2025 AHIP Final Exam with actual correct questions and
answers. An A+ Print
Terms in this set (105)
Mrs. Shields is covered by Original Medicare will cover Mrs. Shield's skilled nursing services provided
Medicare. She sustained a hip during the first 20 days of her stay, after which she would have a
fracture and is being successfully copay until she has been in the facility for 100 days.
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. Mrs. She should contact her state Medicaid agency to see if she
Park has a low fixed income. qualifies for one of several programs that can help with Medicare
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 usually
has recently been diagnosed 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 within
Medicare Parts A and B. She 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 paranoid Medicare will cover a total of 190 days of inpatient psychiatric care
delusions and his physician feels during Mr. Rainey's entire lifetime.
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 most
has come to you for advice as 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 taxes monthly premiums.
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 and Part B primarily covers physician services. She will be paying a
decided after many years of monthly premium and, except for many preventive and screening
work to retire and begin tests, generally will have 20% co- payments for these services,
receiving Social Security 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 first
preparing a budget in 60
days of any inpatient hospital stay, after which it converts into a
anticipation of his retirement
per-day coinsurance amount through day 90. After day 90, he
when he turns 66. He wants to
would pay a daily amount up to 60 days over his lifetime, after
understand the health care costs
which he would be responsible for all 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?
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.
answers. An A+ Print
Terms in this set (105)
Mrs. Shields is covered by Original Medicare will cover Mrs. Shield's skilled nursing services provided
Medicare. She sustained a hip during the first 20 days of her stay, after which she would have a
fracture and is being successfully copay until she has been in the facility for 100 days.
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. Mrs. She should contact her state Medicaid agency to see if she
Park has a low fixed income. qualifies for one of several programs that can help with Medicare
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 usually
has recently been diagnosed 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 within
Medicare Parts A and B. She 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 paranoid Medicare will cover a total of 190 days of inpatient psychiatric care
delusions and his physician feels during Mr. Rainey's entire lifetime.
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 most
has come to you for advice as 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 taxes monthly premiums.
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 and Part B primarily covers physician services. She will be paying a
decided after many years of monthly premium and, except for many preventive and screening
work to retire and begin tests, generally will have 20% co- payments for these services,
receiving Social Security 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 first
preparing a budget in 60
days of any inpatient hospital stay, after which it converts into a
anticipation of his retirement
per-day coinsurance amount through day 90. After day 90, he
when he turns 66. He wants to
would pay a daily amount up to 60 days over his lifetime, after
understand the health care costs
which he would be responsible for all 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?
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.
