2025 AHIP FINAL EXAM WITH
CORRECT QUESTIONS AND ANSWERS
2025
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.
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.
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.
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.
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.
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.
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.
, 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.
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.
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
CORRECT QUESTIONS AND ANSWERS
2025
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.
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.
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.
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.
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.
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.
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.
, 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.
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.
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
