2025 AHIP FINAL EXAM WITH CORRECT
ANSWERS GRADED A+
Mrs. rShields ris rcovered rby rOriginal rMedicare. rShe rsustained ra rhip rfracture rand ris
rbeing rsuccessfully rtreated rfor rthat rcondition. rHowever, rshe rand rher rphysicians rfeel
rthat rafter rher rlengthy rhospital rstay, rshe rwill rneed ra rmonth ror rtwo rof rnursing rand
rrehabilitative rcare. rWhat rshould ryou rtell rthem rabout rOriginal rMedicare's rcoverage rof
rcare rin ra rskilled rnursing rfacility? r- rCORRECT✅✅Medicare rwill rcover rMrs. rShield's
rskilled rnursing rservices rprovided rduring rthe rfirst r20 rdays rof rher rstay, rafter rwhich
rshe rwould rhave ra rcopay runtil rshe rhas rbeen rin rthe rfacility rfor r100 rdays.
Mrs. rWest rwears rglasses rand rdentures rand rhas renjoyed rconsiderable rpain rrelief
rfrom rarthritis rthrough rmassage rtherapy. rShe ris rconcerned rabout rwhether ror rnot
rMedicare rwill rcover rthese ritems rand rservices. rWhat rshould ryou rtell rher? r-
rCORRECT✅✅Medicare rdoes rnot rcover rmassage rtherapy, ror, rin rgeneral, rglasses
ror rdentures.
Mrs. rPark ris ran relderly rretiree. rMrs. rPark rhas ra rlow rfixed rincome. rWhat rcould ryou
rtell rMrs. rPark rthat rmight rbe rof rassistance? r- rCORRECT✅✅She rshould rcontact rher
rstate rMedicaid ragency rto rsee rif rshe rqualifies rfor rone rof rseveral rprograms rthat rcan
rhelp rwith rMedicare rcosts rfor rwhich rshe ris rresponsible.
Mr. rAlonso rreceives rsome rhelp rpaying rfor rhis rtwo rgeneric rprescription rdrugs rfrom
rhis remployer's rretiree rcoverage, rbut rhe rwants rto rcompare rit rto ra rPart rD rprescription
rdrug rplan. rHe rasks ryou rwhat rcosts rhe rwould rgenerally rexpect rto rencounter rwhen
renrolling rinto ra rstandard rMedicare rPart rD rprescription rdrug rplan. rWhat rshould ryou
rtell rhim? r- rCORRECT✅✅He rgenerally rwould rpay ra rmonthly rpremium, rannual
rdeductible, rand rper-prescription rcost-sharing.
Mrs. rGonzalez ris renrolled rin rOriginal rMedicare rand rhas ra rMedigap rpolicy ras rwell,
rbut rit rprovides rno rdrug rcoverage. rShe rwould rlike rto rkeep rthe rcoverage rshe rhas rbut
rreplace rher rexisting rMedigap rplan rwith rone rthat rprovides rdrug rcoverage. rWhat
rshould ryou rtell rher? r- rCORRECT✅✅Mrs. rGonzalez rcannot rpurchase ra rMedigap
rplan rthat rcovers rdrugs, rbut rshe rcould rkeep rher rMedigap rpolicy rand renroll rin ra rPart
rD rprescription rdrug rplan.
Mr. rDavis ris r52 ryears rold rand rhas rrecently rbeen rdiagnosed rwith rend-stage rrenal
rdisease r(ESRD) rand rwill rsoon rbegin rdialysis. rHe ris rwondering rif rhe rcan robtain
rcoverage runder rMedicare. rWhat rshould ryou rtell rhim? r- rCORRECT✅✅He rmay
rsign-up rfor rMedicare rat rany rtime rhowever rcoverage rusually rbegins ron rthe rfourth
rmonth rafter rdialysis rtreatments rstart.
Mrs. rDuarte ris renrolled rin rOriginal rMedicare rParts rA rand rB. rShe rhas rrecently
rreviewed rher rMedicare rSummary rNotice r(MSN) rand rdisagrees rwith ra rdetermination
,rthat rpartially rdenied rone rof rher rclaims rfor rservices. rWhat radvice rwould ryou rgive
rher? r- rCORRECT✅✅Mrs. rDuarte rshould rfile ran rappeal rof rthis rinitial rdetermination
rwithin r120 rdays rof rthe rdate rshe rreceived rthe rMSN rin rthe rmail.
