2025 AHIP Final Exam with Correct
Answers GRADED A+
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? ,- ,CORRECT
,ANSWER-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.
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? ,-
,CORRECT ,ANSWER-Medicare ,does ,not ,cover ,massage ,therapy, ,or, ,in ,general,
,glasses ,or ,dentures.
Mrs. ,Park ,is ,an ,elderly ,retiree. ,Mrs. ,Park ,has ,a ,low ,fixed ,income. ,What ,could
,you ,tell ,Mrs. ,Park ,that ,might ,be ,of ,assistance? ,- ,CORRECT ,ANSWER-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.
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? ,- ,CORRECT ,ANSWER-He ,generally ,would ,pay
,a ,monthly ,premium, ,annual ,deductible, ,and ,per-prescription ,cost-sharing.
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? ,- ,CORRECT ,ANSWER-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.
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? ,- ,CORRECT ,ANSWER-He
,may ,sign-up ,for ,Medicare ,at ,any ,time ,however ,coverage ,usually ,begins ,on ,the
,fourth ,month ,after ,dialysis ,treatments ,start.
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 ,advice
,would ,you ,give ,her? ,- ,CORRECT ,ANSWER-Mrs. ,Duarte ,should ,file ,an ,appeal ,of
,this ,initial ,determination ,within ,120 ,days ,of ,the ,date ,she ,received ,the ,MSN ,in
,the ,mail.
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? ,- ,CORRECT
,ANSWER-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.
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? ,- ,CORRECT ,ANSWER-Medicare ,will ,cover ,a ,total ,of ,190 ,days ,of
,inpatient ,psychiatric ,care ,during ,Mr. ,Rainey's ,entire ,lifetime.
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? ,-
,CORRECT ,ANSWER-Beneficiaries ,under ,Original ,Medicare ,have ,no ,cost-
sharing ,for ,most ,preventive ,services.
Mr. ,Singh ,would ,like ,drug ,coverage ,but ,does ,not ,want ,to ,be ,enrolled ,in ,a
,Medicare ,Advantage ,plan. ,What ,should ,you ,tell ,him? ,- ,CORRECT ,ANSWER-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.
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? ,- ,CORRECT ,ANSWER-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.
, 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? ,- ,CORRECT ,ANSWER-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.
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? ,- ,CORRECT
,ANSWER-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.
What ,impact, ,if ,any, ,have ,recent ,regulatory ,changes ,had ,on ,Medigap ,plans? ,-
,CORRECT ,ANSWER-The ,Part ,B ,deductible ,is ,no ,longer ,covered ,for ,individuals
,newly ,eligible ,for ,Medicare ,starting ,January ,1, ,2020.
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? ,- ,CORRECT ,ANSWER-Medigap ,plans ,do ,not ,cover
,Original ,Medicare ,benefits, ,but ,they ,coordinate ,with ,Original ,Medicare
,coverage.
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? ,- ,CORRECT
,ANSWER-Original ,Medicare ,covers ,ambulance ,services.
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? ,-
,CORRECT ,ANSWER-Medicare ,covers ,hospice ,services, ,and ,they ,will ,be
,available ,for ,her.
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? ,-
,CORRECT ,ANSWER-Mr. ,Diaz ,will ,not ,pay ,any ,penalty ,because ,he ,had
,continuous ,coverage ,under ,his ,employer's ,plan.
Answers GRADED A+
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? ,- ,CORRECT
,ANSWER-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.
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? ,-
,CORRECT ,ANSWER-Medicare ,does ,not ,cover ,massage ,therapy, ,or, ,in ,general,
,glasses ,or ,dentures.
Mrs. ,Park ,is ,an ,elderly ,retiree. ,Mrs. ,Park ,has ,a ,low ,fixed ,income. ,What ,could
,you ,tell ,Mrs. ,Park ,that ,might ,be ,of ,assistance? ,- ,CORRECT ,ANSWER-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.
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? ,- ,CORRECT ,ANSWER-He ,generally ,would ,pay
,a ,monthly ,premium, ,annual ,deductible, ,and ,per-prescription ,cost-sharing.
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? ,- ,CORRECT ,ANSWER-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.
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? ,- ,CORRECT ,ANSWER-He
,may ,sign-up ,for ,Medicare ,at ,any ,time ,however ,coverage ,usually ,begins ,on ,the
,fourth ,month ,after ,dialysis ,treatments ,start.
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 ,advice
,would ,you ,give ,her? ,- ,CORRECT ,ANSWER-Mrs. ,Duarte ,should ,file ,an ,appeal ,of
,this ,initial ,determination ,within ,120 ,days ,of ,the ,date ,she ,received ,the ,MSN ,in
,the ,mail.
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? ,- ,CORRECT
,ANSWER-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.
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? ,- ,CORRECT ,ANSWER-Medicare ,will ,cover ,a ,total ,of ,190 ,days ,of
,inpatient ,psychiatric ,care ,during ,Mr. ,Rainey's ,entire ,lifetime.
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? ,-
,CORRECT ,ANSWER-Beneficiaries ,under ,Original ,Medicare ,have ,no ,cost-
sharing ,for ,most ,preventive ,services.
Mr. ,Singh ,would ,like ,drug ,coverage ,but ,does ,not ,want ,to ,be ,enrolled ,in ,a
,Medicare ,Advantage ,plan. ,What ,should ,you ,tell ,him? ,- ,CORRECT ,ANSWER-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.
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? ,- ,CORRECT ,ANSWER-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.
, 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? ,- ,CORRECT ,ANSWER-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.
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? ,- ,CORRECT
,ANSWER-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.
What ,impact, ,if ,any, ,have ,recent ,regulatory ,changes ,had ,on ,Medigap ,plans? ,-
,CORRECT ,ANSWER-The ,Part ,B ,deductible ,is ,no ,longer ,covered ,for ,individuals
,newly ,eligible ,for ,Medicare ,starting ,January ,1, ,2020.
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? ,- ,CORRECT ,ANSWER-Medigap ,plans ,do ,not ,cover
,Original ,Medicare ,benefits, ,but ,they ,coordinate ,with ,Original ,Medicare
,coverage.
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? ,- ,CORRECT
,ANSWER-Original ,Medicare ,covers ,ambulance ,services.
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? ,-
,CORRECT ,ANSWER-Medicare ,covers ,hospice ,services, ,and ,they ,will ,be
,available ,for ,her.
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? ,-
,CORRECT ,ANSWER-Mr. ,Diaz ,will ,not ,pay ,any ,penalty ,because ,he ,had
,continuous ,coverage ,under ,his ,employer's ,plan.
