AHIP FINAL EXAM 2026/2027
Mrs. Shields is covered by Original Medicare.
She sustained a hip fracture
and is being successfully treated for that Medicare will cover Mrs. Shield's skilled
condition. However, she and her physi- cians feel that after her lengthy hos- pital stay,
she will need a month or two of nursing and rehabilitative care. What should you
tell them about Original nursing services provided during the first 20have a copay
until she has been in the facility for 100 days. days of her stay, after which she
would
Medicare's coverage of care in a skilled nursing
facility?
Mrs. West wears glasses and dentures and
has enjoyed considerable pain relief
from arthritis through massage therapy. Medicare does not cover massage ther-
She is concerned about whether or not apy, or, in general, glasses or dentures.
Medicare will cover these items and ser- vices. What should you tell her?
, 2025 AHIP FINAL EXAM
Mrs. Park is an elderly retiree. Mrs. Park She should contact her state Medicaid has
a low fixed income. What could you agency to see if she qualifies for one tell
Mrs. Park that might be of assis- of several programs that can help with
tance? Medicare costs for which she is respon-
sible.
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 pre- He generally would pay a monthly
premi- scription drug plan. He asks you what um, annual deductible, and
per-prescrip- costs he would generally expect to en- tion cost-sharing.
counter when enrolling into a standard Medicare
Part D prescription drug plan.
What should you tell him?
Mrs. Gonzalez is enrolled in Original Medicare
and has a Medigap policy as
well, but it provides no drug coverage. Mrs. Gonzalez cannot purchase a Medi- She
would like to keep the coverage she gap plan that covers drugs, but she could has
but replace her existing Medigap keep her Medigap policy and enroll in a plan
with one that provides drug cover- Part D prescription drug plan. age. What should
you tell her?
, 2025 AHIP FINAL EXAM
Mr. Davis is 52 years old and has recent- representative) about the length of an
ly been diagnosed with end-stage renal inpatient psychi- atric hospital stay that
disease (ESRD) and will soon begin Medicare will cov- er?
dial- ysis. He is wondering if he can Mr. Xi will soon turn age 65 and has
obtain coverage under Medicare. What come to you for advice as to what
should you tell him? services are provided under Original
Mrs. Duarte is enrolled in Original Medicare. What should you tell Mr. Xi
Medicare Parts A and B. She has re- that best describes the health coverage
provided to Medicare beneficiaries?
cently reviewed her Medicare Summa-
ry Notice (MSN) and disagrees with a
determination that partially denied Mr. Singh would like drug coverage
one of her claims for services. What but does not want to be enrolled in a
advice would you give her? He may sign-up for Medicare at any
time however coverage usually begins
Mrs. Geisler's neighbor told her she
on the fourth month after dialysis
should look at her Part D options
treatments start.
during the annual Medicare enrollment
period because the features of Part D
might have changed. Mrs. Geisler can't
remem- ber what Part D is so she called Mrs. Duarte should file an appeal of this
you to ask what her neighbor was initial determination within 120 days of
talking about. What could you tell her? the date she received the MSN in the
Mr. Rainey is experiencing paranoid mail.
delusions and his physician feels that he
should be hospitalized. What should
you tell Mr. Rainey (or his
, 2025 AHIP FINAL EXAM
Part D covers prescription drugs and she
should look at her premiums, formulary,
and cost-sharing among other factors to
Beneficiaries under Original Medicare
see if they have changed.
have no cost-sharing for most
preventive services.
Mr. Singh can enroll in a stand-alone
Medicare will cover a total of 190 days
prescription drug plan and continue
of inpatient psychiatric care during Mr.
to be covered for Part A and Part B
Rainey's entire lifetime.
ser-
Medicare Advantage plan. What should vices through Original Fee-for-Service
you tell him? Medicare.
she will not qualify for coverage under part A because she was not born in the
United States. What should you tell her? Mrs. Chen will be 65 soon, has been a
citizen for twelve years, has been em- ployed full time, and paid taxes during that
entire period. She is concerned that es while working, though some may be
covered as a result of paying monthly premiums. Most individuals who are
citizens and age 65 or over are covered under Part A by virtue of having paid
Medicare tax-
Mrs. Shields is covered by Original Medicare.