Mrs. rGeisler's rneighbor rtold rher rshe rshould rlook rat rher rPart rD roptions rduring rthe
rannual rMedicare renrollment rperiod rbecause rthe rfeatures rof rPart rD rmight rhave
rchanged. rMrs. rGeisler rcan't rremember rwhat rPart rD ris rso rshe rcalled ryou rto rask
rwhat rher rneighbor rwas rtalking rabout. rWhat rcould ryou rtell rher? r-
rCORRECT✅✅Part rD rcovers rprescription rdrugs rand rshe rshould rlook rat rher
rpremiums, rformulary, rand rcost-sharing ramong rother rfactors rto rsee rif rthey rhave
rchanged.
Mr. rRainey ris rexperiencing rparanoid rdelusions rand rhis rphysician rfeels rthat rhe rshould
rbe rhospitalized. rWhat rshould ryou rtell rMr. rRainey r(or rhis rrepresentative) rabout rthe
rlength rof ran rinpatient rpsychiatric rhospital rstay rthat rMedicare rwill rcover? r-
rCORRECT✅✅Medicare rwill rcover ra rtotal rof r190 rdays rof rinpatient rpsychiatric rcare
rduring rMr. rRainey's rentire rlifetime.
Mr. rXi rwill rsoon rturn rage r65 rand rhas rcome rto ryou rfor radvice ras rto rwhat rservices
rare rprovided runder rOriginal rMedicare. rWhat rshould ryou rtell rMr. rXi rthat rbest
rdescribes rthe rhealth rcoverage rprovided rto rMedicare rbeneficiaries? r-
rCORRECT✅✅Beneficiaries runder rOriginal rMedicare rhave rno rcost-sharing rfor rmost
rpreventive rservices.
Mr. rSingh rwould rlike rdrug rcoverage rbut rdoes rnot rwant rto rbe renrolled rin ra rMedicare
rAdvantage rplan. rWhat rshould ryou rtell rhim? r- rCORRECT✅✅Mr. rSingh rcan renroll
rin ra rstand-alone rprescription rdrug rplan rand rcontinue rto rbe rcovered rfor rPart rA rand
rPart rB rservices rthrough rOriginal rFee-for-Service rMedicare.
Mrs. rChen rwill rbe r65 rsoon, rhas rbeen ra rcitizen rfor rtwelve ryears, rhas rbeen remployed
rfull rtime, rand rpaid rtaxes rduring rthat rentire rperiod. rShe ris rconcerned rthat rshe rwill rnot
rqualify rfor rcoverage runder rpart rA rbecause rshe rwas rnot rborn rin rthe rUnited rStates.
rWhat rshould ryou rtell rher? r- rCORRECT✅✅Most rindividuals rwho rare rcitizens rand
rage r65 ror rover rare rcovered runder rPart rA rby rvirtue rof rhaving rpaid rMedicare rtaxes
rwhile rworking, rthough rsome rmay rbe rcovered ras ra rresult rof rpaying rmonthly
rpremiums.
Mrs. rQuinn rrecently rturned r66 rand rdecided rafter rmany ryears rof rwork rto rretire rand
rbegin rreceiving rSocial rSecurity rbenefits. rShortly rthereafter rMrs. rQuinn rreceived ra
rletter rinforming rher rthat rshe rhad rbeen rautomatically renrolled rin rMedicare rPart rB.
rShe rwants rto runderstand rwhat rthis rmeans. rWhat rshould ryou rtell rMrs. rQuinn? r-
rCORRECT✅✅Part rB rprimarily rcovers rphysician rservices. rShe rwill rbe rpaying ra
rmonthly rpremium rand, rexcept rfor rmany rpreventive rand rscreening rtests, rgenerally
rwill rhave r20% rco-payments rfor rthese rservices, rin raddition rto ran rannual rdeductible.
