AHIP Practice Questions and Answers Latest Update (2024/2025) Rated A+
Anita Magri will turn age 65 in August 2023. Anita intends to enroll in Original Medicare Part A and Part
B. She would also like to enroll in a Medicare Supplement (Medigap) plan. Anita's older neighbor Mel
has told her about the Medigap Plan F in which he is enrolled. It not only provides foreign travel
emergency benefits but also covers his Medicare Part B deductible. Anita comes to you for advice. What
should you tell her? - Answers You are sorry to disappoint Anita, but a Medigap F plan is no longer
available to those who turn age 65 after January 1, 2020. Anita might instead consider other Medigap
plans that offer foreign travel benefits but do not cover the Part B deductible.
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? - Answers Medicare does not cover massage therapy, or, in general, glasses or
dentures.
Mrs. Shields is covered by Original Medicare. She sustained a hip fracture and is being successfully
treated for that condition. However, she and her physicians feel that after her lengthy hospital stay, she
will need a month or two of nursing and rehabilitative care. What should you tell them about Original
Medicare's coverage of care in a skilled nursing facility? - Answers Medicare will cover Mrs. Shield's
skilled nursing services provided during the first 20 days of her stay, after which she would have a copay
until she has been in the facility for 100 days.
Mr. Diaz continued working with his company and was insured under his employer's group plan until he
reached age 68. He has heard that there is a premium penalty for those who did not sign up for Part B
when first eligible and wants to know how much he will have to pay. What should you tell him? -
Answers Mr. Diaz will not pay any penalty because he had continuous coverage under his employer's
plan.
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? - Answers Original Medicare covers ambulance services.
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? - Answers 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.
What impact, if any, have recent regulatory changes had on Medigap plans? - Answers The Part B
deductible is no longer covered for individuals newly eligible for Medicare starting January 1, 2020.
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? - Answers He generally would pay a monthly premium, annual
deductible, and per-prescription cost-sharing.
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? - Answers Medicare will cover a total of 190 days of inpatient
psychiatric care during Mr. Rainey's entire lifetime.
Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What could you tell Mrs. Park that
might be of assistance? - Answers 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.
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? -
Answers 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.
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? - Answers Medigap plans do
not cover Original Medicare benefits, but they coordinate with Original Medicare coverage.
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? - Answers Beneficiaries under Original Medicare have no cost-sharing for most
preventive services.
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? - Answers 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.
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? - Answers 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.
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? - Answers Mrs. Duarte should file an appeal of this initial
determination within 120 days of the date she received the MSN in the mail.
, Mr. Singh would like drug coverage but does not want to be enrolled in a Medicare Advantage plan.
What should you tell him? - Answers 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.
Ms. Brooks has aggressive cancer and would like to know if Medicare will cover hospice services in case
she needs them. What should you tell her? - Answers Medicare covers hospice services, and they will be
available for her.
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? - Answers He may sign-up for Medicare at any time however coverage usually begins on the fourth
month after dialysis treatments start.
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? - Answers 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.
Mrs. Wang wants to know generally how the benefits under Original Medicare might compare to the
benefits package of a Medicare Advantage Plan before she starts looking at specific plans. What could
you tell her? - Answers Medicare Advantage Plans may offer extra benefits that Original Medicare does
not offer such as vision, hearing, and dental services. It must include a maximum out-of-pocket limit on
Part A and Part B services.
Hank's Fish Store, Inc. is a small company with just 15 employees located in Florida. Hank, the store
owner, has provided excellent health benefits to the store's workforce. William, one of the store's long-
time employees, will soon be reaching age 65 and eligible for Medicare. William is in good health. He
intends to remain an active full-time employee, working several years after becoming eligible for
Medicare. What type(s) of retiree health benefit will Hank's Fish Store be able to offer William? -
Answers Employers with less than 20 employees (as calculated under Medicare secondary payor rules)
may be able to offer Medicare Advantage plans to their active employees and their dependents. Larger
firms are not able to offer such plans. In many cases, this helps small businesses save on health coverage
costs since Medicare becomes the primary payor.
