AHIP 2025 FINAL EXAM 50
QUESTIONS
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?---ans-✔✔Original-Medicare-covers-
ambulance-services.
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?---ans-✔✔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?---ans-✔✔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.
Mrs.-Park-is-an-elderly-retiree.-Mrs.-Park-has-a-low-fixed-income.-What-could-you-tell-Mrs.-
Park-that-might-be-of-assistance?---ans-✔✔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.
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?---ans-✔✔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.
Anita-Magri-will-turn-age-65-in-August-2023.-Anita-intends-to-enroll-in-Original-Medicare-
Part-A-and-Part-B.-She-would-also-like-to-enroll-in-a-Medicare-Supplement-(Medigap)-
plan.-Anita's-older-neighbor-Mel-has-told-her-about-the-Medigap-Plan-F-in-which-he-is-
, enrolled.-It-not-only-provides-foreign-travel-emergency-benefits-but-also-covers-his-
Medicare-Part-B-deductible.-Anita-comes-to-you-for-advice.-What-should-you-tell-her?---
ans-✔✔You-are-sorry-to-disappoint-Anita,-but-a-Medigap-F-plan-is-no-longer-available-to-
those-who-turn-age-65-after-January-1,-2020.-Anita-might-instead-consider-other-Medigap-
plans-that-offer-foreign-travel-benefits-but-do-not-cover-the-Part-B-deductible.
Mr.-Singh-would-like-drug-coverage-but-does-not-want-to-be-enrolled-in-a-Medicare-
Advantage-plan.-What-should-you-tell-him?---ans-✔✔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?---ans-✔✔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.
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?---ans-✔✔Beneficiaries-under-
Original-Medicare-have-no-cost-sharing-for-most-preventive-services.
Mr.-Barker-enjoys-a-comfortable-retirement-income.-He-recently-had-surgery-and-
expected-that-he-would-have-certain-services-and-items-covered-by-the-plan-with-minimal-
out-of-pocket-costs-because-his-MA-PD-coverage-has-been-very-good.-However,-when-
he-received-the-bill,-he-was-surprised-to-see-large-charges-in-excess-of-his-maximum-out-
of-pocket-limit-that-included-some-services-and-items-he-thought-would-be-fully-covered.-
He-called-you-to-ask-what-he-could-do?-What-could-you-tell-him?---ans-✔✔You-can-offer-
to-review-the-plans-appeal-process-to-help-him-ask-the-plan-to-review-the-coverage-
decision.
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?---ans-✔✔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.
Mr.-Lopez-has-heard-that-he-can-sign-up-for-a-product-called-"Medicare-Advantage"-but-is-
not-sure-about-what-type-of-plan-designs-are-available-through-this-program.-What-should-
you-tell-him-about-the-types-of-health-plans-that-are-available-through-the-Medicare-
QUESTIONS
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?---ans-✔✔Original-Medicare-covers-
ambulance-services.
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?---ans-✔✔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?---ans-✔✔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.
Mrs.-Park-is-an-elderly-retiree.-Mrs.-Park-has-a-low-fixed-income.-What-could-you-tell-Mrs.-
Park-that-might-be-of-assistance?---ans-✔✔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.
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?---ans-✔✔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.
Anita-Magri-will-turn-age-65-in-August-2023.-Anita-intends-to-enroll-in-Original-Medicare-
Part-A-and-Part-B.-She-would-also-like-to-enroll-in-a-Medicare-Supplement-(Medigap)-
plan.-Anita's-older-neighbor-Mel-has-told-her-about-the-Medigap-Plan-F-in-which-he-is-
, enrolled.-It-not-only-provides-foreign-travel-emergency-benefits-but-also-covers-his-
Medicare-Part-B-deductible.-Anita-comes-to-you-for-advice.-What-should-you-tell-her?---
ans-✔✔You-are-sorry-to-disappoint-Anita,-but-a-Medigap-F-plan-is-no-longer-available-to-
those-who-turn-age-65-after-January-1,-2020.-Anita-might-instead-consider-other-Medigap-
plans-that-offer-foreign-travel-benefits-but-do-not-cover-the-Part-B-deductible.
Mr.-Singh-would-like-drug-coverage-but-does-not-want-to-be-enrolled-in-a-Medicare-
Advantage-plan.-What-should-you-tell-him?---ans-✔✔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?---ans-✔✔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.
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?---ans-✔✔Beneficiaries-under-
Original-Medicare-have-no-cost-sharing-for-most-preventive-services.
Mr.-Barker-enjoys-a-comfortable-retirement-income.-He-recently-had-surgery-and-
expected-that-he-would-have-certain-services-and-items-covered-by-the-plan-with-minimal-
out-of-pocket-costs-because-his-MA-PD-coverage-has-been-very-good.-However,-when-
he-received-the-bill,-he-was-surprised-to-see-large-charges-in-excess-of-his-maximum-out-
of-pocket-limit-that-included-some-services-and-items-he-thought-would-be-fully-covered.-
He-called-you-to-ask-what-he-could-do?-What-could-you-tell-him?---ans-✔✔You-can-offer-
to-review-the-plans-appeal-process-to-help-him-ask-the-plan-to-review-the-coverage-
decision.
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?---ans-✔✔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.
Mr.-Lopez-has-heard-that-he-can-sign-up-for-a-product-called-"Medicare-Advantage"-but-is-
not-sure-about-what-type-of-plan-designs-are-available-through-this-program.-What-should-
you-tell-him-about-the-types-of-health-plans-that-are-available-through-the-Medicare-
