2025 AHIP FINAL EXAM QUESTIONS
WITH CORRECT ANSWERS
Mrs. bShields bis bcovered bby bOriginal bMedicare. bShe bsustained ba bhip bfracture band
bis bbeing bsuccessfully btreated bfor bthat bcondition. bHowever, bshe band bher bphysicians
bfeel bthat bafter bher blengthy bhospital bstay, bshe bwill bneed ba bmonth bor btwo bof
bnursing band brehabilitative bcare. bWhat bshould byou btell bthem babout bOriginal
bMedicare's bcoverage bof bcare bin ba bskilled bnursing bfacility? b- bcorrect banswer
b✔✔Medicare bwill bcover bMrs. bShield's bskilled bnursing bservices bprovided bduring bthe
bfirst b20 bdays bof bher bstay, bafter bwhich bshe bwould bhave ba bcopay buntil bshe bhas
bbeen bin bthe bfacility bfor b100 bdays.
Mrs. bWest bwears bglasses band bdentures band bhas benjoyed bconsiderable bpain brelief
bfrom barthritis bthrough bmassage btherapy. bShe bis bconcerned babout bwhether bor bnot
bMedicare bwill bcover bthese bitems band bservices. bWhat bshould byou btell bher? b-
bcorrect banswer b✔✔Medicare bdoes bnot bcover bmassage btherapy, bor, bin bgeneral,
bglasses bor bdentures.
Mrs. bPark bis ban belderly bretiree. bMrs. bPark bhas ba blow bfixed bincome. bWhat bcould
byou btell bMrs. bPark bthat bmight bbe bof bassistance? b- bcorrect banswer b✔✔She bshould
bcontact bher bstate bMedicaid bagency bto bsee bif bshe bqualifies bfor bone bof bseveral
bprograms bthat bcan bhelp bwith bMedicare bcosts bfor bwhich bshe bis bresponsible.
Mr. bAlonso breceives bsome bhelp bpaying bfor bhis btwo bgeneric bprescription bdrugs
bfrom bhis bemployer's bretiree bcoverage, bbut bhe bwants bto bcompare bit bto ba bPart bD
bprescription bdrug bplan. bHe basks byou bwhat bcosts bhe bwould bgenerally bexpect bto
bencounter bwhen benrolling binto ba bstandard bMedicare bPart bD bprescription bdrug
bplan. bWhat bshould byou btell bhim? b- bcorrect banswer b✔✔He bgenerally bwould bpay ba
bmonthly bpremium, bannual bdeductible, band bper-prescription bcost-sharing.
Mrs. bGonzalez bis benrolled bin bOriginal bMedicare band bhas ba bMedigap bpolicy bas
bwell, bbut bit bprovides bno bdrug bcoverage. bShe bwould blike bto bkeep bthe bcoverage
bshe bhas bbut breplace bher bexisting bMedigap bplan bwith bone bthat bprovides bdrug
bcoverage. bWhat bshould byou btell bher? b- bcorrect banswer b✔✔Mrs. bGonzalez bcannot
bpurchase ba bMedigap bplan bthat bcovers bdrugs, bbut bshe bcould bkeep bher bMedigap
bpolicy band benroll bin ba bPart bD bprescription bdrug bplan.
,Mr. bDavis bis b52 byears bold band bhas brecently bbeen bdiagnosed bwith bend-stage brenal
bdisease b(ESRD) band bwill bsoon bbegin bdialysis. bHe bis bwondering bif bhe bcan bobtain
bcoverage bunder bMedicare. bWhat bshould byou btell bhim? b- bcorrect banswer b✔✔He
bmay bsign-up bfor bMedicare bat bany btime bhowever bcoverage busually bbegins bon bthe
bfourth bmonth bafter bdialysis btreatments bstart.
Mrs. bDuarte bis benrolled bin bOriginal bMedicare bParts bA band bB. bShe bhas brecently
breviewed bher bMedicare bSummary bNotice b(MSN) band bdisagrees bwith ba
bdetermination bthat bpartially bdenied bone bof bher bclaims bfor bservices. bWhat badvice
bwould byou bgive bher? b- bcorrect banswer b✔✔Mrs. bDuarte bshould bfile ban bappeal bof
bthis binitial bdetermination bwithin b120 bdays bof bthe bdate bshe breceived bthe bMSN bin
bthe bmail.
