AHIP 2025/2026 FINAL QUESTIONS WITH ANSWERS
Mrs. Paterson is concerned about the deductibles and co-
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payments associated with Original Medicare. What can you tell her about Medigap as an op
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tion to address this concern? - ans-
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Medigap plans help beneficiaries cover Original Medicare benefits, but they coordinate wit
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h Original Medicare coverage.
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Anita Magri will turn age 65 in August 2023. Anita intends to enroll in Original Medicare Part
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A and Part B. She would also like to enroll in a Medicare Supplement (Medigap) plan. Anita'
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s older neighbor Mel has told her about the Medigap Plan F in which he is enrolled. It not onl
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
y provides foreign travel emergency benefits but also covers his Medicare Part B deductibl
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e. Anita comes to you for advice. What should you tell her? - ans-
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You are sorry to disappoint Anita, but a Medigap F plan is no longer available to those who t
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urn age 65 after January 1, 2020. Anita might instead consider other Medigap plans that off
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
er foreign travel benefits but do not cover the Part B deductible.
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What impact, if any, have recent regulatory changes had on Medigap plans? - ans-b.
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The Part B deductible is no longer covered for individuals newly eligible for Medicare startin
zx zx zx zx zx zx zx zx zx zx zx zx zx zx
g January 1, 2020.
zx zx zx
Mr. Rainey is experiencing paranoid delusions and his physician feels that he should be ho
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spitalized. What should you tell Mr. Rainey (or his representative) about the length of an inp
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atient psychiatric hospital stay that Medicare will cover? - ans-
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Medicare will cover a total of 190 days of inpatient psychiatric care during Mr. Rainey's entir
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e lifetime.
zx
Mrs. Shields is covered by Original Medicare. She sustained a hip fracture and is being suc
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
cessfully treated for that condition. However, she and her physicians feel that after her lengt
zx zx zx zx zx zx zx zx zx zx zx zx zx zx
hy hospital stay, she will need a month or two of nursing and rehabilitative care. What shoul
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
d you tell them about Original Medicare's coverage of care in a skilled nursing facility? - ans-
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Mrs. West wears glasses and dentures and has enjoyed considerable pain relief from arthri
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tis through massage therapy. She is concerned about whether or not Medicare will cover th
zx zx zx zx zx zx zx zx zx zx zx zx zx zx
ese items and services. What should you tell her? - ans-
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Medicare does not cover massage therapy, or, in general, glasses or dentures.
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Ms. Gibson recently lost her employer group health and drug coverage and now she wants t
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o enroll in a PPO that does not include drug coverage. What should you tell her about obtain
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ing drug coverage? - ans-
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She can enroll in the PPO, but she will not be able to purchase a stand-
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alone Medicare Part D prescription drug plan.
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, Mrs. Radford asks whether there are any special eligibility requirements for Medicare Adva
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ntage. What should you tell her? - ans- zx zx zx zx zx zx zx
Mrs. Radford must be entitled to Part A and enrolled in Part B to enroll in Medicare Advanta
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ge.
Mr. Barker enjoys a comfortable retirement income. He recently had surgery and expected
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that he would have certain services and items covered by the plan with minimal out-of-
zx zx zx zx zx zx zx zx zx zx zx zx zx zx
pocket costs because his MA- zx zx zx zx
PD coverage has been very good. However, when he received the bill, he was surprised to
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
see large charges in excess of his maximum out-of-
zx zx zx zx zx zx zx zx
pocket limit that included some services and items he thought would be fully covered. He ca
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
lled you to ask what he could do? What could you tell him? - ans-
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You can offer to review the plans appeal process to help him ask the plan to review the cove
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
rage decision. zx
Mr. Sanchez has just turned 65 and is entitled to Part A but has not enrolled in Part B becau
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se he has coverage through an employer plan. If he wants to enroll in a Medicare Advantag
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e plan, what will he have to do? - ans-He will have to enroll in Part B.
