AHIP 2027 FINAL EXAM 1 REVISED 100+ QUESTIONS
WITH VERIFIED AND CORRECT ANSWERS GRADE A+
WITH RATIONALES
1.Larry Miller – Part A Deductibles
Question:
Larry Miller is an Original Medicare beneficiary with Parts A and B
coverage. Larry is admitted to Good Care Hospital in January with
pneumonia and stays for three days before being discharged. Six months
later in July, Larry takes a bad fall and is admitted to Good Care Hospital
with a broken leg. After emergency surgery to repair his broken leg, Larry
is hospitalized for a week before being discharged home. In December,
Larry is admitted to Mount Wellness Hospital once again with a serious
case of the flu. For how many Part A deductibles will Larry be responsible
for?
A. One Part A deductible
B. Two Part A deductibles
C. Larry will be responsible for three Part A deductibles.
D. Larry will not have to pay any Part A deductibles.
Correct Answer: C
Expert Rationale:
The Medicare Part A hospital deductible applies to each benefit period, not
annually. A benefit period begins the day a beneficiary is admitted as an
inpatient and ends when they have not received inpatient care for 60
consecutive days.
Larry's three hospitalizations (January, July, December) each represent
separate benefit periods because they are separated by more than 60
days. Therefore, he owes three separate Part A deductibles.
2. Kevin Birch – Skilled Nursing Facility Appeal
,Question:
Kevin Birch enrolled in Original Medicare (Parts A and B). Mr. Birch has
been receiving rehabilitation services in a skilled nursing facility. He calls
you to say that he has just received a notice that Medicare will no longer
cover his stay and he still cannot walk properly. He thinks they are ending
his services too soon. What do you tell him?
A. He should accept the decision and prepare for discharge immediately.
B. He should follow the directions on the notice to file a fast appeal. Mr.
Birch should file it by noon of the calendar day following receipt of the
provider's notice of termination of services.
C. He should contact his physician to write a new order for continued stay.
D. He should file a standard appeal within 60 days of discharge.
Correct Answer: B
Expert Rationale:
When a skilled nursing facility (SNF) issues a Notice of Non-Coverage
(NNC) stating Medicare will no longer cover services, beneficiaries have
the right to an expedited (fast) appeal through the Quality Improvement
Organization (QIO). The appeal must be filed by noon the day after
receiving the notice. This is distinct from a standard appeal (D) and does
not require a new physician order (C).
Accepting the decision (A) would forfeit appeal rights.
3. Mr. Ray – Prescription Drug
Coverage Question:
Mr. Ray would like drug coverage but does not want to be enrolled in a
Medicare Advantage plan. What should you tell him?
,A. He must enroll in a Medicare Advantage plan to get drug coverage.
B. Mr. Ray 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.
C. He can only get drug coverage through his employer's plan.
D. He should purchase a Medigap plan that includes drug coverage.
Correct Answer: B
Expert Rationale:
Medicare beneficiaries in Original Medicare can enroll in a stand-alone
Prescription Drug Plan (PDP) to obtain Part D coverage without joining a
Medicare Advantage plan. Option A is incorrect because MA enrollment is
not required for drug coverage. Option C is incorrect because employer
coverage is not the only avenue. Option D is incorrect because Medigap
plans sold today cannot include prescription drug coverage (this ended in
2006).
4. Mrs. Sanders – Medicare Eligibility
Question:
Mrs. Sanders 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?
A. She must have been born in the United States to qualify for Medicare.
B. 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.
C. She must wait an additional five years after becoming a citizen
before qualifying for Medicare.
, D. Only those born in the U.S. who have paid taxes for 20+ years
qualify for premium-free Part A.
Correct Answer: B
Expert Rationale:
Medicare eligibility is based on citizenship or legal residency (5+ years)
and work history, not place of birth. Citizens age 65+ who have paid
Medicare taxes for at least 40 quarters receive premium-free Part A.
Those without sufficient work history may purchase Part A by paying
monthly premiums. The 5-year residency requirement (C) applies to non-
citizens, not citizens. Option D incorrectly states both birthplace and
extended work requirements.
5. Mrs. Andrews – Services Covered by Original Medicare
Question:
Mrs. Andrews 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?
A. Original Medicare covers ambulance services, home health care, and
skilled nursing facility care if the appropriate criteria are met.
