AHIP FINAL EXAM, PRACTICE EXAM
AND STUDY GUIDE LATEST
2025/2026 ACTUAL EXAM 135
QUESTIONS WITH CORRECT
ANSWERS 100% VERIFIED GRADED
A+
Mrs. Shields is covered by Original Medicare. She sustained a hip fracture and is bei
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ng successfully treated for that condition. However, she and her physicians feel that
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after her lengthy hospital stay, she will need a month or two of nursing and rehabilitat
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ive care. What should you tell them about Original Medicare's coverage of care in a s
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killed nursing facility? - ANSWERS-
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Medicare will cover Mrs. Shield's skilled nursing services provided during the first 20
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days of her stay, after which she would have a copay until she has been in the facilit
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y for 100 days.
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Mrs. West wears glasses and dentures and has enjoyed considerable pain relief fro
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m arthritis through massage therapy. She is concerned about whether or not Medicar
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e will cover these items and services. What should you tell her? - ANSWERS-
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Medicare does not cover massage therapy, or, in general, glasses or dentures.
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Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What could you tell
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Mrs. Park that might be of assistance? - ANSWERS-
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She should contact her state Medicaid agency to see if she qualifies for one of sever
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al programs that can help with Medicare costs for which she is responsible.
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Mr. Alonso receives some help paying for his two generic prescription drugs from his
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employer's retiree coverage, but he wants to compare it to a Part D prescription drug
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plan. He asks you what costs he would generally expect to encounter when enrollin
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g into a standard Medicare Part D prescription drug plan. What should you tell him? -
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ANSWERS-He generally would pay a monthly premium, annual deductible, and per-
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prescription cost-sharing. gf
Mrs. Gonzalez is enrolled in Original Medicare and has a Medigap policy as well, but
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it provides no drug coverage. She would like to keep the coverage she has but repla
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ce her existing Medigap plan with one that provides drug coverage. What should you
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tell her? - ANSWERS-
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Mrs. Gonzalez cannot purchase a Medigap plan that covers drugs, but she could kee
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p her Medigap policy and enroll in a Part D prescription drug plan.
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Mr. Davis is 52 years old and has recently been diagnosed with end-
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stage renal disease (ESRD) and will soon begin dialysis. He is wondering if he can o
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btain coverage under Medicare. What should you tell him? - ANSWERS-
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He may sign- gf gf
,up for Medicare at any time however coverage usually begins on the fourth month aft
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er dialysis treatments start.
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Mrs. Duarte is enrolled in Original Medicare Parts A and B. She has recently reviewe
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d her Medicare Summary Notice (MSN) and disagrees with a determination that parti
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ally denied one of her claims for services. What advice would you give her? -
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ANSWERS-
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Mrs. Duarte should file an appeal of this initial determination within 120 days of the d
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ate she received the MSN in the mail.
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Mrs. Geisler's neighbor told her she should look at her Part D options during the ann
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ual Medicare enrollment period because the features of Part D might have changed.
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Mrs. Geisler can't remember what Part D is so she called you to ask what her neighb
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or was talking about. What could you tell her? - ANSWERS-
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Part D covers prescription drugs and she should look at her premiums, formulary, an
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d cost-sharing among other factors to see if they have changed.
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Mr. Rainey is experiencing paranoid delusions and his physician feels that he should
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fbe hospitalized. What should you tell Mr. Rainey (or his representative) about the len
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gth of an inpatient psychiatric hospital stay that Medicare will cover? - ANSWERS-
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Medicare will cover a total of 190 days of inpatient psychiatric care during Mr. Rainey
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's entire lifetime.
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Mr. Xi will soon turn age 65 and has come to you for advice as to what services are p
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rovided under Original Medicare. What should you tell Mr. Xi that best describes the
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health coverage provided to Medicare beneficiaries? - ANSWERS-
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Beneficiaries under Original Medicare have no cost- gf gf gf gf gf gf
sharing for most preventive services. gf gf gf gf
Mr. Singh would like drug coverage but does not want to be enrolled in a Medicare A
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dvantage plan. What should you tell him? - ANSWERS- gf gf gf gf gf gf gf gf
Mr. Singh can enroll in a stand-
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alone prescription drug plan and continue to be covered for Part A and Part B servic
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es through Original Fee-for-Service Medicare.
