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 provided to Medicare beneficiaries? - CORRECT-ANSWERSBeneficiaries
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-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.
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.
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 provided to Medicare beneficiaries? - CORRECT-ANSWERSBeneficiaries
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-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.
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.