B. Original Medicare covers only hospital stays and physician visits.
C. Original Medicare covers dental, vision, and hearing services.
D. Original Medicare covers long-term custodial care in nursing homes.
Correct Answer: A
Expert Rationale:
WITH VERIFIED AND CORRECT ANSWERS GRADE A+
WITH RATIONALES
1.Larry Miller – Part A Deductibles
Question:
Larry Miller is an Original Medicare beneficiary with Parts A and B
coverage. Larry is admitted to Good Care Hospital in January with
pneumonia and stays for three days before being discharged. Six months
later in July, Larry takes a bad fall and is admitted to Good Care Hospital
with a broken leg. After emergency surgery to repair his broken leg, Larry
is hospitalized for a week before being discharged home. In December,
Larry is admitted to Mount Wellness Hospital once again with a serious
case of the flu. For how many Part A deductibles will Larry be responsible
for?
A. One Part A deductible
B. Two Part A deductibles
C. Larry will be responsible for three Part A deductibles.
D. Larry will not have to pay any Part A deductibles.
Correct Answer: C
Expert Rationale:
The Medicare Part A hospital deductible applies to each benefit period, not
annually. A benefit period begins the day a beneficiary is admitted as an
inpatient and ends when they have not received inpatient care for 60
consecutive days.
Larry's three hospitalizations (January, July, December) each represent
separate benefit periods because they are separated by more than 60
days. Therefore, he owes three separate Part A deductibles.
2. Kevin Birch – Skilled Nursing Facility Appeal
,Question:
Kevin Birch enrolled in Original Medicare (Parts A and B). Mr. Birch has
been receiving rehabilitation services in a skilled nursing facility. He calls
you to say that he has just received a notice that Medicare will no longer
cover his stay and he still cannot walk properly. He thinks they are ending
his services too soon. What do you tell him?
A. He should accept the decision and prepare for discharge immediately.
B. He should follow the directions on the notice to file a fast appeal. Mr.
Birch should file it by noon of the calendar day following receipt of the
provider's notice of termination of services.
C. He should contact his physician to write a new order for continued stay.
D. He should file a standard appeal within 60 days of discharge.
Correct Answer: B
Expert Rationale:
When a skilled nursing facility (SNF) issues a Notice of Non-Coverage
(NNC) stating Medicare will no longer cover services, beneficiaries have
the right to an expedited (fast) appeal through the Quality Improvement
Organization (QIO). The appeal must be filed by noon the day after
receiving the notice. This is distinct from a standard appeal (D) and does
not require a new physician order (C).
Accepting the decision (A) would forfeit appeal rights.
3. Mr. Ray – Prescription Drug
Coverage Question:
Mr. Ray would like drug coverage but does not want to be enrolled in a
Medicare Advantage plan. What should you tell him?
,A. He must enroll in a Medicare Advantage plan to get drug coverage.
B. Mr. Ray 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.
C. He can only get drug coverage through his employer's plan.
D. He should purchase a Medigap plan that includes drug coverage.
Correct Answer: B
Expert Rationale:
Medicare beneficiaries in Original Medicare can enroll in a stand-alone
Prescription Drug Plan (PDP) to obtain Part D coverage without joining a
Medicare Advantage plan. Option A is incorrect because MA enrollment is
not required for drug coverage. Option C is incorrect because employer
coverage is not the only avenue. Option D is incorrect because Medigap
plans sold today cannot include prescription drug coverage (this ended in
2006).
4. Mrs. Sanders – Medicare Eligibility
Question:
Mrs. Sanders 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?
A. She must have been born in the United States to qualify for Medicare.
B. 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.
C. She must wait an additional five years after becoming a citizen
before qualifying for Medicare.
, D. Only those born in the U.S. who have paid taxes for 20+ years
qualify for premium-free Part A.
Correct Answer: B
Expert Rationale:
Medicare eligibility is based on citizenship or legal residency (5+ years)
and work history, not place of birth. Citizens age 65+ who have paid
Medicare taxes for at least 40 quarters receive premium-free Part A.
Those without sufficient work history may purchase Part A by paying
monthly premiums. The 5-year residency requirement (C) applies to non-
citizens, not citizens. Option D incorrectly states both birthplace and
extended work requirements.
5. Mrs. Andrews – Services Covered by Original Medicare
Question:
Mrs. Andrews 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?
A. Original Medicare covers ambulance services, home health care, and
skilled nursing facility care if the appropriate criteria are met.
B. Original Medicare covers only hospital stays and physician visits.
C. Original Medicare covers dental, vision, and hearing services.
D. Original Medicare covers long-term custodial care in nursing homes.
Correct Answer: A
Expert Rationale:
