AHIP final exam 100 QUESTIONS AND ANSWERS EXAM 2024-2025 | ACTUAL
EXAM WITH A STUDY GUIDE AND PRACTICE EX4AM | ACCURATE REAL EXAM
QUESTIONS AND ANSWERS | GUARANTEED PASS | LATEST UPDATE
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?
Question 1Answera.Medicare will cover a total of 190 days of inpatient psychiatric care
during Mr. Rainey's entire lifetime.b.Medicare will cover, at its allowable amount, as
many stays as are needed throughout Mr. Rainey's life, as long as no single stay
exceeds 190 days.c.Medicare inpatient psychiatric coverage is limited to the same
number of days covered for typical inpatient stays.d.Inpatient psychiatric services are
not covered under Original Medicare. - CORRECT ANSWER a
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?
Question 2Answera.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.b.Part D covers physician and non-physician practitioner services and the
deductible has not changed this year, but the physician charges may go up.c.Part D
covers long-term care services, and she should not worry because there has been no
change in coverage. d.Part D covers hospital and home health services and the cost-
sharing has changed this year. - CORRECT ANSWER a
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?
Question 3Answera.Medigap is a replacement for Original Medicare and she has been
paying for double coverage. She should simply drop her Medigap policy.b.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.c.Mrs. Gonzalez can
purchase a Medigap plan that covers drugs, but it likely will not offer coverage that is
equivalent to that provided under Part D.d.Mrs. Gonzalez should purchase a K or L
Medigap plan. - CORRECT ANSWER b
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?
Question 4Answera.He may not sign-up for Medicare until he reaches age 62, the date
he first becomes eligible for Social Security benefits.b.He may sign-up for Medicare at
any time however coverage usually begins on the fourth month after dialysis
,treatments start.c.He may sign-up for Medicare at any time however coverage usually
begins on the sixth month after dialysis treatments start.d.He may sign-up for
Medicare at any time and coverage usually begins immediately. - CORRECT ANSWER
b
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?
Question 5Answera.He generally would pay a monthly premium, annual deductible, and
per-prescription cost-sharing.b.He generally would pay only a per-prescription co-
payment. Medicare covers all other costs.c.He generally would pay only a monthly
premium. Medicare covers all other costs.d.He generally would pay only a monthly
premium and deductible. Medicare covers all other costs. - CORRECT ANSWER a
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?
Question 6Answera.If Mrs. Paterson applies during the Medigap open enrollment
period, she will have to undergo a medical review to determine if she has a pre-
existing condition that would increase the premium for a Medigap policy.b.Medigap
plans are not sold by private companies and are a government insurance product.c.All
costs not covered by Medicare are covered by some Medigap plans.d.Medigap plans do
not cover Original Medicare benefits, but they coordinate with Original Medicare
coverage. - CORRECT ANSWER d
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?
Question 7Answera.Mrs. Duarte should file an appeal of this initial determination
within 90 days of the date she received the MSN in the mail. If she still disagrees with
Medicare Administrative Contractor's (MAC's) further decision she should request a
reconsideration by a qualified independent party within 10 days.b.Mrs. Duarte should
file an appeal of this initial determination within 120 days of the date she received the
MSN in the mail.c.Mrs. Duarte has no right to appeal this determination since her claim
has been partially paid.d.Mrs. Duarte should request a reconsideration of the decision
by a qualified independent party within 60 days of the date she received the MSN in t -
CORRECT ANSWER b
Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What could you tell
Mrs. Park that might be of assistance?
Question 8Answera.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.b.She should not sign up for a Medicare Advantage plan.c.She should
,only seek help from private organizations to cover her Medicare costs.d.She can apply
to the Medicare agency for lower premiums and cost-sharing. - CORRECT ANSWER a
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?
Question 9Answera.Medicare covers 50% of the cost of these three
services.b.Medicare covers glasses, but not dentures or massage therapy.c.Medicare
does not cover massage therapy, or, in general, glasses or dentures.d.Medicare covers
80% of the cost of these three services. - CORRECT ANSWER c
Mrs. Walters is enrolled in her state's Medicaid program in addition to Medicare. What
should she be aware of when considering enrollment in a Medicare Advantage (MA)
plan?
Question 10Answera.Once she enrolls in an MA plan she will be automatically
disenrolled from Medicaid.b.As a Medicaid beneficiary, she will be eligible for a low-
deductible MSA health plan.c.She cannot enroll in an MA Medical Savings Account
(MSA) plan.d.If she enrolls in an MSA plan, she will be paying a monthly premium to
the MSA plan that will cover her Part B premium obligation. - CORRECT ANSWER
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? - CORRECT ANSWER Mr. Wu may still qualify for help in paying Part D
costs through his State Pharmaceutical Assistance Program.