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Dr. Elizabeth Brennan does not contract with the ABC PFFS plan but accepts the plan's ter
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
ms and conditions for payment. Mary Rodgers sees Dr. Brennan for treatment. How much
zx zx zx zx zx zx zx zx zx zx zx zx zx zx
may Dr. Brennan charge? - ans-
zx zx zx zx zx
Mrs. Chou likes a Private Fee-for-
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Service (PFFS) plan available in her area that does not include drug coverage. She wants t
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
o enroll in the plan and enroll in a stand-
zx zx zx zx zx zx zx zx zx
alone prescription drug plan. What should you tell her? - ans-
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She could enroll in a PFFS plan and a stand-alone Medicare prescription drug plan.
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Mr. Kelly wants to know whether he is eligible to sign up for a Private fee-for-
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service (PFFS) plan. What questions would you need to ask to determine his eligibility? -
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ans-
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You would need to ask Mr. Kelly if he is enrolled in Part A and Part B and if he lives in the PF
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FS plan's service area.
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Mrs. Lyons is in good health, uses a single prescription, and lives independently in her own
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home. She is attracted by the idea of maintaining control over a Medical Savings Account (
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MSA), but is not sure if the plan associated with the account will fit her needs. What specific
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piece of information about a Medicare MSA plan would it be important for her to know, prior t
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o enrolling in such a plan? - ans-
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All MSAs cover Part A and Part B benefits, but not Part D prescription drug benefits, which c
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ould be obtained by also enrolling in a separate prescription drug plan.
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Who is most likely to benefit from the Medicare Prescription Payment Plan? - ans-
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Mrs. Paterson is concerned about the deductibles and co-
zx zx zx zx zx zx zx zx
payments associated with Original Medicare. What can you tell her about Medigap as an op
zx zx zx zx zx zx zx zx zx zx zx zx zx zx
tion to address this concern? - ans-
zx zx zx zx zx zx
Medigap plans help beneficiaries cover Original Medicare benefits, but they coordinate wit
zx zx zx zx zx zx zx zx zx zx zx
h Original Medicare coverage.
zx zx zx
Anita Magri will turn age 65 in August 2023. Anita intends to enroll in Original Medicare Part
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
A and Part B. She would also like to enroll in a Medicare Supplement (Medigap) plan. Anita'
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
s older neighbor Mel has told her about the Medigap Plan F in which he is enrolled. It not onl
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
y provides foreign travel emergency benefits but also covers his Medicare Part B deductibl
zx zx zx zx zx zx zx zx zx zx zx zx zx
e. Anita comes to you for advice. What should you tell her? - ans-
zx zx zx zx zx zx zx zx zx zx zx zx zx
You are sorry to disappoint Anita, but a Medigap F plan is no longer available to those who t
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
urn age 65 after January 1, 2020. Anita might instead consider other Medigap plans that off
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
er foreign travel benefits but do not cover the Part B deductible.
zx zx zx zx zx zx zx zx zx zx zx
What impact, if any, have recent regulatory changes had on Medigap plans? - ans-b.
zx zx zx zx zx zx zx zx zx zx zx zx zx
The Part B deductible is no longer covered for individuals newly eligible for Medicare startin
zx zx zx zx zx zx zx zx zx zx zx zx zx zx
g January 1, 2020.
zx zx zx
Mr. Rainey is experiencing paranoid delusions and his physician feels that he should be ho
zx zx zx zx zx zx zx zx zx zx zx zx zx zx
spitalized. What should you tell Mr. Rainey (or his representative) about the length of an inp
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
atient psychiatric hospital stay that Medicare will cover? - ans-
zx zx zx zx zx zx zx zx zx
Medicare will cover a total of 190 days of inpatient psychiatric care during Mr. Rainey's entir
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
e lifetime.
zx
Mrs. Shields is covered by Original Medicare. She sustained a hip fracture and is being suc
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
cessfully treated for that condition. However, she and her physicians feel that after her lengt
zx zx zx zx zx zx zx zx zx zx zx zx zx zx
hy hospital stay, she will need a month or two of nursing and rehabilitative care. What shoul
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
d you tell them about Original Medicare's coverage of care in a skilled nursing facility? - ans-
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
Mrs. West wears glasses and dentures and has enjoyed considerable pain relief from arthri
zx zx zx zx zx zx zx zx zx zx zx zx zx
tis through massage therapy. She is concerned about whether or not Medicare will cover th
zx zx zx zx zx zx zx zx zx zx zx zx zx zx
ese items and services. What should you tell her? - ans-
zx zx zx zx zx zx zx zx zx zx
Medicare does not cover massage therapy, or, in general, glasses or dentures.