Mrs. bGeisler's bneighbor btold bher bshe bshould blook bat bher bPart bD boptions bduring
bthe bannual bMedicare benrollment bperiod bbecause bthe bfeatures bof bPart bD bmight
bhave bchanged. bMrs. bGeisler bcan't bremember bwhat bPart bD bis bso bshe bcalled byou
bto bask bwhat bher bneighbor bwas btalking babout. bWhat bcould byou btell bher? b- bcorrect
banswer b✔✔Part bD bcovers bprescription bdrugs band bshe bshould blook bat bher
bpremiums, bformulary, band bcost-sharing bamong bother bfactors bto bsee bif bthey bhave
bchanged.
Mr. bRainey bis bexperiencing bparanoid bdelusions band bhis bphysician bfeels bthat bhe
bshould bbe bhospitalized. bWhat bshould byou btell bMr. bRainey b(or bhis brepresentative)
babout bthe blength bof ban binpatient bpsychiatric bhospital bstay bthat bMedicare bwill
bcover? b- bcorrect banswer b✔✔Medicare bwill bcover ba btotal bof b190 bdays bof binpatient
bpsychiatric bcare bduring bMr. bRainey's bentire blifetime.
Mr. bXi bwill bsoon bturn bage b65 band bhas bcome bto byou bfor badvice bas bto bwhat
bservices bare bprovided bunder bOriginal bMedicare. bWhat bshould byou btell bMr. bXi bthat
bbest bdescribes bthe bhealth bcoverage bprovided bto bMedicare bbeneficiaries? b- bcorrect
banswer b✔✔Beneficiaries bunder bOriginal bMedicare bhave bno bcost-sharing bfor bmost
bpreventive bservices.
Mr. bSingh bwould blike bdrug bcoverage bbut bdoes bnot bwant bto bbe benrolled bin ba
bMedicare bAdvantage bplan. bWhat bshould byou btell bhim? b- bcorrect banswer b✔✔Mr.
bSingh bcan benroll bin ba bstand-alone bprescription bdrug bplan band bcontinue bto bbe
bcovered bfor bPart bA band bPart bB bservices bthrough bOriginal bFee-for-Service
bMedicare.
Mrs. bChen bwill bbe b65 bsoon, bhas bbeen ba bcitizen bfor btwelve byears, bhas bbeen
bemployed bfull btime, band bpaid btaxes bduring bthat bentire bperiod. bShe bis bconcerned
bthat bshe bwill bnot bqualify bfor bcoverage bunder bpart bA bbecause bshe bwas bnot bborn
bin bthe bUnited bStates. bWhat bshould byou btell bher? b- bcorrect banswer b✔✔Most
bindividuals bwho bare bcitizens band bage b65 bor bover bare bcovered bunder bPart bA bby
, bvirtue bof bhaving bpaid bMedicare btaxes bwhile bworking, bthough bsome bmay bbe
bcovered bas ba bresult bof bpaying bmonthly bpremiums.
Mrs. bQuinn brecently bturned b66 band bdecided bafter bmany byears bof bwork bto bretire
band bbegin breceiving bSocial bSecurity bbenefits. bShortly bthereafter bMrs. bQuinn
breceived ba bletter binforming bher bthat bshe bhad bbeen bautomatically benrolled bin
bMedicare bPart bB. bShe bwants bto bunderstand bwhat bthis bmeans. bWhat bshould byou
btell bMrs. bQuinn? b- bcorrect banswer b✔✔Part bB bprimarily bcovers bphysician bservices.
bShe bwill bbe bpaying ba bmonthly bpremium band, bexcept bfor bmany bpreventive band
bscreening btests, bgenerally bwill bhave b20% bco-payments bfor bthese bservices, bin
baddition bto ban bannual bdeductible.
Mr. bPatel bis bin bgood bhealth band bis bpreparing ba bbudget bin banticipation bof bhis
bretirement bwhen bhe bturns b66. bHe bwants bto bunderstand bthe bhealth bcare bcosts bhe
bmight bbe bexposed bto bunder bMedicare bif bhe bwere bto brequire bhospitalization
bbecause bof ban billness. bIn bgeneral bterms, bwhat bcould byou btell bhim babout bhis
bcosts bfor binpatient bhospital bservices bunder bOriginal bMedicare? b- bcorrect banswer
b✔✔Under bOriginal bMedicare, bthere bis ba bsingle bdeductible bamount bdue bfor bthe
bfirst b60 bdays bof bany binpatient bhospital bstay, bafter bwhich bit bconverts binto ba bper-
day bcoinsurance bamount bthrough bday b90. bAfter bday b90, bhe bwould bpay ba bdaily
bamount bup bto b60 bdays bover bhis blifetime, bafter bwhich bhe bwould bbe bresponsible
bfor ball bcosts.
