AHIP Final Exam – Medicare Certification
,AHIP Final Exam – Medicare Certification
AHIP Final Exam – Medicare Certification
Q1. Edward suffered from serious kidney disease. As a result, Edward became
eligible for Medicare coverage due to end-stage renal disease (ESRD). A close
relative donated their kidney and Edward successfully underwent transplant
surgery 12 months ago. Edward is now age 50 and asks you if his Medicare
coverage will continue, what should you say?
A) His Medicare coverage will end 12 months after transplant surgery, regardless of his
age.
B) His Medicare coverage will continue as long as he receives follow-up care for the
transplant.
C) His Medicare coverage will end 36 months after the transplant unless he
otherwise qualifies.
D) His Medicare coverage ends immediately after transplant surgery.
*Correct Answer: C) His Medicare coverage will end 36 months after the transplant
unless he otherwise qualifies. *
Rationale: For individuals eligible for Medicare due to ESRD, coverage ends 36 months
after a successful kidney transplant unless they qualify for Medicare due to age (65+) or
disability. Edward's coverage will continue for 3 years post-transplant unless he turns 65
or qualifies for disability before that time .
Q2. Mrs. Foster 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?
,AHIP Final Exam – Medicare Certification
A) Medicare covers only 3 days per benefit period.
B) Medicare covers all nursing facility care indefinitely.
C) Medicare covers 100 days per benefit period, first 20 days fully covered, next 80
days with copay, after that, no coverage.
D) Medicare only covers outpatient rehabilitative care.
*Correct Answer: C) Medicare covers 100 days per benefit period, first 20 days fully
covered, next 80 days with copay, after that, no coverage. *
Rationale: After a qualifying 3-day hospital stay, Original Medicare covers skilled nursing
facility care for up to 100 days per benefit period — the first 20 days at no cost to the
beneficiary, days 21-100 with a daily coinsurance, after which all costs are the patient's
responsibility .
Q3. Mr. Wu is eligible for Medicare. He has limited financial resources but failed to
qualify for the Part D low-income subsidy. Where might he turn for help with his
prescription drug costs?
A) He is ineligible for any further assistance.
B) He may still qualify for help through his State Pharmaceutical Assistance
Program (SPAP).
C) Only Medicaid can cover his drug costs.
D) He must pay full cost for medications.
*Correct Answer: B) He may still qualify for help through his State Pharmaceutical
Assistance Program (SPAP). *
Rationale: Many states offer State Pharmaceutical Assistance Programs (SPAPs) to help
residents with prescription drug costs, particularly those who do not qualify for the federal
Extra Help program (Low-Income Subsidy). Eligibility and benefits vary by state, but these
programs can provide meaningful financial support when other federal options aren't
available .
Q4. Mr. Capadona would like to purchase a Medicare Advantage (MA) plan and a
Medigap plan to pick up costs not covered by that plan. What should you tell him?
, AHIP Final Exam – Medicare Certification
A) He can enroll in both MA and Medigap plans.
B) It is illegal to sell him a Medigap plan if he is enrolled in an MA plan, and
Medigap only works with Original Medicare.
C) Medigap plans are designed to work alongside Medicare Advantage plans.
D) He must disenroll from his MA plan before buying a Medigap plan.
*Correct Answer: B) It is illegal to sell him a Medigap plan if he is enrolled in an
MA plan, and Medigap only works with Original Medicare. *
Rationale: Medigap plans are supplemental policies that fill gaps in Original Medicare
(Parts A and B) coverage. Federal law prohibits the sale of a Medigap policy to anyone
currently enrolled in a Medicare Advantage plan; Medigap cannot pay costs associated
with Medicare Advantage. This ensures coordination of benefits and prevents duplicate
coverage .
Q5. Mr. Vasquez 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?
A) There are no costs for inpatient hospitalization.
B) He pays a deductible for the first 60 days, then daily coinsurance rates apply.
C) He pays a flat rate regardless of length of stay.
D) He pays a premium for each hospital stay.
*Correct Answer: B) He pays a deductible for the first 60 days, then daily
coinsurance rates apply. *
Rationale: Under Part A, Original Medicare requires payment of a deductible for each
benefit period. For days 1-60, only the deductible is required; days 61-90 require daily
coinsurance; days 91+ up to 60 "lifetime reserve days" also require higher coinsurance;
after that, all costs are out-of-pocket .
