2025 AHIP FINAL EXAM WITH
CORRECT QUESTIONS AND ANSWERS
2025
1) 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-ANSWERSMedicare 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.
2) 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-ANSWERSMedicare does not
cover massage therapy, or, in general, glasses or dentures.
3) 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-
ANSWERSShe 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.
,4) 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-
ANSWERSHe generally would pay a monthly premium, annual
deductible, and per-prescription cost-sharing.
5) 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-
ANSWERSMrs. 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.
6) 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-ANSWERSHe may sign-up for Medicare at any
time however coverage usually begins on the fourth month after
dialysis treatments start.
7) 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-ANSWERSMrs.
Duarte should file an appeal of this initial determination within 120
days of the date she received the MSN in the mail.
8) 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-ANSWERSPart D covers prescription
drugs and she should look at her premiums, formulary, and cost-
sharing among other factors to see if they have changed.
9) 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-ANSWERSMedicare will cover
a total of 190 days of inpatient psychiatric care during Mr. Rainey's
entire lifetime.
10) 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-ANSWERSBeneficiaries under
Original Medicare have no cost-sharing for most preventive services.
11) Mr. Singh would like drug coverage but does not want to be
enrolled in a Medicare Advantage plan. What should you tell him? -
, CORRECT-ANSWERSMr. 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.
12) 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-ANSWERSMost 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.
13) 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-
ANSWERSPart 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.
14) 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
CORRECT QUESTIONS AND ANSWERS
2025
1) 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-ANSWERSMedicare 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.
2) 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-ANSWERSMedicare does not
cover massage therapy, or, in general, glasses or dentures.
3) 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-
ANSWERSShe 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.
,4) 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-
ANSWERSHe generally would pay a monthly premium, annual
deductible, and per-prescription cost-sharing.
5) 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-
ANSWERSMrs. 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.
6) 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-ANSWERSHe may sign-up for Medicare at any
time however coverage usually begins on the fourth month after
dialysis treatments start.
7) 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-ANSWERSMrs.
Duarte should file an appeal of this initial determination within 120
days of the date she received the MSN in the mail.
8) 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-ANSWERSPart D covers prescription
drugs and she should look at her premiums, formulary, and cost-
sharing among other factors to see if they have changed.
9) 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-ANSWERSMedicare will cover
a total of 190 days of inpatient psychiatric care during Mr. Rainey's
entire lifetime.
10) 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-ANSWERSBeneficiaries under
Original Medicare have no cost-sharing for most preventive services.
11) Mr. Singh would like drug coverage but does not want to be
enrolled in a Medicare Advantage plan. What should you tell him? -
, CORRECT-ANSWERSMr. 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.
12) 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-ANSWERSMost 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.
13) 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-
ANSWERSPart 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.
14) 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