What bimpact, bif bany, bhave brecent bregulatory bchanges bhad bon bMedigap bplans? b-
bcorrect banswer b✔✔The bPart bB bdeductible bis bno blonger bcovered bfor bindividuals
bnewly beligible bfor bMedicare bstarting bJanuary b1, b2020.
Mrs. bPaterson bis bconcerned babout bthe bdeductibles band bco-payments bassociated
bwith bOriginal bMedicare. bWhat bcan byou btell bher babout bMedigap bas ban boption bto
baddress bthis bconcern? b- bcorrect banswer b✔✔Medigap bplans bdo bnot bcover bOriginal
bMedicare bbenefits, bbut bthey bcoordinate bwith bOriginal bMedicare bcoverage.
Mrs. bTurner bis bcomparing bher bemployer's bretiree binsurance bto bOriginal bMedicare
band bwould blike bto bknow bwhich bof bthe bfollowing bservices bOriginal bMedicare bwill
bcover bif bthe bappropriate bcriteria bare bmet. bWhat bcould byou btell bher? b- bcorrect
banswer b✔✔Original bMedicare bcovers bambulance bservices.
Ms. bBrooks bhas baggressive bcancer band bwould blike bto bknow bif bMedicare bwill bcover
bhospice bservices bin bcase bshe bneeds bthem. bWhat bshould byou btell bher? b- bcorrect
banswer b✔✔Medicare bcovers bhospice bservices, band bthey bwill bbe bavailable bfor bher.
Mr. bDiaz bcontinued bworking bwith bhis bcompany band bwas binsured bunder bhis
bemployer's bgroup bplan buntil bhe breached bage b68. bHe bhas bheard bthat bthere bis ba
bpremium bpenalty bfor bthose bwho bdid bnot bsign bup bfor bPart bB bwhen bfirst beligible
band bwants bto bknow bhow bmuch bhe bwill bhave bto bpay. bWhat bshould byou btell bhim?
WITH CORRECT ANSWERS
Mrs. bShields bis bcovered bby bOriginal bMedicare. bShe bsustained ba bhip bfracture band
bis bbeing bsuccessfully btreated bfor bthat bcondition. bHowever, bshe band bher bphysicians
bfeel bthat bafter bher blengthy bhospital bstay, bshe bwill bneed ba bmonth bor btwo bof
bnursing band brehabilitative bcare. bWhat bshould byou btell bthem babout bOriginal
bMedicare's bcoverage bof bcare bin ba bskilled bnursing bfacility? b- bcorrect banswer
b✔✔Medicare bwill bcover bMrs. bShield's bskilled bnursing bservices bprovided bduring bthe
bfirst b20 bdays bof bher bstay, bafter bwhich bshe bwould bhave ba bcopay buntil bshe bhas
bbeen bin bthe bfacility bfor b100 bdays.
Mrs. bWest bwears bglasses band bdentures band bhas benjoyed bconsiderable bpain brelief
bfrom barthritis bthrough bmassage btherapy. bShe bis bconcerned babout bwhether bor bnot
bMedicare bwill bcover bthese bitems band bservices. bWhat bshould byou btell bher? b-
bcorrect banswer b✔✔Medicare bdoes bnot bcover bmassage btherapy, bor, bin bgeneral,
bglasses bor bdentures.
Mrs. bPark bis ban belderly bretiree. bMrs. bPark bhas ba blow bfixed bincome. bWhat bcould
byou btell bMrs. bPark bthat bmight bbe bof bassistance? b- bcorrect banswer b✔✔She bshould
bcontact bher bstate bMedicaid bagency bto bsee bif bshe bqualifies bfor bone bof bseveral
bprograms bthat bcan bhelp bwith bMedicare bcosts bfor bwhich bshe bis bresponsible.
Mr. bAlonso breceives bsome bhelp bpaying bfor bhis btwo bgeneric bprescription bdrugs
bfrom bhis bemployer's bretiree bcoverage, bbut bhe bwants bto bcompare bit bto ba bPart bD
bprescription bdrug bplan. bHe basks byou bwhat bcosts bhe bwould bgenerally bexpect bto
bencounter bwhen benrolling binto ba bstandard bMedicare bPart bD bprescription bdrug
bplan. bWhat bshould byou btell bhim? b- bcorrect banswer b✔✔He bgenerally bwould bpay ba
bmonthly bpremium, bannual bdeductible, band bper-prescription bcost-sharing.