,AHIP Final Exam – Medicare Certification
AHIP Final Exam – Medicare Certification
Q1. Edward suffered from serious kidney disease. As a result, Edward became
eligible for Medicare coverage due to end-stage renal disease (ESRD). A close
relative donated their kidney and Edward successfully underwent transplant
surgery 12 months ago. Edward is now age 50 and asks you if his Medicare
coverage will continue, what should you say?
A) His Medicare coverage will end 12 months after transplant surgery, regardless of his
age.
B) His Medicare coverage will continue as long as he receives follow-up care for the
transplant.
C) His Medicare coverage will end 36 months after the transplant unless he
otherwise qualifies.
D) His Medicare coverage ends immediately after transplant surgery.
*Correct Answer: C) His Medicare coverage will end 36 months after the transplant
unless he otherwise qualifies. *
Rationale: For individuals eligible for Medicare due to ESRD, coverage ends 36 months
after a successful kidney transplant unless they qualify for Medicare due to age (65+) or
disability. Edward's coverage will continue for 3 years post-transplant unless he turns 65
or qualifies for disability before that time .
Q2. Mrs. Foster 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?
,AHIP Final Exam – Medicare Certification
A) Medicare covers only 3 days per benefit period.
B) Medicare covers all nursing facility care indefinitely.
C) Medicare covers 100 days per benefit period, first 20 days fully covered, next 80
days with copay, after that, no coverage.
D) Medicare only covers outpatient rehabilitative care.
*Correct Answer: C) Medicare covers 100 days per benefit period, first 20 days fully
covered, next 80 days with copay, after that, no coverage. *
Rationale: After a qualifying 3-day hospital stay, Original Medicare covers skilled nursing
facility care for up to 100 days per benefit period — the first 20 days at no cost to the
beneficiary, days 21-100 with a daily coinsurance, after which all costs are the patient's
responsibility .
Q3. Mr. Wu is eligible for Medicare. He has limited financial resources but failed to
qualify for the Part D low-income subsidy. Where might he turn for help with his
prescription drug costs?
A) He is ineligible for any further assistance.
B) He may still qualify for help through his State Pharmaceutical Assistance
Program (SPAP).
C) Only Medicaid can cover his drug costs.
D) He must pay full cost for medications.
*Correct Answer: B) He may still qualify for help through his State Pharmaceutical
Assistance Program (SPAP). *
Rationale: Many states offer State Pharmaceutical Assistance Programs (SPAPs) to help
residents with prescription drug costs, particularly those who do not qualify for the federal
Extra Help program (Low-Income Subsidy). Eligibility and benefits vary by state, but these
programs can provide meaningful financial support when other federal options aren't
available .
Q4. Mr. Capadona would like to purchase a Medicare Advantage (MA) plan and a
Medigap plan to pick up costs not covered by that plan. What should you tell him?
, AHIP Final Exam – Medicare Certification
A) He can enroll in both MA and Medigap plans.
B) It is illegal to sell him a Medigap plan if he is enrolled in an MA plan, and
Medigap only works with Original Medicare.
C) Medigap plans are designed to work alongside Medicare Advantage plans.
D) He must disenroll from his MA plan before buying a Medigap plan.
*Correct Answer: B) It is illegal to sell him a Medigap plan if he is enrolled in an
MA plan, and Medigap only works with Original Medicare. *
Rationale: Medigap plans are supplemental policies that fill gaps in Original Medicare
(Parts A and B) coverage. Federal law prohibits the sale of a Medigap policy to anyone
currently enrolled in a Medicare Advantage plan; Medigap cannot pay costs associated
with Medicare Advantage. This ensures coordination of benefits and prevents duplicate
coverage .
Q5. Mr. Vasquez 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?
A) There are no costs for inpatient hospitalization.
B) He pays a deductible for the first 60 days, then daily coinsurance rates apply.
C) He pays a flat rate regardless of length of stay.
D) He pays a premium for each hospital stay.
*Correct Answer: B) He pays a deductible for the first 60 days, then daily
coinsurance rates apply. *
Rationale: Under Part A, Original Medicare requires payment of a deductible for each
benefit period. For days 1-60, only the deductible is required; days 61-90 require daily
coinsurance; days 91+ up to 60 "lifetime reserve days" also require higher coinsurance;
after that, all costs are out-of-pocket .
