AHIP 2025 FINAL EXAM VERIFIED Q&A (UPDATED)
Mrs. Shields is covered by Original Medicare. She sustained a hip fracture and is being successfull
treated for that condition. However, she and her physicians feel that after her lengthy hospital stay, sh
will need a month or two of nursing and rehabilitative care. What should you tell them about Origina
Medicare's coverage of care in a skilled nursing facility? - ✔✔ANS Medicare will cover Mrs. Shield's skille
nursing services provided during the first 20 days of her stay, after which she would have a copay unt
she has been in the facility for 100 days.
Mrs. West wears glasses and dentures and has enjoyed considerable pain relief from arthritis throug
massage therapy. She is concerned about whether or not Medicare will cover these items and services
What should you tell her? - ✔✔ANS Medicare does not cover massage therapy, or, in general, glasses o
dentures.
Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What could you tell Mrs. Park that migh
be of assistance? - ✔✔ANS She should contact her state Medicaid agency to see if she qualifies for on
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 retire
coverage, but he wants to compare it to a Part D prescription drug plan. He asks you what costs he woul
generally expect to encounter when enrolling into a standard Medicare Part D prescription drug plan
What should you tell him? - ✔✔ANS He generally would pay a monthly premium, annual deductible, an
per-prescription cost-sharing.
Mrs. Gonzalez is enrolled in Original Medicare and has a Medigap policy as well, but it provides no dru
coverage. She would like to keep the coverage she has but replace her existing Medigap plan with on
that provides drug coverage. What should you tell her? - ✔✔ANS Mrs. Gonzalez cannot purchase
Medigap plan that covers drugs, but she could keep her Medigap policy and enroll in a Part D prescriptio
drug plan.
Mr. Davis is 52 years old and has recently been diagnosed with end-stage renal disease (ESRD) and wi
soon begin dialysis. He is wondering if he can obtain coverage under Medicare. What should you tell him
- ✔✔ANS He may sign-up for Medicare at any time however coverage usually begins on the fourth mont
after dialysis treatments start.
,Mrs. Duarte is enrolled in Original Medicare Parts A and B. She has recently reviewed her Medicar
Summary Notice (MSN) and disagrees with a determination that partially denied one of her claims fo
services. What advice would you give her? - ✔✔ANS Mrs. Duarte should file an appeal of this initia
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 Medicar
enrollment period because the features of Part D might have changed. Mrs. Geisler can't remember wha
Part D is so she called you to ask what her neighbor was talking about. What could you tell her? - ✔✔AN
Part D covers prescription drugs and she should look at her premiums, formulary, and cost-sharin
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 hospita
stay that Medicare will cover? - ✔✔ANS Medicare will cover a total of 190 days of inpatient psychiatri
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 Origina
Medicare. What should you tell Mr. Xi that best describes the health coverage provided to Medicar
beneficiaries? - ✔✔ANS Beneficiaries under Original Medicare have no cost-sharing for most preventiv
services.
Mr. Singh would like drug coverage but does not want to be enrolled in a Medicare Advantage plan. Wha
should you tell him? - ✔✔ANS Mr. Singh can enroll in a stand-alone prescription drug plan and continu
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 taxe
during that entire period. She is concerned that she will not qualify for coverage under part A becaus
she was not born in the United States. What should you tell her? - ✔✔ANS Most individuals who ar
citizens and age 65 or over are covered under Part A by virtue of having paid Medicare taxes whil
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 Socia
Security benefits. Shortly thereafter Mrs. Quinn received a letter informing her that she had bee
automatically enrolled in Medicare Part B. She wants to understand what this means. What should yo
tell Mrs. Quinn? - ✔✔ANS Part B primarily covers physician services. She will be paying a monthl
premium and, except for many preventive and screening tests, generally will have 20% co-payments fo
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 requir
hospitalization because of an illness. In general terms, what could you tell him about his costs fo
inpatient hospital services under Original Medicare? - ✔✔ANS Under Original Medicare, there is a singl
, deductible amount due for the first 60 days of any inpatient hospital stay, after which it converts into
per-day coinsurance amount through day 90. After day 90, he would pay a daily amount up to 60 day
over his lifetime, after which he would be responsible for all costs.