, Mr. rPatel ris rin rgood rhealth rand ris rpreparing ra rbudget rin ranticipation rof rhis rretirement
rwhen rhe rturns r66. rHe rwants rto runderstand rthe rhealth rcare rcosts rhe rmight rbe
rexposed rto runder rMedicare rif rhe rwere rto rrequire rhospitalization rbecause rof ran
rillness. rIn rgeneral rterms, rwhat rcould ryou rtell rhim rabout rhis rcosts rfor rinpatient
rhospital rservices runder rOriginal rMedicare? r- rCORRECT✅✅Under rOriginal
rMedicare, rthere ris ra rsingle rdeductible ramount rdue rfor rthe rfirst r60 rdays rof rany
rinpatient rhospital rstay, rafter rwhich rit rconverts rinto ra rper-day rcoinsurance ramount
rthrough rday r90. rAfter rday r90, rhe rwould rpay ra rdaily ramount rup rto r60 rdays rover rhis
rlifetime, rafter rwhich rhe rwould rbe rresponsible rfor rall rcosts.
What rimpact, rif rany, rhave rrecent rregulatory rchanges rhad ron rMedigap rplans? r-
rCORRECT✅✅The rPart rB rdeductible ris rno rlonger rcovered rfor rindividuals rnewly
religible rfor rMedicare rstarting rJanuary r1, r2020.
Mrs. rPaterson ris rconcerned rabout rthe rdeductibles rand rco-payments rassociated rwith
rOriginal rMedicare. rWhat rcan ryou rtell rher rabout rMedigap ras ran roption rto raddress
rthis rconcern? r- rCORRECT✅✅Medigap rplans rdo rnot rcover rOriginal rMedicare
rbenefits, rbut rthey rcoordinate rwith rOriginal rMedicare rcoverage.
Mrs. rTurner ris rcomparing rher remployer's rretiree rinsurance rto rOriginal rMedicare rand
rwould rlike rto rknow rwhich rof rthe rfollowing rservices rOriginal rMedicare rwill rcover rif rthe
rappropriate rcriteria rare rmet. rWhat rcould ryou rtell rher? r- rCORRECT✅✅Original
rMedicare rcovers rambulance rservices.
Ms. rBrooks rhas raggressive rcancer rand rwould rlike rto rknow rif rMedicare rwill rcover
rhospice rservices rin rcase rshe rneeds rthem. rWhat rshould ryou rtell rher? r-
rCORRECT✅✅Medicare rcovers rhospice rservices, rand rthey rwill rbe ravailable rfor
rher.
Mr. rDiaz rcontinued rworking rwith rhis rcompany rand rwas rinsured runder rhis remployer's
rgroup rplan runtil rhe rreached rage r68. rHe rhas rheard rthat rthere ris ra rpremium rpenalty
rfor rthose rwho rdid rnot rsign rup rfor rPart rB rwhen rfirst religible rand rwants rto rknow rhow
rmuch rhe rwill rhave rto rpay. rWhat rshould ryou rtell rhim? r- rCORRECT✅✅Mr. rDiaz rwill
rnot rpay rany rpenalty rbecause rhe rhad rcontinuous rcoverage runder rhis remployer's
rplan.
Anita rMagri rwill rturn rage r65 rin rAugust r2023. rAnita rintends rto renroll rin rOriginal
rMedicare rPart rA rand rPart rB. rShe rwould ralso rlike rto renroll rin ra rMedicare
rSupplement r(Medigap) rplan. rAnita's rolder rneighbor rMel rhas rtold rher rabout rthe
rMedigap rPlan rF rin rwhich rhe ris renrolled. rIt rnot ronly rprovides rforeign rtravel
remergency rbenefits rbut ralso rcovers rhis rMedicare rPart rB rdeductible. rAnita rcomes rto
ryou rfor radvice. rWhat rshould ryou rtell rher? r- rCORRECT✅✅You rare rsorry rto
rdisappoint rAnita, rbut ra rMedigap rF rplan ris rno rlonger ravailable rto rthose rwho rturn rage
r65 rafter rJanuary r1, r2020. rAnita rmight rinstead rconsider rother rMedigap rplans rthat
roffer rforeign rtravel rbenefits rbut rdo rnot rcover rthe rPart rB rdeductible.
