AHIP 2025 Final Exam 50 questions
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1. 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?: Original Medicare covers ambulance services.
2. Mrs. Duarte is enrolled in Original Medicare Parts A and B. She has recently
reviewed her Medicare Summary Notice (MSN) and disagrees with a determi-
nation that partially denied one of her claims for services. What advice would
you give her?: Mrs. Duarte should file an appeal of this initial determination within
120 days of the date she received the MSN in the mail.
3. 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?: 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.
4. Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What could
you tell Mrs. Park that might be of assistance?: 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.
5. 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?: 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.
6. 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?: 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.
7. Mr. Singh would like drug coverage but does not want to be enrolled in a
Medicare Advantage plan. What should you tell him?: 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.
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8. 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?: 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.
9. 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?-
: Beneficiaries under Original Medicare have no cost-sharing for most preventive
services.
10. 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?: You can offer to review the
plans appeal process to help him ask the plan to review the coverage decision.
11. 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?: He could enroll either in one of the MA plans that include prescrip-
tion 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.
12. 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?: There are
Medicare health plans such as HMOs, PPOs, PFFS, and MSAs.
13. 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 deter-
mine his eligibility?: 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.
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1. 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?: Original Medicare covers ambulance services.
2. Mrs. Duarte is enrolled in Original Medicare Parts A and B. She has recently
reviewed her Medicare Summary Notice (MSN) and disagrees with a determi-
nation that partially denied one of her claims for services. What advice would
you give her?: Mrs. Duarte should file an appeal of this initial determination within
120 days of the date she received the MSN in the mail.
3. 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?: 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.
4. Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What could
you tell Mrs. Park that might be of assistance?: 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.
5. 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?: 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.
6. 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?: 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.
7. Mr. Singh would like drug coverage but does not want to be enrolled in a
Medicare Advantage plan. What should you tell him?: 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.
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, AHIP 2025 Final Exam 50 questions
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8. 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?: 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.
9. 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?-
: Beneficiaries under Original Medicare have no cost-sharing for most preventive
services.
10. 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?: You can offer to review the
plans appeal process to help him ask the plan to review the coverage decision.
11. 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?: He could enroll either in one of the MA plans that include prescrip-
tion 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.
12. 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?: There are
Medicare health plans such as HMOs, PPOs, PFFS, and MSAs.
13. 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 deter-
mine his eligibility?: 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.
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