Mrs. bGonzalez bis benrolled bin bOriginal bMedicare band bhas ba bMedigap bpolicy bas
bwell, bbut bit bprovides bno bdrug bcoverage. bShe bwould blike bto bkeep bthe bcoverage
bshe bhas bbut breplace bher bexisting bMedigap bplan bwith bone bthat bprovides bdrug
bcoverage. bWhat bshould byou btell bher? b- bcorrect banswer b✔✔Mrs. bGonzalez bcannot
bpurchase ba bMedigap bplan bthat bcovers bdrugs, bbut bshe bcould bkeep bher bMedigap
bpolicy band benroll bin ba bPart bD bprescription bdrug bplan.
,Mr. bDavis bis b52 byears bold band bhas brecently bbeen bdiagnosed bwith bend-stage brenal
bdisease b(ESRD) band bwill bsoon bbegin bdialysis. bHe bis bwondering bif bhe bcan bobtain
bcoverage bunder bMedicare. bWhat bshould byou btell bhim? b- bcorrect banswer b✔✔He
bmay bsign-up bfor bMedicare bat bany btime bhowever bcoverage busually bbegins bon bthe
bfourth bmonth bafter bdialysis btreatments bstart.
Mrs. bDuarte bis benrolled bin bOriginal bMedicare bParts bA band bB. bShe bhas brecently
breviewed bher bMedicare bSummary bNotice b(MSN) band bdisagrees bwith ba
bdetermination bthat bpartially bdenied bone bof bher bclaims bfor bservices. bWhat badvice
bwould byou bgive bher? b- bcorrect banswer b✔✔Mrs. bDuarte bshould bfile ban bappeal bof
bthis binitial bdetermination bwithin b120 bdays bof bthe bdate bshe breceived bthe bMSN bin
bthe bmail.
Mrs. bGeisler's bneighbor btold bher bshe bshould blook bat bher bPart bD boptions bduring
bthe bannual bMedicare benrollment bperiod bbecause bthe bfeatures bof bPart bD bmight
bhave bchanged. bMrs. bGeisler bcan't bremember bwhat bPart bD bis bso bshe bcalled byou
bto bask bwhat bher bneighbor bwas btalking babout. bWhat bcould byou btell bher? b- bcorrect
banswer b✔✔Part bD bcovers bprescription bdrugs band bshe bshould blook bat bher
bpremiums, bformulary, band bcost-sharing bamong bother bfactors bto bsee bif bthey bhave
bchanged.
Mr. bRainey bis bexperiencing bparanoid bdelusions band bhis bphysician bfeels bthat bhe
bshould bbe bhospitalized. bWhat bshould byou btell bMr. bRainey b(or bhis brepresentative)
babout bthe blength bof ban binpatient bpsychiatric bhospital bstay bthat bMedicare bwill
bcover? b- bcorrect banswer b✔✔Medicare bwill bcover ba btotal bof b190 bdays bof binpatient
bpsychiatric bcare bduring bMr. bRainey's bentire blifetime.
Mr. bXi bwill bsoon bturn bage b65 band bhas bcome bto byou bfor badvice bas bto bwhat
bservices bare bprovided bunder bOriginal bMedicare. bWhat bshould byou btell bMr. bXi bthat
bbest bdescribes bthe bhealth bcoverage bprovided bto bMedicare bbeneficiaries? b- bcorrect
banswer b✔✔Beneficiaries bunder bOriginal bMedicare bhave bno bcost-sharing bfor bmost
bpreventive bservices.
Mr. bSingh bwould blike bdrug bcoverage bbut bdoes bnot bwant bto bbe benrolled bin ba
bMedicare bAdvantage bplan. bWhat bshould byou btell bhim? b- bcorrect banswer b✔✔Mr.
bSingh bcan benroll bin ba bstand-alone bprescription bdrug bplan band bcontinue bto bbe
bcovered bfor bPart bA band bPart bB bservices bthrough bOriginal bFee-for-Service
bMedicare.
