1
2025 AHIP FINAL EXAM NEWEST VERSION -2025/2026- 100+
QUESTIONS AND VERIFIED ANSWERS 100% CORRECT
GUARANTEED SUCCESS
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?
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?
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.
Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What could you
tell Mrs. Park that might be of assistance?
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?
, 2
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?
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?
He may sign-up for Medicare at any time however coverage usually begins on the
fourth month after dialysis treatments start.
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?
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?
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?
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.
, 3
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?
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?
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?
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?
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?
2025 AHIP FINAL EXAM NEWEST VERSION -2025/2026- 100+
QUESTIONS AND VERIFIED ANSWERS 100% CORRECT
GUARANTEED SUCCESS
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?
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?
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.
Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What could you
tell Mrs. Park that might be of assistance?
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?
, 2
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?
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?
He may sign-up for Medicare at any time however coverage usually begins on the
fourth month after dialysis treatments start.
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?
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?
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?
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.
, 3
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?
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?
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?
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?
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?
