicare.
, ◉ Mrs. Chen will be 65 soon, has been a citizen for twelve years, has
been employed full time, and paid taxes during that entire period.
She is concerned that she will not qualify for coverage under part A
because she was not born in the United States. What should you tell
her?
Answer: Most individuals who are citizens and age 65 or over are
covered under Part A by virtue of having paid Medicare taxes while
working, though some may be covered as a result of paying monthly
premiums.
◉ Mrs. Quinn recently turned 66 and decided after many years of
work to retire and begin receiving Social Security benefits. Shortly
thereafter Mrs. Quinn 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. Quinn?
Answer: 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.
◉ Mr. Patel 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?
