1|Page
AHIP FINAL EXAM 2025 ACTUAL EXAM CURRENTLY TESTING
COMPLETE QUESTIONS WITH DETAILED VERIFIED ANSWERS
|GRADED A+
. West wears glasses and dentures and has enjoyed considerable pain relief from arthritis through
acupuncture. She is concerned about whether or not Medicare will cover these items and
services. What should you tell her?
Medicare does not cover acupuncture, or, in general, glasses or dentures.
Mr. Chen has heard about Medical Savings Account (MSA), but wants to know if it is just about
saving money, or if he will get insurance coverage for his health care expenditures as well. What
should you tell him?
Under the Medicare Advantage program. an MSA plan involves the combination of high
deductible health plan and savings account for health expenses. Medicare will make
contributions to this savings account to help him pay his health care expenses while in the
deductible.
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 over age 65 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.
Ms. Edwards is enrolled in a Medicare Advantage plan that includes prescription drug plan
(PDP) coverage. She is traveling and wishes to fill two of her prescriptions that she has lost.
How would you advise her?
She may fill prescriptions for covered drugs at non-network pharmacies, but likely at a higher
cost than paid at an in-network pharmacy.
Mr. Rockwell, age 67, is enrolled in Medicare Part A, but because he continues to work and is
covered by an employer health plan, he has not enrolled in Part B or Part D. He receives a notice
on June 1 that his employer is cutting back on prescription drug benefits and that as of July 1 his
coverage will no longer be creditable. He has come to you for advice. What advice would you
give Mr. Rockwell about special enrollment periods (SEPs)?
Mr. Rockwell is eligible for a SEP due to his involuntary loss of creditable drug coverage; the
SEP begins in June and ends September 1 - two months after the loss of creditable coverage.
, 2|Page
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.
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.
Mr. and Mrs. Nunez attended one of your sales presentations. They've asked you to come to their
home to clear up a few questions. During the presentation, Mrs. Nunez feels tired and tells you
that her husband can finish things up. She goes to bed. At the end of your discussion, Mr. Nunez
says that he wants to enroll both himself and his wife. What should you do?
As long as she is able to do so, only Mrs. Nunez can sign her enrollment form. Mrs. Nunez will
have to wake up to sign her form or do so at another time.
Mr. Cole has been a Medicaid beneficiary for some time, and recently qualified for Medicare as
well. He is concerned about changes in his cost-sharing. What should you tell him?
He should know that Medicaid will pay cost sharing only for services provided by Medicaid
participating providers.
Mr. Bickford did not quite qualify for the extra help low-income subsidy under the Medicare Part
D Prescription Drug program and he is wondering if there is any other option he has for
obtaining help with his considerable drug costs. What should you tell him?
He could check with the manufacturers of his medications to see if they offer an assistance
program to help people with limited means obtain the medications they need. Alternatively, he
could check to see whether his state has a pharmacy assistance program to help him with his
expenses.
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 in one of the MA plans that include prescription drug coverage or a Medigap
plan and a stand-alone prescription drug plan, but he cannot enroll in the MA-only PPO plan and
a stand-alone prescription drug plan.
AHIP FINAL EXAM 2025 ACTUAL EXAM CURRENTLY TESTING
COMPLETE QUESTIONS WITH DETAILED VERIFIED ANSWERS
|GRADED A+
. West wears glasses and dentures and has enjoyed considerable pain relief from arthritis through
acupuncture. She is concerned about whether or not Medicare will cover these items and
services. What should you tell her?
Medicare does not cover acupuncture, or, in general, glasses or dentures.
Mr. Chen has heard about Medical Savings Account (MSA), but wants to know if it is just about
saving money, or if he will get insurance coverage for his health care expenditures as well. What
should you tell him?
Under the Medicare Advantage program. an MSA plan involves the combination of high
deductible health plan and savings account for health expenses. Medicare will make
contributions to this savings account to help him pay his health care expenses while in the
deductible.
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 over age 65 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.
Ms. Edwards is enrolled in a Medicare Advantage plan that includes prescription drug plan
(PDP) coverage. She is traveling and wishes to fill two of her prescriptions that she has lost.
How would you advise her?
She may fill prescriptions for covered drugs at non-network pharmacies, but likely at a higher
cost than paid at an in-network pharmacy.
Mr. Rockwell, age 67, is enrolled in Medicare Part A, but because he continues to work and is
covered by an employer health plan, he has not enrolled in Part B or Part D. He receives a notice
on June 1 that his employer is cutting back on prescription drug benefits and that as of July 1 his
coverage will no longer be creditable. He has come to you for advice. What advice would you
give Mr. Rockwell about special enrollment periods (SEPs)?
Mr. Rockwell is eligible for a SEP due to his involuntary loss of creditable drug coverage; the
SEP begins in June and ends September 1 - two months after the loss of creditable coverage.
, 2|Page
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.
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.
Mr. and Mrs. Nunez attended one of your sales presentations. They've asked you to come to their
home to clear up a few questions. During the presentation, Mrs. Nunez feels tired and tells you
that her husband can finish things up. She goes to bed. At the end of your discussion, Mr. Nunez
says that he wants to enroll both himself and his wife. What should you do?
As long as she is able to do so, only Mrs. Nunez can sign her enrollment form. Mrs. Nunez will
have to wake up to sign her form or do so at another time.
Mr. Cole has been a Medicaid beneficiary for some time, and recently qualified for Medicare as
well. He is concerned about changes in his cost-sharing. What should you tell him?
He should know that Medicaid will pay cost sharing only for services provided by Medicaid
participating providers.
Mr. Bickford did not quite qualify for the extra help low-income subsidy under the Medicare Part
D Prescription Drug program and he is wondering if there is any other option he has for
obtaining help with his considerable drug costs. What should you tell him?
He could check with the manufacturers of his medications to see if they offer an assistance
program to help people with limited means obtain the medications they need. Alternatively, he
could check to see whether his state has a pharmacy assistance program to help him with his
expenses.
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 in one of the MA plans that include prescription drug coverage or a Medigap
plan and a stand-alone prescription drug plan, but he cannot enroll in the MA-only PPO plan and
a stand-alone prescription drug plan.