What impact, if any, have recent regulatory changes had on Medigap plans? - ✔✔ANS The Part
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? - ✔✔ANS Medigap plans d
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 coul
you tell her? - ✔✔ANS Original Medicare covers ambulance services.
Ms. Brooks has aggressive cancer and would like to know if Medicare will cover hospice services in cas
she needs them. What should you tell her? - ✔✔ANS Medicare covers hospice services, and they will b
available for her.
Mr. Diaz continued working with his company and was insured under his employer's group plan until h
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? - ✔✔AN
Mr. Diaz will not pay any penalty because he had continuous coverage under his employer's plan.
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 ha
told her about the Medigap Plan F in which he is enrolled. It not only provides foreign travel emergenc
benefits but also covers his Medicare Part B deductible. Anita comes to you for advice. What should yo
tell her? - ✔✔ANS You are sorry to disappoint Anita, but a Medigap F plan is no longer available to thos
who turn age 65 after January 1, 2020. Anita might instead consider other Medigap plans that offer foreig
travel benefits but do not cover the Part B deductible.
Hank's Fish Store, Inc. is a small company with just 15 employees located in Florida. Hank, the stor
owner, has provided excellent health benefits to the store's workforce. William, one of the store's long
time employees, will soon be reaching age 65 and eligible for Medicare. William is in good health. H
intends to remain an active full-time employee, working several years after becoming eligible fo
Medicare. What type(s) of retiree health benefit will Hank's Fish Store be able to offer William? - ✔✔AN
Hank's can continue to offer William the same employee health benefit plan, or, if William enrolls i
Medicare Part B, it can enroll him in a Medicare Advantage plan that is offered to the public.
Mrs. Shields is covered by Original Medicare. She sustained a hip fracture and is being successfull
treated for that condition. However, she and her physicians feel that after her lengthy hospital stay, sh
will need a month or two of nursing and rehabilitative care. What should you tell them about Origina
Medicare's coverage of care in a skilled nursing facility? - ✔✔ANS Medicare will cover Mrs. Shield's skille
nursing services provided during the first 20 days of her stay, after which she would have a copay unt
she has been in the facility for 100 days.
Mrs. West wears glasses and dentures and has enjoyed considerable pain relief from arthritis throug
massage therapy. She is concerned about whether or not Medicare will cover these items and services
What should you tell her? - ✔✔ANS Medicare does not cover massage therapy, or, in general, glasses o
dentures.
Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What could you tell Mrs. Park that migh
be of assistance? - ✔✔ANS She should contact her state Medicaid agency to see if she qualifies for on
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 retire
coverage, but he wants to compare it to a Part D prescription drug plan. He asks you what costs he woul
generally expect to encounter when enrolling into a standard Medicare Part D prescription drug plan
What should you tell him? - ✔✔ANS He generally would pay a monthly premium, annual deductible, an
per-prescription cost-sharing.
Mrs. Gonzalez is enrolled in Original Medicare and has a Medigap policy as well, but it provides no dru
coverage. She would like to keep the coverage she has but replace her existing Medigap plan with on
that provides drug coverage. What should you tell her? - ✔✔ANS Mrs. Gonzalez cannot purchase
Medigap plan that covers drugs, but she could keep her Medigap policy and enroll in a Part D prescriptio
drug plan.
Mr. Davis is 52 years old and has recently been diagnosed with end-stage renal disease (ESRD) and wi
soon begin dialysis. He is wondering if he can obtain coverage under Medicare. What should you tell him
- ✔✔ANS He may sign-up for Medicare at any time however coverage usually begins on the fourth mont
after dialysis treatments start.