zx zx zx zx zx zx zx zx zx zx zx
Ms. Gibson recently lost her employer group health and drug coverage and now she wants t
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
o enroll in a PPO that does not include drug coverage. What should you tell her about obtain
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
ing drug coverage? - ans-
zx zx zx zx
She can enroll in the PPO, but she will not be able to purchase a stand-
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
alone Medicare Part D prescription drug plan.
zx zx zx zx zx zx
, Mrs. Radford asks whether there are any special eligibility requirements for Medicare Adva
zx zx zx zx zx zx zx zx zx zx zx zx
ntage. What should you tell her? - ans- zx zx zx zx zx zx zx
Mrs. Radford must be entitled to Part A and enrolled in Part B to enroll in Medicare Advanta
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
ge.
Mr. Barker enjoys a comfortable retirement income. He recently had surgery and expected
zx zx zx zx zx zx zx zx zx zx zx zx zx
that he would have certain services and items covered by the plan with minimal out-of-
zx zx zx zx zx zx zx zx zx zx zx zx zx zx
pocket costs because his MA- zx zx zx zx
PD coverage has been very good. However, when he received the bill, he was surprised to
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
see large charges in excess of his maximum out-of-
zx zx zx zx zx zx zx zx
pocket limit that included some services and items he thought would be fully covered. He ca
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
lled you to ask what he could do? What could you tell him? - ans-
zx zx zx zx zx zx zx zx zx zx zx zx zx zx
You can offer to review the plans appeal process to help him ask the plan to review the cove
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
rage decision. zx
Mr. Sanchez has just turned 65 and is entitled to Part A but has not enrolled in Part B becau
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
se he has coverage through an employer plan. If he wants to enroll in a Medicare Advantag
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
e plan, what will he have to do? - ans-He will have to enroll in Part B.
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
Dr. Elizabeth Brennan does not contract with the ABC PFFS plan but accepts the plan's ter
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
ms and conditions for payment. Mary Rodgers sees Dr. Brennan for treatment. How much
zx zx zx zx zx zx zx zx zx zx zx zx zx zx
may Dr. Brennan charge? - ans-
zx zx zx zx zx
Mrs. Chou likes a Private Fee-for-
zx zx zx zx zx
Service (PFFS) plan available in her area that does not include drug coverage. She wants t
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
o enroll in the plan and enroll in a stand-
zx zx zx zx zx zx zx zx zx
alone prescription drug plan. What should you tell her? - ans-
zx zx zx zx zx zx zx zx zx zx
She could enroll in a PFFS plan and a stand-alone Medicare prescription drug plan.
zx zx zx zx zx zx zx zx zx zx zx zx zx
Mr. Kelly wants to know whether he is eligible to sign up for a Private fee-for-
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
service (PFFS) plan. What questions would you need to ask to determine his eligibility? -
zx zx zx zx zx zx zx zx zx zx zx zx zx zx
ans-
zx
You would need to ask Mr. Kelly if he is enrolled in Part A and Part B and if he lives in the PF
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
FS plan's service area.
zx zx zx
Mrs. Lyons is in good health, uses a single prescription, and lives independently in her own
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
home. She is attracted by the idea of maintaining control over a Medical Savings Account (
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
MSA), but is not sure if the plan associated with the account will fit her needs. What specific
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
piece of information about a Medicare MSA plan would it be important for her to know, prior t
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
o enrolling in such a plan? - ans-
zx zx zx zx zx zx zx
All MSAs cover Part A and Part B benefits, but not Part D prescription drug benefits, which c
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
ould be obtained by also enrolling in a separate prescription drug plan.
zx zx zx zx zx zx zx zx zx zx zx
Who is most likely to benefit from the Medicare Prescription Payment Plan? - ans-
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