ANSWERS GRADED A+
Mrs. rShields ris rcovered rby rOriginal rMedicare. rShe rsustained ra rhip rfracture rand ris
rbeing rsuccessfully rtreated rfor rthat rcondition. rHowever, rshe rand rher rphysicians rfeel
rthat rafter rher rlengthy rhospital rstay, rshe rwill rneed ra rmonth ror rtwo rof rnursing rand
rrehabilitative rcare. rWhat rshould ryou rtell rthem rabout rOriginal rMedicare's rcoverage rof
rcare rin ra rskilled rnursing rfacility? r- rCORRECT✅✅Medicare rwill rcover rMrs. rShield's
rskilled rnursing rservices rprovided rduring rthe rfirst r20 rdays rof rher rstay, rafter rwhich
rshe rwould rhave ra rcopay runtil rshe rhas rbeen rin rthe rfacility rfor r100 rdays.
Mrs. rWest rwears rglasses rand rdentures rand rhas renjoyed rconsiderable rpain rrelief
rfrom rarthritis rthrough rmassage rtherapy. rShe ris rconcerned rabout rwhether ror rnot
rMedicare rwill rcover rthese ritems rand rservices. rWhat rshould ryou rtell rher? r-
rCORRECT✅✅Medicare rdoes rnot rcover rmassage rtherapy, ror, rin rgeneral, rglasses
ror rdentures.
Mrs. rPark ris ran relderly rretiree. rMrs. rPark rhas ra rlow rfixed rincome. rWhat rcould ryou
rtell rMrs. rPark rthat rmight rbe rof rassistance? r- rCORRECT✅✅She rshould rcontact rher
rstate rMedicaid ragency rto rsee rif rshe rqualifies rfor rone rof rseveral rprograms rthat rcan
rhelp rwith rMedicare rcosts rfor rwhich rshe ris rresponsible.
Mr. rAlonso rreceives rsome rhelp rpaying rfor rhis rtwo rgeneric rprescription rdrugs rfrom
rhis remployer's rretiree rcoverage, rbut rhe rwants rto rcompare rit rto ra rPart rD rprescription
rdrug rplan. rHe rasks ryou rwhat rcosts rhe rwould rgenerally rexpect rto rencounter rwhen
renrolling rinto ra rstandard rMedicare rPart rD rprescription rdrug rplan. rWhat rshould ryou
rtell rhim? r- rCORRECT✅✅He rgenerally rwould rpay ra rmonthly rpremium, rannual
rdeductible, rand rper-prescription rcost-sharing.
Mrs. rGonzalez ris renrolled rin rOriginal rMedicare rand rhas ra rMedigap rpolicy ras rwell,
rbut rit rprovides rno rdrug rcoverage. rShe rwould rlike rto rkeep rthe rcoverage rshe rhas rbut
rreplace rher rexisting rMedigap rplan rwith rone rthat rprovides rdrug rcoverage. rWhat
rshould ryou rtell rher? r- rCORRECT✅✅Mrs. rGonzalez rcannot rpurchase ra rMedigap
rplan rthat rcovers rdrugs, rbut rshe rcould rkeep rher rMedigap rpolicy rand renroll rin ra rPart
rD rprescription rdrug rplan.
Mr. rDavis ris r52 ryears rold rand rhas rrecently rbeen rdiagnosed rwith rend-stage rrenal
rdisease r(ESRD) rand rwill rsoon rbegin rdialysis. rHe ris rwondering rif rhe rcan robtain
rcoverage runder rMedicare. rWhat rshould ryou rtell rhim? r- rCORRECT✅✅He rmay
rsign-up rfor rMedicare rat rany rtime rhowever rcoverage rusually rbegins ron rthe rfourth
rmonth rafter rdialysis rtreatments rstart.
Mrs. rDuarte ris renrolled rin rOriginal rMedicare rParts rA rand rB. rShe rhas rrecently
rreviewed rher rMedicare rSummary rNotice r(MSN) rand rdisagrees rwith ra rdetermination
,rthat rpartially rdenied rone rof rher rclaims rfor rservices. rWhat radvice rwould ryou rgive
rher? r- rCORRECT✅✅Mrs. rDuarte rshould rfile ran rappeal rof rthis rinitial rdetermination
rwithin r120 rdays rof rthe rdate rshe rreceived rthe rMSN rin rthe rmail.
