2025 AHIP Final Exam
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 Answer) - Medicare 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 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 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 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? - (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 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 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? - (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 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 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? - (correct 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? - (correct 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? - (correct 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? -
(correct 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? - (correct Answer) - Under 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 Answer) - The 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 Answer) - Medigap 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 Answer) -
Original 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
Answer) - Medicare covers hospice services, and they will be available for her.
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.
Anita Magri will turn age 65 in August 2023. Anita intends to enroll in Original
Medicare Part A and Part B. She would also like to enroll in a Medicare Supplement
(Medigap) plan. Anita's older neighbor Mel has told her about the Medigap Plan F in
which he is enrolled. It not only provides foreign travel emergency benefits but
also covers his Medicare Part B deductible. Anita comes to you for advice. What
should you tell her? - (correct Answer) - You are sorry to disappoint Anita, but a
Medigap F plan is no longer available to those who turn age 65 after January 1,
2020. Anita might instead consider other Medigap plans that offer foreign travel
benefits but do not cover the Part B deductible.
Hank's Fish Store, Inc. is a small company with just 15 employees located in
Florida. Hank, the store owner, has provided excellent health benefits to the
store's workforce. William, one of the store's long-time employees, will soon be
reaching age 65 and eligible for Medicare. William is in good health. He intends to
remain an active full-time employee, working several years after becoming eligible
for Medicare. What type(s) of retiree health benefit will Hank's Fish Store be able
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 Answer) - Medicare 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 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 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 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? - (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 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 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? - (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 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 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? - (correct 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? - (correct 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? - (correct 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? -
(correct 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? - (correct Answer) - Under 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 Answer) - The 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 Answer) - Medigap 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 Answer) -
Original 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
Answer) - Medicare covers hospice services, and they will be available for her.
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.
Anita Magri will turn age 65 in August 2023. Anita intends to enroll in Original
Medicare Part A and Part B. She would also like to enroll in a Medicare Supplement
(Medigap) plan. Anita's older neighbor Mel has told her about the Medigap Plan F in
which he is enrolled. It not only provides foreign travel emergency benefits but
also covers his Medicare Part B deductible. Anita comes to you for advice. What
should you tell her? - (correct Answer) - You are sorry to disappoint Anita, but a
Medigap F plan is no longer available to those who turn age 65 after January 1,
2020. Anita might instead consider other Medigap plans that offer foreign travel
benefits but do not cover the Part B deductible.
Hank's Fish Store, Inc. is a small company with just 15 employees located in
Florida. Hank, the store owner, has provided excellent health benefits to the
store's workforce. William, one of the store's long-time employees, will soon be
reaching age 65 and eligible for Medicare. William is in good health. He intends to
remain an active full-time employee, working several years after becoming eligible
for Medicare. What type(s) of retiree health benefit will Hank's Fish Store be able
