AHIP FINAL EXAM, PRACTICE EXAM AND STUDY GUIDE
LATEST 2025/2026 ACTUAL EXAM 135 QUESTIONS WITH
CORRECT ANSWERS 100% VERIFIED GRADED A+
Terms in this set (100)
Mrs. Shields is covered by Medicare will cover Mrs. Shield's skilled nursing services
Original provided during the first 20 days of her stay, after which she
Medicare. She sustained a hip would have a copay until she has been in the facility for 100 days.
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?
Mrs. West wears glasses and Medicare does not cover massage therapy, or, in general, glasses or dentures.
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?
Mrs. Park is an elderly retiree. She should contact her state Medicaid agency to see if she
Mrs. Park has a low fixed qualifies for one of several programs that can help with Medicare
income. What could you tell costs for which she is responsible.
Mrs. Park that might be of
assistance?
,Mr. Alonso receives some help He generally would pay a monthly premium, annual deductible, and
paying for his two generic per-prescription cost-sharing.
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?
Mrs. Gonzalez is enrolled in Mrs. Gonzalez cannot purchase a Medigap plan that covers drugs,
Original Medicare and has a but she could keep her Medigap policy and enroll in a Part D
Medigap policy as prescription drug plan.
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?
Mr. Davis is 52 years old and He may sign-up for Medicare at any time however coverage
has recently been diagnosed usually begins on the fourth month after dialysis treatments start.
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?
Mrs. Duarte is enrolled in Original Mrs. Duarte should file an appeal of this initial determination
Medicare Parts A and B. She within 120 days of the date she received the MSN in the mail.
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. Geisler's neighbor told her Part D covers prescription drugs and she should look at her
she should look at her Part D premiums, formulary, and cost-sharing among other factors to
options during the annual Medicare see if they have changed.
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?
Mr. Rainey is experiencing Medicare will cover a total of 190 days of inpatient psychiatric
paranoid care during Mr. Rainey's entire lifetime.
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?
Mr. Xi will soon turn age 65 and Beneficiaries under Original Medicare have no cost-sharing for
has come to you for advice as most preventive services.
to what services are provided
under Original Medicare. What
should you tell Mr. Xi that best
describes
the health coverage provided to
Medicare beneficiaries?
Mr. Singh would like drug Mr. Singh can enroll in a stand-alone prescription drug plan and
coverage but does not want to be continue to be covered for Part A and Part B services through
enrolled in a Medicare Advantage Original Fee-for-Service Medicare.
plan. What should you tell him?
, Mrs. Chen will be 65 soon, has Most individuals who are citizens and age 65 or over are
been a citizen for twelve years, covered under Part A by virtue of having paid Medicare taxes
has been while working, though some may be covered as a result of paying
employed full time, and paid monthly premiums.
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?
Mrs. Quinn recently turned 66 Part B primarily covers physician services. She will be paying
and decided after many years of a monthly premium and, except for many preventive and
work to retire and begin screening tests, generally will have 20% co- payments for
receiving Social Security these services, in addition to an annual deductible.
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?
Mr. Patel is in good health and is Under Original Medicare, there is a single deductible amount due for the
preparing a budget in first 60
anticipation of his retirement days of any inpatient hospital stay, after which it converts into a per-
when he turns 66. He wants to day coinsurance amount through day 90. After day 90, he would
understand the health care costs pay a daily amount up to 60 days over his lifetime, after which
he might be exposed to under he would be responsible for all costs.
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?
What impact, if any, have recent The Part B deductible is no longer covered for individuals newly
regulatory changes had on eligible for Medicare starting January 1, 2020.
Medigap plans?
Mrs. Paterson is concerned about Medigap plans do not cover Original Medicare benefits, but they
the coordinate with Original Medicare coverage.
LATEST 2025/2026 ACTUAL EXAM 135 QUESTIONS WITH
CORRECT ANSWERS 100% VERIFIED GRADED A+
Terms in this set (100)
Mrs. Shields is covered by Medicare will cover Mrs. Shield's skilled nursing services
Original provided during the first 20 days of her stay, after which she
Medicare. She sustained a hip would have a copay until she has been in the facility for 100 days.
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?
Mrs. West wears glasses and Medicare does not cover massage therapy, or, in general, glasses or dentures.
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?
Mrs. Park is an elderly retiree. She should contact her state Medicaid agency to see if she
Mrs. Park has a low fixed qualifies for one of several programs that can help with Medicare
income. What could you tell costs for which she is responsible.
Mrs. Park that might be of
assistance?
,Mr. Alonso receives some help He generally would pay a monthly premium, annual deductible, and
paying for his two generic per-prescription cost-sharing.
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?
Mrs. Gonzalez is enrolled in Mrs. Gonzalez cannot purchase a Medigap plan that covers drugs,
Original Medicare and has a but she could keep her Medigap policy and enroll in a Part D
Medigap policy as prescription drug plan.
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?
Mr. Davis is 52 years old and He may sign-up for Medicare at any time however coverage
has recently been diagnosed usually begins on the fourth month after dialysis treatments start.
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?
Mrs. Duarte is enrolled in Original Mrs. Duarte should file an appeal of this initial determination
Medicare Parts A and B. She within 120 days of the date she received the MSN in the mail.
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. Geisler's neighbor told her Part D covers prescription drugs and she should look at her
she should look at her Part D premiums, formulary, and cost-sharing among other factors to
options during the annual Medicare see if they have changed.
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?
Mr. Rainey is experiencing Medicare will cover a total of 190 days of inpatient psychiatric
paranoid care during Mr. Rainey's entire lifetime.
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?
Mr. Xi will soon turn age 65 and Beneficiaries under Original Medicare have no cost-sharing for
has come to you for advice as most preventive services.
to what services are provided
under Original Medicare. What
should you tell Mr. Xi that best
describes
the health coverage provided to
Medicare beneficiaries?
Mr. Singh would like drug Mr. Singh can enroll in a stand-alone prescription drug plan and
coverage but does not want to be continue to be covered for Part A and Part B services through
enrolled in a Medicare Advantage Original Fee-for-Service Medicare.
plan. What should you tell him?
, Mrs. Chen will be 65 soon, has Most individuals who are citizens and age 65 or over are
been a citizen for twelve years, covered under Part A by virtue of having paid Medicare taxes
has been while working, though some may be covered as a result of paying
employed full time, and paid monthly premiums.
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?
Mrs. Quinn recently turned 66 Part B primarily covers physician services. She will be paying
and decided after many years of a monthly premium and, except for many preventive and
work to retire and begin screening tests, generally will have 20% co- payments for
receiving Social Security these services, in addition to an annual deductible.
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?
Mr. Patel is in good health and is Under Original Medicare, there is a single deductible amount due for the
preparing a budget in first 60
anticipation of his retirement days of any inpatient hospital stay, after which it converts into a per-
when he turns 66. He wants to day coinsurance amount through day 90. After day 90, he would
understand the health care costs pay a daily amount up to 60 days over his lifetime, after which
he might be exposed to under he would be responsible for all costs.
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?
What impact, if any, have recent The Part B deductible is no longer covered for individuals newly
regulatory changes had on eligible for Medicare starting January 1, 2020.
Medigap plans?
Mrs. Paterson is concerned about Medigap plans do not cover Original Medicare benefits, but they
the coordinate with Original Medicare coverage.
