AHIP 2027
FINAL EXAM
Actual Questions with Correct Answers
PASS THE "Final Exam" with a 90% or higher
What’s Included:
• 100+ verified questions with Correct
answers with Rationales.
• Ideal for exam preparation and concept reinforcement.
,1. 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 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 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 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 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:
Original Medicare (Parts A and B) covers a wide range of medically necessary services
when specific criteria are met. This includes ambulance transportation when medically
necessary, home health care for eligible beneficiaries, and skilled nursing facility care
following a qualifying hospital stay. Options B, C, and D are incorrect because Original
Medicare does not cover routine dental, vision, or hearing services (C), nor does it cover
long-term custodial care (D). Option B is too restrictive as it omits many covered services.
6. What impact, if any, have recent regulatory changes had on Medigap plans?
A. Medigap plans are no longer available to new Medicare beneficiaries.
B. The Part B deductible is no longer covered for individuals newly eligible for Medicare
starting January 1, 2020.
C. Medigap plans now cover prescription drugs for all beneficiaries.
D. Medigap premiums have been standardized nationwide.
Correct Answer: B
Expert Rationale:
The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) prohibited Medigap
plans from covering the Part B deductible for individuals newly eligible for Medicare on or
after January 1, 2020. This means Plans C and F are no longer available to new
beneficiaries, though those already enrolled may keep them. Option A is incorrect because
Medigap plans remain available. Option C is incorrect because Medigap plans have not
covered prescription drugs since 2006. Option D is incorrect because Medigap premiums
vary by insurer and location.
FINAL EXAM
Actual Questions with Correct Answers
PASS THE "Final Exam" with a 90% or higher
What’s Included:
• 100+ verified questions with Correct
answers with Rationales.
• Ideal for exam preparation and concept reinforcement.
,1. 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 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 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 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 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:
Original Medicare (Parts A and B) covers a wide range of medically necessary services
when specific criteria are met. This includes ambulance transportation when medically
necessary, home health care for eligible beneficiaries, and skilled nursing facility care
following a qualifying hospital stay. Options B, C, and D are incorrect because Original
Medicare does not cover routine dental, vision, or hearing services (C), nor does it cover
long-term custodial care (D). Option B is too restrictive as it omits many covered services.
6. What impact, if any, have recent regulatory changes had on Medigap plans?
A. Medigap plans are no longer available to new Medicare beneficiaries.
B. The Part B deductible is no longer covered for individuals newly eligible for Medicare
starting January 1, 2020.
C. Medigap plans now cover prescription drugs for all beneficiaries.
D. Medigap premiums have been standardized nationwide.
Correct Answer: B
Expert Rationale:
The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) prohibited Medigap
plans from covering the Part B deductible for individuals newly eligible for Medicare on or
after January 1, 2020. This means Plans C and F are no longer available to new
beneficiaries, though those already enrolled may keep them. Option A is incorrect because
Medigap plans remain available. Option C is incorrect because Medigap plans have not
covered prescription drugs since 2006. Option D is incorrect because Medigap premiums
vary by insurer and location.
