AHIP Final Exam 2027 Question and Answer | Guaranteed Pass
Question 1.
Mrs. West wears glasses and dentures and has enjoyed considerable pain relief from
arthritis through massage therapy. She is concerned about whether or not Medicare will
cover these items and services. What should you tell her?
Correct Answer: Medicare does not cover massage therapy, or, in general,
glasses or dentures.
Question 2.
Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What could you tell Mrs.
Park that might be of assistance?
Correct Answer: 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.
Question 3.
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 prescription drug
plan. He asks you what costs he would generally expect to encounter when enrolling
into a standard Medicare Part D prescription drug plan. What should you tell him?
Correct Answer: He generally would pay a monthly premium, annual
deductible, and per-prescription cost-sharing.
Question 4.
Mrs. Gonzalez is enrolled in Original Medicare and has a Medigap policy as well, but it
provides no drug coverage. She would like to keep the coverage she has but replace her
existing Medigap plan with one that provides drug coverage. What should you tell her?
Correct Answer: Mrs. Gonzalez cannot purchase a Medigap plan that covers
drugs, but she could keep her Medigap policy and enroll in a Part D
prescription drug plan.
Question 5.
Mr. Davis is 52 years old and has recently been diagnosed with end-stage renal disease
(ESRD) and will soon begin dialysis. He is wondering if he can obtain coverage under
Medicare. What should you tell him?
Correct Answer: He may sign-up for Medicare at any time however coverage
usually begins on the fourth month after dialysis treatments start.
,Question 6.
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?
Correct Answer: Mrs. Duarte should file an appeal of this initial determination
within 120 days of the date she received the MSN in the mail.
Question 7.
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?
Correct Answer: 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.
Question 8.
Mr. Rainey is experiencing paranoid delusions and his physician feels that he should be
hospitalized. What should you tell Mr. Rainey (or his representative) about the length of
an inpatient psychiatric hospital stay that Medicare will cover?
Correct Answer: Medicare will cover a total of 190 days of inpatient psychiatric
care during Mr. Rainey's entire lifetime.
Question 9.
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?
Correct Answer: Beneficiaries under Original Medicare have no cost-sharing
for most preventive services.
Question 10.
Mr. Singh would like drug coverage but does not want to be enrolled in a Medicare
Advantage plan. What should you tell him?
Correct Answer: 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.
Question 11.
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?
Correct Answer: 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.
Question 12.
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?
Correct Answer: 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.
Question 13.
Mr. Patel is in good health and is preparing a budget in anticipation of his retirement
when he turns 66. He wants to understand the health care costs he might be exposed to
under Medicare if he were to require hospitalization because of an illness. In general
terms, what could you tell him about his costs for inpatient hospital services under
Original Medicare?
Correct Answer: Under Original Medicare, there is a single deductible amount
due for the first 60 days of any inpatient hospital stay, after which it converts
into a per- day coinsurance amount through day 90. After day 90, he would
pay a daily amount up to 60 days over his lifetime, after which he would be
responsible for all costs.
Question 14.
What impact, if any, have recent regulatory changes had on Medigap plans?
Correct Answer: The Part B deductible is no longer covered for individuals
newly eligible for Medicare starting January 1, 2020.
• Mrs. Paterson is concerned about the deductibles and co-payments
associated with Original Medicare. What can you tell her about Medigap as an
option to address this concern? -✓✓Medigap plans do not cover Original
Medicare benefits, but they coordinate with Original Medicare coverage.
Question 15.
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?
Question 1.
Mrs. West wears glasses and dentures and has enjoyed considerable pain relief from
arthritis through massage therapy. She is concerned about whether or not Medicare will
cover these items and services. What should you tell her?
Correct Answer: Medicare does not cover massage therapy, or, in general,
glasses or dentures.
Question 2.
Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What could you tell Mrs.
Park that might be of assistance?
Correct Answer: 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.
Question 3.
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 prescription drug
plan. He asks you what costs he would generally expect to encounter when enrolling
into a standard Medicare Part D prescription drug plan. What should you tell him?
Correct Answer: He generally would pay a monthly premium, annual
deductible, and per-prescription cost-sharing.
Question 4.
Mrs. Gonzalez is enrolled in Original Medicare and has a Medigap policy as well, but it
provides no drug coverage. She would like to keep the coverage she has but replace her
existing Medigap plan with one that provides drug coverage. What should you tell her?
Correct Answer: Mrs. Gonzalez cannot purchase a Medigap plan that covers
drugs, but she could keep her Medigap policy and enroll in a Part D
prescription drug plan.
Question 5.
Mr. Davis is 52 years old and has recently been diagnosed with end-stage renal disease
(ESRD) and will soon begin dialysis. He is wondering if he can obtain coverage under
Medicare. What should you tell him?
Correct Answer: He may sign-up for Medicare at any time however coverage
usually begins on the fourth month after dialysis treatments start.
,Question 6.
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?
Correct Answer: Mrs. Duarte should file an appeal of this initial determination
within 120 days of the date she received the MSN in the mail.
Question 7.
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?
Correct Answer: 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.
Question 8.
Mr. Rainey is experiencing paranoid delusions and his physician feels that he should be
hospitalized. What should you tell Mr. Rainey (or his representative) about the length of
an inpatient psychiatric hospital stay that Medicare will cover?
Correct Answer: Medicare will cover a total of 190 days of inpatient psychiatric
care during Mr. Rainey's entire lifetime.
Question 9.
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?
Correct Answer: Beneficiaries under Original Medicare have no cost-sharing
for most preventive services.
Question 10.
Mr. Singh would like drug coverage but does not want to be enrolled in a Medicare
Advantage plan. What should you tell him?
Correct Answer: 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.
Question 11.
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?
Correct Answer: 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.
Question 12.
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?
Correct Answer: 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.
Question 13.
Mr. Patel is in good health and is preparing a budget in anticipation of his retirement
when he turns 66. He wants to understand the health care costs he might be exposed to
under Medicare if he were to require hospitalization because of an illness. In general
terms, what could you tell him about his costs for inpatient hospital services under
Original Medicare?
Correct Answer: Under Original Medicare, there is a single deductible amount
due for the first 60 days of any inpatient hospital stay, after which it converts
into a per- day coinsurance amount through day 90. After day 90, he would
pay a daily amount up to 60 days over his lifetime, after which he would be
responsible for all costs.
Question 14.
What impact, if any, have recent regulatory changes had on Medigap plans?
Correct Answer: The Part B deductible is no longer covered for individuals
newly eligible for Medicare starting January 1, 2020.
• Mrs. Paterson is concerned about the deductibles and co-payments
associated with Original Medicare. What can you tell her about Medigap as an
option to address this concern? -✓✓Medigap plans do not cover Original
Medicare benefits, but they coordinate with Original Medicare coverage.
Question 15.
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?