Mr. Bauer is 49 years old, but eighteen months ago he was declared disabled by the
Social Security Administration and has been receiving disability payments. He is
wondering whether he can obtain coverage under Medicare. What should you tell him?
- CORRECT ANSWER After receiving such disability payments for 24 months, he will
be automatically enrolled in Medicare, regardless of age.
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? - CORRECT ANSWER Mildred may
remain enrolled in Allcare and make a hospice election. Hospice benefits will be paid
for by Original Medicare under Part A and Allcare will continue to pay for any non-
hospice services.
Mr. Schmidt would like to plan for retirement and has asked you what is covered under
Original Fee-for-Service (FFS) Medicare. What could you tell him? - CORRECT
ANSWER 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.
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? - CORRECT
ANSWER Tell prospect Jerry Smith that he should consider adding a standalone Part D
prescription drug coverage policy to his present coverage.
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 after
dialysis treatments start.
Mr. Diaz continued working with his company and was insured under his employer's
group plan until he reached age 68. He has heard that there is a premium penalty for
those who did not sign up for Part B when first eligible and wants to know how much
he will have to pay. What should you tell him? - CORRECT ANSWER Mr. Diaz will not
pay any penalty because he had continuous coverage under his employer's plan.
Madeline Martinez was widowed several years ago. Her husband worked for many
years and contributed into the Medicare system. He also left a substantial estate which
provides Madeline with an annual income of approximately $130,000. Madeline, who
has only worked part-time for the last three years, will soon turn age 65 and hopes to
enroll in Original Medicare. She comes to you for advice. What should you tell her? -
CORRECT ANSWER You should tell Madeline that she will be able to enroll in Medicare
Part A without paying monthly premiums due to her husband's long work record and
participation in the Medicare system. You should also tell Madeline that she will pay
Part B premiums at more than the standard lowest rate but less than the highest rate
due her substantial income.
Edward IP 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? - CORRECT ANSWER Individuals eligible for Medicare based on ESRD
generally lose eligibility 36 months after the month in which the individual receives a
kidney transplant unless they are eligible for Medicare on another basis such as age or
disability. Edward may, however, remain enrolled in Part B but solely for coverage of
immunosuppressive drugs if he has no other health care coverage that would cover
the drugs.
EXAM WITH A STUDY GUIDE AND PRACTICE EX4AM | ACCURATE REAL EXAM
QUESTIONS AND ANSWERS | GUARANTEED PASS | LATEST UPDATE
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?
Question 1Answera.Medicare will cover a total of 190 days of inpatient psychiatric care
during Mr. Rainey's entire lifetime.b.Medicare will cover, at its allowable amount, as
many stays as are needed throughout Mr. Rainey's life, as long as no single stay
exceeds 190 days.c.Medicare inpatient psychiatric coverage is limited to the same
number of days covered for typical inpatient stays.d.Inpatient psychiatric services are
not covered under Original Medicare. - CORRECT ANSWER a
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?
Question 2Answera.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.b.Part D covers physician and non-physician practitioner services and the
deductible has not changed this year, but the physician charges may go up.c.Part D
covers long-term care services, and she should not worry because there has been no
change in coverage. d.Part D covers hospital and home health services and the cost-
sharing has changed this year. - CORRECT ANSWER a
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?
Question 3Answera.Medigap is a replacement for Original Medicare and she has been
paying for double coverage. She should simply drop her Medigap policy.b.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.c.Mrs. Gonzalez can
purchase a Medigap plan that covers drugs, but it likely will not offer coverage that is
equivalent to that provided under Part D.d.Mrs. Gonzalez should purchase a K or L
Medigap plan. - CORRECT ANSWER b
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?
Question 4Answera.He may not sign-up for Medicare until he reaches age 62, the date
he first becomes eligible for Social Security benefits.b.He may sign-up for Medicare at
any time however coverage usually begins on the fourth month after dialysis
,treatments start.c.He may sign-up for Medicare at any time however coverage usually
begins on the sixth month after dialysis treatments start.d.He may sign-up for
Medicare at any time and coverage usually begins immediately. - CORRECT ANSWER
b
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?
Question 5Answera.He generally would pay a monthly premium, annual deductible, and
per-prescription cost-sharing.b.He generally would pay only a per-prescription co-
payment. Medicare covers all other costs.c.He generally would pay only a monthly
premium. Medicare covers all other costs.d.He generally would pay only a monthly
premium and deductible. Medicare covers all other costs. - CORRECT ANSWER a
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?
Question 6Answera.If Mrs. Paterson applies during the Medigap open enrollment
period, she will have to undergo a medical review to determine if she has a pre-
existing condition that would increase the premium for a Medigap policy.b.Medigap
plans are not sold by private companies and are a government insurance product.c.All
costs not covered by Medicare are covered by some Medigap plans.d.Medigap plans do
not cover Original Medicare benefits, but they coordinate with Original Medicare
coverage. - CORRECT ANSWER d
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?
Question 7Answera.Mrs. Duarte should file an appeal of this initial determination
within 90 days of the date she received the MSN in the mail. If she still disagrees with
Medicare Administrative Contractor's (MAC's) further decision she should request a
reconsideration by a qualified independent party within 10 days.b.Mrs. Duarte should
file an appeal of this initial determination within 120 days of the date she received the
MSN in the mail.c.Mrs. Duarte has no right to appeal this determination since her claim
has been partially paid.d.Mrs. Duarte should request a reconsideration of the decision
by a qualified independent party within 60 days of the date she received the MSN in t -
CORRECT ANSWER b
Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What could you tell
Mrs. Park that might be of assistance?
Question 8Answera.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.b.She should not sign up for a Medicare Advantage plan.c.She should
,only seek help from private organizations to cover her Medicare costs.d.She can apply
to the Medicare agency for lower premiums and cost-sharing. - CORRECT ANSWER a
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?
Question 9Answera.Medicare covers 50% of the cost of these three
services.b.Medicare covers glasses, but not dentures or massage therapy.c.Medicare
does not cover massage therapy, or, in general, glasses or dentures.d.Medicare covers
80% of the cost of these three services. - CORRECT ANSWER c
Mrs. Walters is enrolled in her state's Medicaid program in addition to Medicare. What
should she be aware of when considering enrollment in a Medicare Advantage (MA)
plan?
Question 10Answera.Once she enrolls in an MA plan she will be automatically
disenrolled from Medicaid.b.As a Medicaid beneficiary, she will be eligible for a low-
deductible MSA health plan.c.She cannot enroll in an MA Medical Savings Account
(MSA) plan.d.If she enrolls in an MSA plan, she will be paying a monthly premium to
the MSA plan that will cover her Part B premium obligation. - CORRECT ANSWER
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? - CORRECT ANSWER Mr. Wu may still qualify for help in paying Part D
costs through his State Pharmaceutical Assistance Program.
Mr. Bauer is 49 years old, but eighteen months ago he was declared disabled by the
Social Security Administration and has been receiving disability payments. He is
wondering whether he can obtain coverage under Medicare. What should you tell him?
- CORRECT ANSWER After receiving such disability payments for 24 months, he will
be automatically enrolled in Medicare, regardless of age.
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? - CORRECT ANSWER Mildred may
remain enrolled in Allcare and make a hospice election. Hospice benefits will be paid
for by Original Medicare under Part A and Allcare will continue to pay for any non-
hospice services.
Mr. Schmidt would like to plan for retirement and has asked you what is covered under
Original Fee-for-Service (FFS) Medicare. What could you tell him? - CORRECT
ANSWER 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.
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? - CORRECT
ANSWER Tell prospect Jerry Smith that he should consider adding a standalone Part D
prescription drug coverage policy to his present coverage.
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 after
dialysis treatments start.
Mr. Diaz continued working with his company and was insured under his employer's
group plan until he reached age 68. He has heard that there is a premium penalty for
those who did not sign up for Part B when first eligible and wants to know how much
he will have to pay. What should you tell him? - CORRECT ANSWER Mr. Diaz will not
pay any penalty because he had continuous coverage under his employer's plan.
Madeline Martinez was widowed several years ago. Her husband worked for many
years and contributed into the Medicare system. He also left a substantial estate which
provides Madeline with an annual income of approximately $130,000. Madeline, who
has only worked part-time for the last three years, will soon turn age 65 and hopes to
enroll in Original Medicare. She comes to you for advice. What should you tell her? -
CORRECT ANSWER You should tell Madeline that she will be able to enroll in Medicare
Part A without paying monthly premiums due to her husband's long work record and
participation in the Medicare system. You should also tell Madeline that she will pay
Part B premiums at more than the standard lowest rate but less than the highest rate
due her substantial income.
Edward IP 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? - CORRECT ANSWER Individuals eligible for Medicare based on ESRD
generally lose eligibility 36 months after the month in which the individual receives a
kidney transplant unless they are eligible for Medicare on another basis such as age or
disability. Edward may, however, remain enrolled in Part B but solely for coverage of
immunosuppressive drugs if he has no other health care coverage that would cover
the drugs.
