2025 AHIP FINAL EXAM
1. 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?: 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.
2. 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?: Medicare does not cover massage therapy, or, in general, glasses
or dentures.
3. 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.
4. 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?: He generally
would pay a monthly premium, annual deductible, and per-prescription cost-
sharing.
5. 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?: 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.
6. 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?: He may
sign-up for Medicare at any time however coverage usually begins on the fourth
month after dialysis treatments start.
7. 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
,2025 AHIP FINAL EXAM
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.
8. 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.
9. 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?: Medicare will cover a total of 190 days of inpatient
psychiatric care during Mr. Rainey's entire lifetime.
10. 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.
11. 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.
12. 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.
13. 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.
, 2025 AHIP FINAL EXAM
14. 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?: 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.
15. What impact, if any, have recent regulatory changes had on Medigap
plans?: The Part B deductible is no longer covered for individuals newly eligible
for Medicare starting January 1, 2020.
16. 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?: Medigap plans do not cover Original
Medicare benefits, but they coordinate with Original Medicare coverage.
17. 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.
18. 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?:
Medicare covers hospice services, and they will be available for her.
19. 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?: Mr. Diaz will not pay any penalty because he had continuous
coverage under his employer's plan.
20. 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
1. 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?: 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.
2. 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?: Medicare does not cover massage therapy, or, in general, glasses
or dentures.
3. 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.
4. 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?: He generally
would pay a monthly premium, annual deductible, and per-prescription cost-
sharing.
5. 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?: 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.
6. 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?: He may
sign-up for Medicare at any time however coverage usually begins on the fourth
month after dialysis treatments start.
7. 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
,2025 AHIP FINAL EXAM
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.
8. 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.
9. 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?: Medicare will cover a total of 190 days of inpatient
psychiatric care during Mr. Rainey's entire lifetime.
10. 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.
11. 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.
12. 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.
13. 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.
, 2025 AHIP FINAL EXAM
14. 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?: 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.
15. What impact, if any, have recent regulatory changes had on Medigap
plans?: The Part B deductible is no longer covered for individuals newly eligible
for Medicare starting January 1, 2020.
16. 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?: Medigap plans do not cover Original
Medicare benefits, but they coordinate with Original Medicare coverage.
17. 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.
18. 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?:
Medicare covers hospice services, and they will be available for her.
19. 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?: Mr. Diaz will not pay any penalty because he had continuous
coverage under his employer's plan.
20. 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