Mr. Barker enjoys a comfortable retirement income. He recently had surgery and expected that he
would have certain services and items covered by the plan with minimal out-of-pocket costs because his
MA-PD coverage has been very good. However, when he received the bill, he was surprised to see large
charges in excess of his maximum out-of-pocket limit that included some services and items he thought
would be fully covered. He called you to ask what he could do? What could you tell him? - Answers
Medicare Advantage (MA) plan enrollees have a right to obtain a review (appeal) to certain decisions
Anita Magri will turn age 65 in August 2023. Anita intends to enroll in Original Medicare Part A and Part
B. She would also like to enroll in a Medicare Supplement (Medigap) plan. Anita's older neighbor Mel
has told her about the Medigap Plan F in which he is enrolled. It not only provides foreign travel
emergency benefits but also covers his Medicare Part B deductible. Anita comes to you for advice. What
should you tell her? - Answers You are sorry to disappoint Anita, but a Medigap F plan is no longer
available to those who turn age 65 after January 1, 2020. Anita might instead consider other Medigap
plans that offer foreign travel benefits but do not cover the Part B deductible.
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? - Answers Medicare does not cover massage therapy, or, in general, glasses or
dentures.
Mrs. Shields is covered by Original Medicare. She sustained a hip fracture and is being successfully
treated for that condition. However, she and her physicians feel that after her lengthy hospital stay, she
will need a month or two of nursing and rehabilitative care. What should you tell them about Original
Medicare's coverage of care in a skilled nursing facility? - Answers Medicare will cover Mrs. Shield's
skilled nursing services provided during the first 20 days of her stay, after which she would have a copay
until she has been in the facility for 100 days.
Mr. Diaz continued working with his company and was insured under his employer's group plan until he
reached age 68. He has heard that there is a premium penalty for those who did not sign up for Part B
when first eligible and wants to know how much he will have to pay. What should you tell him? -
Answers Mr. Diaz will not pay any penalty because he had continuous coverage under his employer's
plan.
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? - Answers Original Medicare covers ambulance services.
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? - Answers 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.
What impact, if any, have recent regulatory changes had on Medigap plans? - Answers The Part B
deductible is no longer covered for individuals newly eligible for Medicare starting January 1, 2020.
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? - Answers He generally would pay a monthly premium, annual
deductible, and per-prescription cost-sharing.
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? - Answers Medicare will cover a total of 190 days of inpatient
psychiatric care during Mr. Rainey's entire lifetime.
Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What could you tell Mrs. Park that
might be of assistance? - Answers 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.
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? -
Answers 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.
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? - Answers Medigap plans do
not cover Original Medicare benefits, but they coordinate with Original Medicare coverage.
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? - Answers Beneficiaries under Original Medicare have no cost-sharing for most
preventive services.
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? - Answers 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.
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? - Answers 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.
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? - Answers Mrs. Duarte should file an appeal of this initial
determination within 120 days of the date she received the MSN in the mail.
, Mr. Singh would like drug coverage but does not want to be enrolled in a Medicare Advantage plan.
What should you tell him? - Answers 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.
Ms. Brooks has aggressive cancer and would like to know if Medicare will cover hospice services in case
she needs them. What should you tell her? - Answers Medicare covers hospice services, and they will be
available for her.
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? - Answers He may sign-up for Medicare at any time however coverage usually begins on the fourth
month after dialysis treatments start.
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? - Answers 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.
Mrs. Wang wants to know generally how the benefits under Original Medicare might compare to the
benefits package of a Medicare Advantage Plan before she starts looking at specific plans. What could
you tell her? - Answers Medicare Advantage Plans may offer extra benefits that Original Medicare does
not offer such as vision, hearing, and dental services. It must include a maximum out-of-pocket limit on
Part A and Part B services.
Hank's Fish Store, Inc. is a small company with just 15 employees located in Florida. Hank, the store
owner, has provided excellent health benefits to the store's workforce. William, one of the store's long-
time employees, will soon be reaching age 65 and eligible for Medicare. William is in good health. He
intends to remain an active full-time employee, working several years after becoming eligible for
Medicare. What type(s) of retiree health benefit will Hank's Fish Store be able to offer William? -
Answers Employers with less than 20 employees (as calculated under Medicare secondary payor rules)
may be able to offer Medicare Advantage plans to their active employees and their dependents. Larger
firms are not able to offer such plans. In many cases, this helps small businesses save on health coverage
costs since Medicare becomes the primary payor.
Mr. Barker enjoys a comfortable retirement income. He recently had surgery and expected that he
would have certain services and items covered by the plan with minimal out-of-pocket costs because his
MA-PD coverage has been very good. However, when he received the bill, he was surprised to see large
charges in excess of his maximum out-of-pocket limit that included some services and items he thought
would be fully covered. He called you to ask what he could do? What could you tell him? - Answers
Medicare Advantage (MA) plan enrollees have a right to obtain a review (appeal) to certain decisions
