AHIP 2025/2026 Final Exam 50 Questions
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? - ANS-Original Medicare covers ambulance services.
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? - ANS-Mrs. Duarte should file an
appeal of this initial determination within 120 days of the date she received the MSN in the mail.
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? - ANS-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. Park is an elderly retiree. Mrs. Park has a low fixed income. What could you tell Mrs. Park
that might be of assistance? - ANS-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. 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? - ANS-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.
Anita Magri will turn 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? - ANS-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.
, Mr. Singh would like drug coverage but does not want to be enrolled in a Medicare Advantage
plan. What should you tell him? - ANS-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.
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? -
ANS-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.
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? - ANS-Beneficiaries under Original Medicare have no
cost-sharing for most preventive services.
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? - ANS-You can offer to review the plans appeal process to help him
ask the plan to review the coverage decision.
Mr. Lombardi is interested in a Medicare Advantage (MA) PPO plan that you represent. It is one
of three plans operated by the same organization in Mr. Lombardi's area. The MA PPO plan
does not include drug coverage, but the other two plans do. Mr. Lombardi likes the PPO plan
that does not include drug coverage and intends to obtain his drug coverage through a
stand-alone Medicare prescription drug plan. What should you tell him about this situation? -
ANS-He could enroll either in one of the MA plans that include prescription drug coverage or
Original Medicare with a Medigap plan and standalone Part D prescription drug coverage, but
he cannot enroll in the MA-only PPO plan and a stand-alone prescription drug plan.
Mr. Lopez has heard that he can sign up for a product called "Medicare Advantage" but is not
sure about what type of plan designs are available through this program. What should you tell
him about the types of health plans that are available through the Medicare Advantage
program? - ANS-There are Medicare health plans such as HMOs, PPOs, PFFS, and MSAs.
Mr. Kelly wants to know whether he is eligible to sign up for a private fee-for-service (PFFS)
plan. What questions would you need to ask to determine his eligibility? - ANS-You would need
to ask Mr. Kelly if he is entitled to Part A, enrolled in Part B, and if he lives in the PFFS plan's
service area.
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? - ANS-Original Medicare covers ambulance services.
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? - ANS-Mrs. Duarte should file an
appeal of this initial determination within 120 days of the date she received the MSN in the mail.
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? - ANS-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. Park is an elderly retiree. Mrs. Park has a low fixed income. What could you tell Mrs. Park
that might be of assistance? - ANS-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. 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? - ANS-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.
Anita Magri will turn 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? - ANS-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.
, Mr. Singh would like drug coverage but does not want to be enrolled in a Medicare Advantage
plan. What should you tell him? - ANS-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.
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? -
ANS-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.
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? - ANS-Beneficiaries under Original Medicare have no
cost-sharing for most preventive services.
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? - ANS-You can offer to review the plans appeal process to help him
ask the plan to review the coverage decision.
Mr. Lombardi is interested in a Medicare Advantage (MA) PPO plan that you represent. It is one
of three plans operated by the same organization in Mr. Lombardi's area. The MA PPO plan
does not include drug coverage, but the other two plans do. Mr. Lombardi likes the PPO plan
that does not include drug coverage and intends to obtain his drug coverage through a
stand-alone Medicare prescription drug plan. What should you tell him about this situation? -
ANS-He could enroll either in one of the MA plans that include prescription drug coverage or
Original Medicare with a Medigap plan and standalone Part D prescription drug coverage, but
he cannot enroll in the MA-only PPO plan and a stand-alone prescription drug plan.
Mr. Lopez has heard that he can sign up for a product called "Medicare Advantage" but is not
sure about what type of plan designs are available through this program. What should you tell
him about the types of health plans that are available through the Medicare Advantage
program? - ANS-There are Medicare health plans such as HMOs, PPOs, PFFS, and MSAs.
Mr. Kelly wants to know whether he is eligible to sign up for a private fee-for-service (PFFS)
plan. What questions would you need to ask to determine his eligibility? - ANS-You would need
to ask Mr. Kelly if he is entitled to Part A, enrolled in Part B, and if he lives in the PFFS plan's
service area.
