AHIP FInAl ExAm lAtEst (2025/2026) | 50
VErIFIEd QuEstIons And CorrECt AnswErs
| A+ GrAdEd
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? - 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? - 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? - 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? - 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? - 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? - Answer-He 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? - 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? - 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?
- Answer-Medicare will cover a total of 190 days of inpatient psychiatric care
during Mr. Rainey's entire lifetime.
Mr. Lombardi is interested in a Medicare Advantage (MA) PPO plan that you
represent. It is one of three plans operated by the same organization in Mr.
Lombardi's area. The MA PPO plan does not include drug coverage, but the other
two plans do. Mr. Lombardi likes the PPO plan that does not include drug
coverage and intends to obtain his drug coverage through a stand-alone Medicare
prescription drug plan. What should you tell him about this situation? - Answer-He
could enroll either in one of the MA plans that include prescription drug coverage
or Original Medicare with a Medigap plan and standalone Part D prescription drug
coverage, but he cannot enroll in the MA-only PPO plan and a stand-alone
prescription drug plan.
Mrs. Wang wants to know generally how the benefits under Original Medicare
might compare to the benefits package of a Medicare Advantage Plan before she
starts looking at specific plans. What could you tell her? - Answer-Medicare
Advantage Plans may offer extra benefits that Original Medicare does not offer
such as vision, hearing, and dental services. It must include a maximum out-of-
pocket limit on Part A and Part B services.
Mrs. Chou likes a Private Fee-for-Service (PFFS) plan available in her area that does
not include drug coverage. She wants to enroll in the plan and enroll in a stand-
alone prescription drug plan. What should you tell her? - Answer-She could enroll
in a PFFS plan and a stand-alone Medicare prescription drug plan.
VErIFIEd QuEstIons And CorrECt AnswErs
| A+ GrAdEd
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? - 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? - 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? - 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? - 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? - 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? - Answer-He 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? - 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? - 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?
- Answer-Medicare will cover a total of 190 days of inpatient psychiatric care
during Mr. Rainey's entire lifetime.
Mr. Lombardi is interested in a Medicare Advantage (MA) PPO plan that you
represent. It is one of three plans operated by the same organization in Mr.
Lombardi's area. The MA PPO plan does not include drug coverage, but the other
two plans do. Mr. Lombardi likes the PPO plan that does not include drug
coverage and intends to obtain his drug coverage through a stand-alone Medicare
prescription drug plan. What should you tell him about this situation? - Answer-He
could enroll either in one of the MA plans that include prescription drug coverage
or Original Medicare with a Medigap plan and standalone Part D prescription drug
coverage, but he cannot enroll in the MA-only PPO plan and a stand-alone
prescription drug plan.
Mrs. Wang wants to know generally how the benefits under Original Medicare
might compare to the benefits package of a Medicare Advantage Plan before she
starts looking at specific plans. What could you tell her? - Answer-Medicare
Advantage Plans may offer extra benefits that Original Medicare does not offer
such as vision, hearing, and dental services. It must include a maximum out-of-
pocket limit on Part A and Part B services.
Mrs. Chou likes a Private Fee-for-Service (PFFS) plan available in her area that does
not include drug coverage. She wants to enroll in the plan and enroll in a stand-
alone prescription drug plan. What should you tell her? - Answer-She could enroll
in a PFFS plan and a stand-alone Medicare prescription drug plan.