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Mrs. Chen will be 65 soon, has been a citizen for twelve years, has been employed f
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ull time, and paid taxes during that entire period. She is concerned that she will not q
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ualify for coverage under part A because she was not born in the United States. Wha
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t should you tell her? - ANSWERS-
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Most individuals who are citizens and age 65 or over are covered under Part A by vir
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tue of having paid Medicare taxes while working, though some may be covered as a
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result of paying monthly premiums. gf gf gf gf
Mrs. Quinn recently turned 66 and decided after many years of work to retire and be
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gin receiving Social Security benefits. Shortly thereafter Mrs. Quinn received a letter i
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nforming her that she had been automatically enrolled in Medicare Part B. She wants
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to understand what this means. What should you tell Mrs. Quinn? - ANSWERS-
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Part B primarily covers physician services. She will be paying a monthly premium an
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d, except for many preventive and screening tests, generally will have 20% co-
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payments for these services, in addition to an annual deductible. gf gf gf gf gf gf gf gf gf
, Mr. Patel is in good health and is preparing a budget in anticipation of his retirement
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when he turns 66. He wants to understand the health care costs he might be expose
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d to under Medicare if he were to require hospitalization because of an illness. In gen
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eral terms, what could you tell him about his costs for inpatient hospital services und
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er Original Medicare? - ANSWERS-
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Under Original Medicare, there is a single deductible amount due for the first 60 days
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of any inpatient hospital stay, after which it converts into a per-
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day coinsurance amount through day 90. After day 90, he would pay a daily amount
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up to 60 days over his lifetime, after which he would be responsible for all costs.
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What impact, if any, have recent regulatory changes had on Medigap plans? -
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ANSWERS-
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The Part B deductible is no longer covered for individuals newly eligible for Medicare
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starting January 1, 2020.
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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 a
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s an option to address this concern? - ANSWERS-
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Medigap plans do not cover Original Medicare benefits, but they coordinate with Orig
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inal Medicare coverage.
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Mrs. Turner is comparing her employer's retiree insurance to Original Medicare and
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would like to know which of the following services Original Medicare will cover if the
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appropriate criteria are met. What could you tell her? - ANSWERS- gf gf gf gf gf gf gf gf gf gf
Original Medicare covers ambulance services. gf gf gf gf
Ms. Brooks has aggressive cancer and would like to know if Medicare will cover hos
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pice services in case she needs them. What should you tell her? - ANSWERS-
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Medicare covers hospice services, and they will be available for her.
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Mr. Diaz continued working with his company and was insured under his employer's
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group plan until he reached age 68. He has heard that there is a premium penalty for
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those who did not sign up for Part B when first eligible and wants to know how much
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he will have to pay. What should you tell him? - ANSWERS-
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Mr. Diaz will not pay any penalty because he had continuous coverage under his em
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ployer's plan. gf
Anita Magri will turn age 65 in August 2023. Anita intends to enroll in Original Medica
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re Part A and Part B. She would also like to enroll in a Medicare Supplement (Medig
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ap) plan. Anita's older neighbor Mel has told her about the Medigap Plan F in which
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he is enrolled. It not only provides foreign travel emergency benefits but also covers
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his Medicare Part B deductible. Anita comes to you for advice. What should you tell
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her? - ANSWERS- gf gf
You are sorry to disappoint Anita, but a Medigap F plan is no longer available to thos
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e who turn age 65 after January 1, 2020. Anita might instead consider other Medigap
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plans that offer foreign travel benefits but do not cover the Part B deductible.
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Hank's Fish Store, Inc. is a small company with just 15 employees located in Florida.