She sustained a hip fracture
and is being successfully treated for that Medicare will cover Mrs. Shield's skilled
condition. However, she and her physi- cians feel that after her lengthy hos- pital stay,
she will need a month or two of nursing and rehabilitative care. What should you
tell them about Original nursing services provided during the first 20have a copay
until she has been in the facility for 100 days. days of her stay, after which she
would
Medicare's coverage of care in a skilled nursing
facility?
Mrs. West wears glasses and dentures and
has enjoyed considerable pain relief
from arthritis through massage therapy. Medicare does not cover massage ther-
She is concerned about whether or not apy, or, in general, glasses or dentures.
Medicare will cover these items and ser- vices. What should you tell her?
, 2025 AHIP FINAL EXAM
Mrs. Park is an elderly retiree. Mrs. Park She should contact her state Medicaid has
a low fixed income. What could you agency to see if she qualifies for one tell
Mrs. Park that might be of assis- of several programs that can help with
tance? Medicare costs for which she is respon-
sible.
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 pre- He generally would pay a monthly
premi- scription drug plan. He asks you what um, annual deductible, and
per-prescrip- costs he would generally expect to en- tion cost-sharing.
counter when enrolling into a standard Medicare
Part D prescription drug plan.
What should you tell him?
Mrs. Gonzalez is enrolled in Original Medicare
and has a Medigap policy as
well, but it provides no drug coverage. Mrs. Gonzalez cannot purchase a Medi- She
would like to keep the coverage she gap plan that covers drugs, but she could has
but replace her existing Medigap keep her Medigap policy and enroll in a plan
with one that provides drug cover- Part D prescription drug plan. age. What should
you tell her?
, 2025 AHIP FINAL EXAM
Mr. Davis is 52 years old and has recent- representative) about the length of an
ly been diagnosed with end-stage renal inpatient psychi- atric hospital stay that
disease (ESRD) and will soon begin Medicare will cov- er?
dial- ysis. He is wondering if he can Mr. Xi will soon turn age 65 and has
obtain coverage under Medicare. What come to you for advice as to what
should you tell him? services are provided under Original
Mrs. Duarte is enrolled in Original Medicare. What should you tell Mr. Xi
Medicare Parts A and B. She has re- that best describes the health coverage
provided to Medicare beneficiaries?
cently reviewed her Medicare Summa-
ry Notice (MSN) and disagrees with a
determination that partially denied Mr. Singh would like drug coverage
one of her claims for services. What but does not want to be enrolled in a
advice would you give her? He may sign-up for Medicare at any
time however coverage usually begins
Mrs. Geisler's neighbor told her she
on the fourth month after dialysis
should look at her Part D options
treatments start.
during the annual Medicare enrollment
period because the features of Part D
might have changed. Mrs. Geisler can't
remem- ber what Part D is so she called Mrs. Duarte should file an appeal of this
you to ask what her neighbor was initial determination within 120 days of
talking about. What could you tell her? the date she received the MSN in the
Mr. Rainey is experiencing paranoid mail.
delusions and his physician feels that he
should be hospitalized. What should
you tell Mr. Rainey (or his
, 2025 AHIP FINAL EXAM
Part D covers prescription drugs and she
should look at her premiums, formulary,
and cost-sharing among other factors to
Beneficiaries under Original Medicare
see if they have changed.
have no cost-sharing for most
preventive services.
Mr. Singh can enroll in a stand-alone
Medicare will cover a total of 190 days
prescription drug plan and continue
of inpatient psychiatric care during Mr.
to be covered for Part A and Part B
Rainey's entire lifetime.
ser-
Medicare Advantage plan. What should vices through Original Fee-for-Service
you tell him? Medicare.
she will not qualify for coverage under part A because she was not born in the
United States. What should you tell her? Mrs. Chen will be 65 soon, has been a
citizen for twelve years, has been em- ployed full time, and paid taxes during that
entire period. She is concerned that es while working, though some may be
covered as a result of paying monthly premiums. Most individuals who are
citizens and age 65 or over are covered under Part A by virtue of having paid
Medicare tax-