Mrs. bChen bwill bbe b65 bsoon, bhas bbeen ba bcitizen bfor btwelve byears, bhas bbeen
bemployed bfull btime, band bpaid btaxes bduring bthat bentire bperiod. bShe bis bconcerned
bthat bshe bwill bnot bqualify bfor bcoverage bunder bpart bA bbecause bshe bwas bnot bborn
bin bthe bUnited bStates. bWhat bshould byou btell bher? b- bcorrect banswer b✔✔Most
bindividuals bwho bare bcitizens band bage b65 bor bover bare bcovered bunder bPart bA bby
, bvirtue bof bhaving bpaid bMedicare btaxes bwhile bworking, bthough bsome bmay bbe
bcovered bas ba bresult bof bpaying bmonthly bpremiums.
Mrs. bQuinn brecently bturned b66 band bdecided bafter bmany byears bof bwork bto bretire
band bbegin breceiving bSocial bSecurity bbenefits. bShortly bthereafter bMrs. bQuinn
breceived ba bletter binforming bher bthat bshe bhad bbeen bautomatically benrolled bin
bMedicare bPart bB. bShe bwants bto bunderstand bwhat bthis bmeans. bWhat bshould byou
btell bMrs. bQuinn? b- bcorrect banswer b✔✔Part bB bprimarily bcovers bphysician bservices.
bShe bwill bbe bpaying ba bmonthly bpremium band, bexcept bfor bmany bpreventive band
bscreening btests, bgenerally bwill bhave b20% bco-payments bfor bthese bservices, bin
baddition bto ban bannual bdeductible.
Mr. bPatel bis bin bgood bhealth band bis bpreparing ba bbudget bin banticipation bof bhis
bretirement bwhen bhe bturns b66. bHe bwants bto bunderstand bthe bhealth bcare bcosts bhe
bmight bbe bexposed bto bunder bMedicare bif bhe bwere bto brequire bhospitalization
bbecause bof ban billness. bIn bgeneral bterms, bwhat bcould byou btell bhim babout bhis
bcosts bfor binpatient bhospital bservices bunder bOriginal bMedicare? b- bcorrect banswer
b✔✔Under bOriginal bMedicare, bthere bis ba bsingle bdeductible bamount bdue bfor bthe
bfirst b60 bdays bof bany binpatient bhospital bstay, bafter bwhich bit bconverts binto ba bper-
day bcoinsurance bamount bthrough bday b90. bAfter bday b90, bhe bwould bpay ba bdaily
bamount bup bto b60 bdays bover bhis blifetime, bafter bwhich bhe bwould bbe bresponsible
bfor ball bcosts.
What bimpact, bif bany, bhave brecent bregulatory bchanges bhad bon bMedigap bplans? b-
bcorrect banswer b✔✔The bPart bB bdeductible bis bno blonger bcovered bfor bindividuals
bnewly beligible bfor bMedicare bstarting bJanuary b1, b2020.
Mrs. bPaterson bis bconcerned babout bthe bdeductibles band bco-payments bassociated
bwith bOriginal bMedicare. bWhat bcan byou btell bher babout bMedigap bas ban boption bto
baddress bthis bconcern? b- bcorrect banswer b✔✔Medigap bplans bdo bnot bcover bOriginal
bMedicare bbenefits, bbut bthey bcoordinate bwith bOriginal bMedicare bcoverage.
Mrs. bTurner bis bcomparing bher bemployer's bretiree binsurance bto bOriginal bMedicare
band bwould blike bto bknow bwhich bof bthe bfollowing bservices bOriginal bMedicare bwill
bcover bif bthe bappropriate bcriteria bare bmet. bWhat bcould byou btell bher? b- bcorrect
banswer b✔✔Original bMedicare bcovers bambulance bservices.
Ms. bBrooks bhas baggressive bcancer band bwould blike bto bknow bif bMedicare bwill bcover
bhospice bservices bin bcase bshe bneeds bthem. bWhat bshould byou btell bher? b- bcorrect
banswer b✔✔Medicare bcovers bhospice bservices, band bthey bwill bbe bavailable bfor bher.
Mr. bDiaz bcontinued bworking bwith bhis bcompany band bwas binsured bunder bhis
bemployer's bgroup bplan buntil bhe breached bage b68. bHe bhas bheard bthat bthere bis ba
bpremium bpenalty bfor bthose bwho bdid bnot bsign bup bfor bPart bB bwhen bfirst beligible
band bwants bto bknow bhow bmuch bhe bwill bhave bto bpay. bWhat bshould byou btell bhim?