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Hank, the store owner, has provided excellent health benefits to the store's workforc
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AND STUDY GUIDE LATEST
2025/2026 ACTUAL EXAM 135
QUESTIONS WITH CORRECT
ANSWERS 100% VERIFIED GRADED
A+
Mrs. Shields is covered by Original Medicare. She sustained a hip fracture and is bei
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ng successfully treated for that condition. However, she and her physicians feel that
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after her lengthy hospital stay, she will need a month or two of nursing and rehabilitat
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ive care. What should you tell them about Original Medicare's coverage of care in a s
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killed nursing facility? - ANSWERS-
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Medicare will cover Mrs. Shield's skilled nursing services provided during the first 20
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days of her stay, after which she would have a copay until she has been in the facilit
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y for 100 days.
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Mrs. West wears glasses and dentures and has enjoyed considerable pain relief fro
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m arthritis through massage therapy. She is concerned about whether or not Medicar
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e will cover these items and services. What should you tell her? - ANSWERS-
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Medicare does not cover massage therapy, or, in general, glasses or dentures.
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Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What could you tell
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Mrs. Park that might be of assistance? - ANSWERS-
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She should contact her state Medicaid agency to see if she qualifies for one of sever
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al programs that can help with Medicare costs for which she is responsible.
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Mr. Alonso receives some help paying for his two generic prescription drugs from his
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employer's retiree coverage, but he wants to compare it to a Part D prescription drug
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plan. He asks you what costs he would generally expect to encounter when enrollin
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g into a standard Medicare Part D prescription drug plan. What should you tell him? -
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ANSWERS-He generally would pay a monthly premium, annual deductible, and per-
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prescription cost-sharing. gf
Mrs. Gonzalez is enrolled in Original Medicare and has a Medigap policy as well, but
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it provides no drug coverage. She would like to keep the coverage she has but repla
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ce her existing Medigap plan with one that provides drug coverage. What should you
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tell her? - ANSWERS-
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Mrs. Gonzalez cannot purchase a Medigap plan that covers drugs, but she could kee
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p her Medigap policy and enroll in a Part D prescription drug plan.
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Mr. Davis is 52 years old and has recently been diagnosed with end-
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stage renal disease (ESRD) and will soon begin dialysis. He is wondering if he can o
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btain coverage under Medicare. What should you tell him? - ANSWERS-
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He may sign- gf gf
,up for Medicare at any time however coverage usually begins on the fourth month aft
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er dialysis treatments start.
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Mrs. Duarte is enrolled in Original Medicare Parts A and B. She has recently reviewe
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d her Medicare Summary Notice (MSN) and disagrees with a determination that parti
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ally denied one of her claims for services. What advice would you give her? -
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ANSWERS-
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Mrs. Duarte should file an appeal of this initial determination within 120 days of the d
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ate she received the MSN in the mail.
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Mrs. Geisler's neighbor told her she should look at her Part D options during the ann
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ual Medicare enrollment period because the features of Part D might have changed.
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Mrs. Geisler can't remember what Part D is so she called you to ask what her neighb
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or was talking about. What could you tell her? - ANSWERS-
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Part D covers prescription drugs and she should look at her premiums, formulary, an
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d cost-sharing among other factors to see if they have changed.
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Mr. Rainey is experiencing paranoid delusions and his physician feels that he should
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fbe hospitalized. What should you tell Mr. Rainey (or his representative) about the len
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gth of an inpatient psychiatric hospital stay that Medicare will cover? - ANSWERS-
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Medicare will cover a total of 190 days of inpatient psychiatric care during Mr. Rainey
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's entire lifetime.
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Mr. Xi will soon turn age 65 and has come to you for advice as to what services are p
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rovided under Original Medicare. What should you tell Mr. Xi that best describes the
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health coverage provided to Medicare beneficiaries? - ANSWERS-
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Beneficiaries under Original Medicare have no cost- gf gf gf gf gf gf
sharing for most preventive services. gf gf gf gf
Mr. Singh would like drug coverage but does not want to be enrolled in a Medicare A
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dvantage plan. What should you tell him? - ANSWERS- gf gf gf gf gf gf gf gf
Mr. Singh can enroll in a stand-
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alone prescription drug plan and continue to be covered for Part A and Part B servic
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es through Original Fee-for-Service Medicare.
