AHIP FINAL EXAM 2025 COMPLETE QUESTIONS WITH ANSWERS
100% RATED CORRECT(ACCURATELY PASSED)GRADED A+
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 Answer)-Medicare 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 Answer)-Medicare 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 Answer)-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? - (Correct Answer)-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? - (Correct Answer)-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? - (Correct Answer)-He may sign-up for Medicare at any time however
coverage usually begins on the fourth month after dialysis treatments start.
,[Type here]
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 Answer)-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? - (Correct Answer)-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.
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 Answer)-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? - (Correct Answer)-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? - (Correct Answer)-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.
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
Answer)-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.
, [Type here]
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? - (Correct Answer)-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? - (Correct Answer)-
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? - (Correct Answer)-
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? - (Correct
Answer)-Medigap plans do not cover Original Medicare benefits, but they coordinate with
Original Medicare coverage.
Mrs. Turner is comparing her employer's retiree insurance to Original Medicare and would like
to know which of the following services Original Medicare will cover if the appropriate criteria
are met. What could you tell her? - (Correct Answer)-Original Medicare covers ambulance
services.
Ms. Brooks has aggressive cancer and would like to know if Medicare will cover hospice
services in case she needs them. What should you tell her? - (Correct Answer)-Medicare covers
hospice services, and they will be available for her.
100% RATED CORRECT(ACCURATELY PASSED)GRADED A+
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 Answer)-Medicare 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 Answer)-Medicare 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 Answer)-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? - (Correct Answer)-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? - (Correct Answer)-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? - (Correct Answer)-He may sign-up for Medicare at any time however
coverage usually begins on the fourth month after dialysis treatments start.
,[Type here]
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 Answer)-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? - (Correct Answer)-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.
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 Answer)-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? - (Correct Answer)-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? - (Correct Answer)-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.
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
Answer)-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.
, [Type here]
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? - (Correct Answer)-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? - (Correct Answer)-
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? - (Correct Answer)-
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? - (Correct
Answer)-Medigap plans do not cover Original Medicare benefits, but they coordinate with
Original Medicare coverage.
Mrs. Turner is comparing her employer's retiree insurance to Original Medicare and would like
to know which of the following services Original Medicare will cover if the appropriate criteria
are met. What could you tell her? - (Correct Answer)-Original Medicare covers ambulance
services.
Ms. Brooks has aggressive cancer and would like to know if Medicare will cover hospice
services in case she needs them. What should you tell her? - (Correct Answer)-Medicare covers
hospice services, and they will be available for her.