Mrs. rGeisler's rneighbor rtold rher rshe rshould rlook rat rher rPart rD roptions rduring rthe
rannual rMedicare renrollment rperiod rbecause rthe rfeatures rof rPart rD rmight rhave
rchanged. rMrs. rGeisler rcan't rremember rwhat rPart rD ris rso rshe rcalled ryou rto rask
rwhat rher rneighbor rwas rtalking rabout. rWhat rcould ryou rtell rher? r-
rCORRECT✅✅Part rD rcovers rprescription rdrugs rand rshe rshould rlook rat rher
rpremiums, rformulary, rand rcost-sharing ramong rother rfactors rto rsee rif rthey rhave
rchanged.
Mr. rRainey ris rexperiencing rparanoid rdelusions rand rhis rphysician rfeels rthat rhe rshould
rbe rhospitalized. rWhat rshould ryou rtell rMr. rRainey r(or rhis rrepresentative) rabout rthe
rlength rof ran rinpatient rpsychiatric rhospital rstay rthat rMedicare rwill rcover? r-
rCORRECT✅✅Medicare rwill rcover ra rtotal rof r190 rdays rof rinpatient rpsychiatric rcare
rduring rMr. rRainey's rentire rlifetime.
Mr. rXi rwill rsoon rturn rage r65 rand rhas rcome rto ryou rfor radvice ras rto rwhat rservices
rare rprovided runder rOriginal rMedicare. rWhat rshould ryou rtell rMr. rXi rthat rbest
rdescribes rthe rhealth rcoverage rprovided rto rMedicare rbeneficiaries? r-
rCORRECT✅✅Beneficiaries runder rOriginal rMedicare rhave rno rcost-sharing rfor rmost
rpreventive rservices.
Mr. rSingh rwould rlike rdrug rcoverage rbut rdoes rnot rwant rto rbe renrolled rin ra rMedicare
rAdvantage rplan. rWhat rshould ryou rtell rhim? r- rCORRECT✅✅Mr. rSingh rcan renroll
rin ra rstand-alone rprescription rdrug rplan rand rcontinue rto rbe rcovered rfor rPart rA rand
rPart rB rservices rthrough rOriginal rFee-for-Service rMedicare.
Mrs. rChen rwill rbe r65 rsoon, rhas rbeen ra rcitizen rfor rtwelve ryears, rhas rbeen remployed
rfull rtime, rand rpaid rtaxes rduring rthat rentire rperiod. rShe ris rconcerned rthat rshe rwill rnot
rqualify rfor rcoverage runder rpart rA rbecause rshe rwas rnot rborn rin rthe rUnited rStates.
rWhat rshould ryou rtell rher? r- rCORRECT✅✅Most rindividuals rwho rare rcitizens rand
rage r65 ror rover rare rcovered runder rPart rA rby rvirtue rof rhaving rpaid rMedicare rtaxes
rwhile rworking, rthough rsome rmay rbe rcovered ras ra rresult rof rpaying rmonthly
rpremiums.
Mrs. rQuinn rrecently rturned r66 rand rdecided rafter rmany ryears rof rwork rto rretire rand
rbegin rreceiving rSocial rSecurity rbenefits. rShortly rthereafter rMrs. rQuinn rreceived ra
rletter rinforming rher rthat rshe rhad rbeen rautomatically renrolled rin rMedicare rPart rB.
rShe rwants rto runderstand rwhat rthis rmeans. rWhat rshould ryou rtell rMrs. rQuinn? r-
rCORRECT✅✅Part rB rprimarily rcovers rphysician rservices. rShe rwill rbe rpaying ra
rmonthly rpremium rand, rexcept rfor rmany rpreventive rand rscreening rtests, rgenerally
rwill rhave r20% rco-payments rfor rthese rservices, rin raddition rto ran rannual rdeductible.