,Mrs. Duarte is enrolled in Original Medicare Parts A and B. She has recently reviewed her Medicar
Summary Notice (MSN) and disagrees with a determination that partially denied one of her claims fo
services. What advice would you give her? - ✔✔ANS Mrs. Duarte should file an appeal of this initia
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 Medicar
enrollment period because the features of Part D might have changed. Mrs. Geisler can't remember wha
Part D is so she called you to ask what her neighbor was talking about. What could you tell her? - ✔✔AN
Part D covers prescription drugs and she should look at her premiums, formulary, and cost-sharin
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 hospita
stay that Medicare will cover? - ✔✔ANS Medicare will cover a total of 190 days of inpatient psychiatri
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 Origina
Medicare. What should you tell Mr. Xi that best describes the health coverage provided to Medicar
beneficiaries? - ✔✔ANS Beneficiaries under Original Medicare have no cost-sharing for most preventiv
services.
Mr. Singh would like drug coverage but does not want to be enrolled in a Medicare Advantage plan. Wha
should you tell him? - ✔✔ANS Mr. Singh can enroll in a stand-alone prescription drug plan and continu
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 taxe
during that entire period. She is concerned that she will not qualify for coverage under part A becaus
she was not born in the United States. What should you tell her? - ✔✔ANS Most individuals who ar
citizens and age 65 or over are covered under Part A by virtue of having paid Medicare taxes whil
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 Socia
Security benefits. Shortly thereafter Mrs. Quinn received a letter informing her that she had bee
automatically enrolled in Medicare Part B. She wants to understand what this means. What should yo
tell Mrs. Quinn? - ✔✔ANS Part B primarily covers physician services. She will be paying a monthl
premium and, except for many preventive and screening tests, generally will have 20% co-payments fo
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 requir
hospitalization because of an illness. In general terms, what could you tell him about his costs fo
inpatient hospital services under Original Medicare? - ✔✔ANS Under Original Medicare, there is a singl
, deductible amount due for the first 60 days of any inpatient hospital stay, after which it converts into
per-day coinsurance amount through day 90. After day 90, he would pay a daily amount up to 60 day
over his lifetime, after which he would be responsible for all costs.
What impact, if any, have recent regulatory changes had on Medigap plans? - ✔✔ANS The Part
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? - ✔✔ANS Medigap plans d
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 coul
you tell her? - ✔✔ANS Original Medicare covers ambulance services.
Ms. Brooks has aggressive cancer and would like to know if Medicare will cover hospice services in cas
she needs them. What should you tell her? - ✔✔ANS Medicare covers hospice services, and they will b
available for her.
Mr. Diaz continued working with his company and was insured under his employer's group plan until h
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? - ✔✔AN
Mr. Diaz will not pay any penalty because he had continuous coverage under his employer's plan.
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 ha
told her about the Medigap Plan F in which he is enrolled. It not only provides foreign travel emergenc
benefits but also covers his Medicare Part B deductible. Anita comes to you for advice. What should yo
tell her? - ✔✔ANS You are sorry to disappoint Anita, but a Medigap F plan is no longer available to thos
who turn age 65 after January 1, 2020. Anita might instead consider other Medigap plans that offer foreig
travel benefits but do not cover the Part B deductible.
Hank's Fish Store, Inc. is a small company with just 15 employees located in Florida. Hank, the stor
owner, has provided excellent health benefits to the store's workforce. William, one of the store's long
time employees, will soon be reaching age 65 and eligible for Medicare. William is in good health. H
intends to remain an active full-time employee, working several years after becoming eligible fo
Medicare. What type(s) of retiree health benefit will Hank's Fish Store be able to offer William? - ✔✔AN
Hank's can continue to offer William the same employee health benefit plan, or, if William enrolls i
Medicare Part B, it can enroll him in a Medicare Advantage plan that is offered to the public.