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Mrs. Chen will be 65 soon, has been a citizen for twelve years, has been employed f
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ull time, and paid taxes during that entire period. She is concerned that she will not q
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ualify for coverage under part A because she was not born in the United States. Wha
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t should you tell her? - ANSWERS-
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Most individuals who are citizens and age 65 or over are covered under Part A by vir
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tue of having paid Medicare taxes while working, though some may be covered as a
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result of paying monthly premiums. gf gf gf gf
Mrs. Quinn recently turned 66 and decided after many years of work to retire and be
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gin receiving Social Security benefits. Shortly thereafter Mrs. Quinn received a letter i
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nforming her that she had been automatically enrolled in Medicare Part B. She wants
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to understand what this means. What should you tell Mrs. Quinn? - ANSWERS-
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Part B primarily covers physician services. She will be paying a monthly premium an
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d, except for many preventive and screening tests, generally will have 20% co-
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payments for these services, in addition to an annual deductible. gf gf gf gf gf gf gf gf gf
, Mr. Patel is in good health and is preparing a budget in anticipation of his retirement
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when he turns 66. He wants to understand the health care costs he might be expose
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d to under Medicare if he were to require hospitalization because of an illness. In gen
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eral terms, what could you tell him about his costs for inpatient hospital services und
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er Original Medicare? - ANSWERS-
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Under Original Medicare, there is a single deductible amount due for the first 60 days
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of any inpatient hospital stay, after which it converts into a per-
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day coinsurance amount through day 90. After day 90, he would pay a daily amount
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up to 60 days over his lifetime, after which he would be responsible for all costs.
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What impact, if any, have recent regulatory changes had on Medigap plans? -
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ANSWERS-
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The Part B deductible is no longer covered for individuals newly eligible for Medicare
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starting January 1, 2020.
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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 a
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s an option to address this concern? - ANSWERS-
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Medigap plans do not cover Original Medicare benefits, but they coordinate with Orig
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inal Medicare coverage.
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Mrs. Turner is comparing her employer's retiree insurance to Original Medicare and
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would like to know which of the following services Original Medicare will cover if the
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appropriate criteria are met. What could you tell her? - ANSWERS- gf gf gf gf gf gf gf gf gf gf
Original Medicare covers ambulance services. gf gf gf gf
Ms. Brooks has aggressive cancer and would like to know if Medicare will cover hos
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pice services in case she needs them. What should you tell her? - ANSWERS-
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Medicare covers hospice services, and they will be available for her.
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Mr. Diaz continued working with his company and was insured under his employer's
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group plan until he reached age 68. He has heard that there is a premium penalty for
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those who did not sign up for Part B when first eligible and wants to know how much
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he will have to pay. What should you tell him? - ANSWERS-
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Mr. Diaz will not pay any penalty because he had continuous coverage under his em
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ployer's plan. gf
Anita Magri will turn age 65 in August 2023. Anita intends to enroll in Original Medica
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re Part A and Part B. She would also like to enroll in a Medicare Supplement (Medig
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ap) plan. Anita's older neighbor Mel has told her about the Medigap Plan F in which
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he is enrolled. It not only provides foreign travel emergency benefits but also covers
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his Medicare Part B deductible. Anita comes to you for advice. What should you tell
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her? - ANSWERS- gf gf
You are sorry to disappoint Anita, but a Medigap F plan is no longer available to thos
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e who turn age 65 after January 1, 2020. Anita might instead consider other Medigap
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plans that offer foreign travel benefits but do not cover the Part B deductible.
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Hank's Fish Store, Inc. is a small company with just 15 employees located in Florida.
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Hank, the store owner, has provided excellent health benefits to the store's workforc
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