, Mr. rPatel ris rin rgood rhealth rand ris rpreparing ra rbudget rin ranticipation rof rhis rretirement
rwhen rhe rturns r66. rHe rwants rto runderstand rthe rhealth rcare rcosts rhe rmight rbe
rexposed rto runder rMedicare rif rhe rwere rto rrequire rhospitalization rbecause rof ran
rillness. rIn rgeneral rterms, rwhat rcould ryou rtell rhim rabout rhis rcosts rfor rinpatient
rhospital rservices runder rOriginal rMedicare? r- rCORRECT✅✅Under rOriginal
rMedicare, rthere ris ra rsingle rdeductible ramount rdue rfor rthe rfirst r60 rdays rof rany
rinpatient rhospital rstay, rafter rwhich rit rconverts rinto ra rper-day rcoinsurance ramount
rthrough rday r90. rAfter rday r90, rhe rwould rpay ra rdaily ramount rup rto r60 rdays rover rhis
rlifetime, rafter rwhich rhe rwould rbe rresponsible rfor rall rcosts.
What rimpact, rif rany, rhave rrecent rregulatory rchanges rhad ron rMedigap rplans? r-
rCORRECT✅✅The rPart rB rdeductible ris rno rlonger rcovered rfor rindividuals rnewly
religible rfor rMedicare rstarting rJanuary r1, r2020.
Mrs. rPaterson ris rconcerned rabout rthe rdeductibles rand rco-payments rassociated rwith
rOriginal rMedicare. rWhat rcan ryou rtell rher rabout rMedigap ras ran roption rto raddress
rthis rconcern? r- rCORRECT✅✅Medigap rplans rdo rnot rcover rOriginal rMedicare
rbenefits, rbut rthey rcoordinate rwith rOriginal rMedicare rcoverage.
Mrs. rTurner ris rcomparing rher remployer's rretiree rinsurance rto rOriginal rMedicare rand
rwould rlike rto rknow rwhich rof rthe rfollowing rservices rOriginal rMedicare rwill rcover rif rthe
rappropriate rcriteria rare rmet. rWhat rcould ryou rtell rher? r- rCORRECT✅✅Original
rMedicare rcovers rambulance rservices.
Ms. rBrooks rhas raggressive rcancer rand rwould rlike rto rknow rif rMedicare rwill rcover
rhospice rservices rin rcase rshe rneeds rthem. rWhat rshould ryou rtell rher? r-
rCORRECT✅✅Medicare rcovers rhospice rservices, rand rthey rwill rbe ravailable rfor
rher.
Mr. rDiaz rcontinued rworking rwith rhis rcompany rand rwas rinsured runder rhis remployer's
rgroup rplan runtil rhe rreached rage r68. rHe rhas rheard rthat rthere ris ra rpremium rpenalty
rfor rthose rwho rdid rnot rsign rup rfor rPart rB rwhen rfirst religible rand rwants rto rknow rhow
rmuch rhe rwill rhave rto rpay. rWhat rshould ryou rtell rhim? r- rCORRECT✅✅Mr. rDiaz rwill
rnot rpay rany rpenalty rbecause rhe rhad rcontinuous rcoverage runder rhis remployer's
rplan.
Anita rMagri rwill rturn rage r65 rin rAugust r2023. rAnita rintends rto renroll rin rOriginal
rMedicare rPart rA rand rPart rB. rShe rwould ralso rlike rto renroll rin ra rMedicare
rSupplement r(Medigap) rplan. rAnita's rolder rneighbor rMel rhas rtold rher rabout rthe
rMedigap rPlan rF rin rwhich rhe ris renrolled. rIt rnot ronly rprovides rforeign rtravel
remergency rbenefits rbut ralso rcovers rhis rMedicare rPart rB rdeductible. rAnita rcomes rto
ryou rfor radvice. rWhat rshould ryou rtell rher? r- rCORRECT✅✅You rare rsorry rto
rdisappoint rAnita, rbut ra rMedigap rF rplan ris rno rlonger ravailable rto rthose rwho rturn rage
r65 rafter rJanuary r1, r2020. rAnita rmight rinstead rconsider rother rMedigap rplans rthat
roffer rforeign rtravel rbenefits rbut rdo rnot rcover rthe rPart rB rdeductible.
