2025 AHIP Final Exam with verified correct answers

2025 AHIP Final Exam with verified correct t t t t t t t




answers




Mrs. Shields is covered by Original Medicare. She sustained a hip fracture and is being successfully
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treated for that condition. However, she and her physicians feel that after her lengthy hospital
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stay, she will need a month or two of nursing and rehabilitative care. What should you tell them
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about Original Medicare's coverage of care in a skilled nursing facility? - correct answer Medicare
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will cover Mrs. Shield's skilled nursing services provided during the first 20 days of her stay, after
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which she would have a copay until she has been in the facility for 100 days.
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Mrs. West wears glasses and dentures and has enjoyed considerable pain relief from arthritis
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through massage therapy. She is concerned about whether or not Medicare will cover these items
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and services. What should you tell her? - correct answer Medicare does not cover massage
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therapy, or, in general, glasses or dentures. t t t t t t




Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What could you tell Mrs. Park that
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might be of assistance? - correct answer She should contact her state Medicaid agency to see if she
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qualifies for one of several programs that can help with Medicare costs for which she is
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responsible.



Mr. Alonso receives some help paying for his two generic prescription drugs from his employer's
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retiree coverage, but he wants to compare it to a Part D prescription drug plan. He asks you what
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costs he would generally expect to encounter when enrolling into a standard Medicare Part D
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prescription drug plan. What should you tell him? - correct answer He generally would pay a t t t t t t t t tt t tt t t t t t




monthly premium, annual deductible, and per-prescription cost-sharing.
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,Mrs. Gonzalez is enrolled in Original Medicare and has a Medigap policy as well, but it provides no
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drug coverage. She would like to keep the coverage she has but replace her existing Medigap plan
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with one that provides drug coverage. What should you tell her? - correct answer Mrs. Gonzalez
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cannot purchase a Medigap plan that covers drugs, but she could keep her Medigap policy and
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enroll in a Part D prescription drug plan.
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Mr. Davis is 52 years old and has recently been diagnosed with end-stage renal disease (ESRD) and
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will soon begin dialysis. He is wondering if he can obtain coverage under Medicare. What should
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you tell him? - correct answer He may sign-up for Medicare at any time however coverage usually
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begins on the fourth month after dialysis treatments start.
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Mrs. Duarte is enrolled in Original Medicare Parts A and B. She has recently reviewed her Medicare
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Summary Notice (MSN) and disagrees with a determination that partially denied one of her claims
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for services. What advice would you give her? - correct answer Mrs. Duarte should file an appeal of
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this initial determination within 120 days of the date she received the MSN in the mail.
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Mrs. Geisler's neighbor told her she should look at her Part D options during the annual Medicare
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enrollment period because the features of Part D might have changed. Mrs. Geisler can't t t t t t t t t t t t t t t




remember what Part D is so she called you to ask what her neighbor was talking about. What could t t t t t t t t t t t t t t t t t t t




you tell her? - correct answer Part D covers prescription drugs and she should look at her
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premiums, formulary, and cost-sharing among other factors to see if they have changed. t t t t t t t t t t t t




Mr. Rainey is experiencing paranoid delusions and his physician feels that he should be
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hospitalized. What should you tell Mr. Rainey (or his representative) about the length of an t t t t t t t t t t t t t t t




inpatient psychiatric hospital stay that Medicare will cover? - correct answer Medicare will cover a
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total of 190 days of inpatient psychiatric care during Mr. Rainey's entire lifetime.
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Mr. Xi will soon turn age 65 and has come to you for advice as to what services are provided under
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Original Medicare. What should you tell Mr. Xi that best describes the health coverage provided to
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Medicare beneficiaries? - correct answer Beneficiaries under Original Medicare have no cost-
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sharing for most preventive services. t t t t




Mr. Singh would like drug coverage but does not want to be enrolled in a Medicare Advantage plan.
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What should you tell him? - correct answer Mr. Singh can enroll in a stand-alone prescription drug
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, plan and continue to be covered for Part A and Part B services through Original Fee-for-Service
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Medicare.



Mrs. Chen will be 65 soon, has been a citizen for twelve years, has been employed full time, and
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paid taxes during that entire period. She is concerned that she will not qualify for coverage under
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part A because she was not born in the United States. What should you tell her? - correct answer
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Most individuals who are citizens and age 65 or over are covered under Part A by virtue of having
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paid Medicare taxes while working, though some may be covered as a result of paying monthly
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premiums.



Mrs. Quinn recently turned 66 and decided after many years of work to retire and begin receiving
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Social Security benefits. Shortly thereafter Mrs. Quinn received a letter informing her that she had
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been automatically enrolled in Medicare Part B. She wants to understand what this means. What
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should you tell Mrs. Quinn? - correct answer Part B primarily covers physician services. She will be
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paying a monthly premium and, except for many preventive and screening tests, generally will
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have 20% co-payments for these services, in addition to an annual deductible.
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Mr. Patel is in good health and is preparing a budget in anticipation of his retirement when he turns
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66. He wants to understand the health care costs he might be exposed to under Medicare if he
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were to require hospitalization because of an illness. In general terms, what could you tell him
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about his costs for inpatient hospital services under Original Medicare? - correct answer Under
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Original Medicare, there is a single deductible amount due for the first 60 days of any inpatient
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hospital stay, after which it converts into a per-day coinsurance amount through day 90. After day
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90, he would pay a daily amount up to 60 days over his lifetime, after which he would be
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responsible for all costs. t t t




What impact, if any, have recent regulatory changes had on Medigap plans? - correct answer The
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Part B deductible is no longer covered for individuals newly eligible for Medicare starting January
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1, 2020.
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Mrs. Paterson is concerned about the deductibles and co-payments associated with Original
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Medicare. What can you tell her about Medigap as an option to address this concern? - correct t t t t t t t t t t t t t t t tt t




answer Medigap plans do not cover Original Medicare benefits, but they coordinate with Original
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Medicare coverage. t