2025 AHIP Final Exam Questions And
Answers
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? - correct answerMedicare 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? - correct answerMedicare
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 answerShe 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? -
correct answerHe 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? - correct answerMrs. 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 answerHe 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? - correct
answerMrs. 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? - correct answerPart 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? - correct answerMedicare
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? - correct answerBeneficiaries
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? - correct answerMr. 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? - correct answerMost 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? - correct answerPart 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? - correct answerUnder 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.
What impact, if any, have recent regulatory changes had on Medigap plans? - correct
answerThe Part B deductible is no longer covered for individuals newly eligible for
Medicare starting January 1, 2020.
Mrs. Paterson is concerned about the deductibles and co-payments associated with
Original Medicare. What can you tell her about Medigap as an option to address this
concern? - correct answerMedigap plans do not cover Original Medicare benefits, but
they coordinate with Original Medicare coverage.
Mrs. Turner is comparing her employer's retiree insurance to Original Medicare and
would like to know which of the following services Original Medicare will cover if the
appropriate criteria are met. What could you tell her? - correct answerOriginal Medicare
covers ambulance services.
Ms. Brooks has aggressive cancer and would like to know if Medicare will cover hospice
services in case she needs them. What should you tell her? - correct answerMedicare
covers hospice services, and they will be available for her.
Answers
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? - correct answerMedicare 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? - correct answerMedicare
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 answerShe 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? -
correct answerHe 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? - correct answerMrs. 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 answerHe 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? - correct
answerMrs. 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? - correct answerPart 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? - correct answerMedicare
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? - correct answerBeneficiaries
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? - correct answerMr. 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? - correct answerMost 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? - correct answerPart 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? - correct answerUnder 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.
What impact, if any, have recent regulatory changes had on Medigap plans? - correct
answerThe Part B deductible is no longer covered for individuals newly eligible for
Medicare starting January 1, 2020.
Mrs. Paterson is concerned about the deductibles and co-payments associated with
Original Medicare. What can you tell her about Medigap as an option to address this
concern? - correct answerMedigap plans do not cover Original Medicare benefits, but
they coordinate with Original Medicare coverage.
Mrs. Turner is comparing her employer's retiree insurance to Original Medicare and
would like to know which of the following services Original Medicare will cover if the
appropriate criteria are met. What could you tell her? - correct answerOriginal Medicare
covers ambulance services.
Ms. Brooks has aggressive cancer and would like to know if Medicare will cover hospice
services in case she needs them. What should you tell her? - correct answerMedicare
covers hospice services, and they will be available for her.
