2025 AHIP - FINAL EXAM Q AND A
Mr.nkRaineynkisnkexperiencingnkparanoidnkdelusionsnkandnkhisnkphysiciannkfeelsnkthatnkhenk
shouldnkbenkhospitalized.nkWhatnkshouldnkyounktellnkMr.nkRaineynk(ornkhisnkrepresentative)
nkaboutnkthenklengthnkofnkannkinpatientnkpsychiatricnkhospitalnkstaynkthatnkMedicarenkwillnkco
ver?
Questionnk1Answera.Medicarenkwillnkcovernkanktotalnkofnk190nkdaysnkofnkinpatientnkpsychia
tricnkcarenkduringnkMr.nkRainey'snkentirenklifetime.b.Medicarenkwillnkcover,nkatnkitsnkallowabl
enkamount,nkasnkmanynkstaysnkasnkarenkneedednkthroughoutnkMr.nkRainey'snklife,nkasnklongn
kasnknonksinglenkstaynkexceedsnk190nkdays.c.Medicarenkinpatientnkpsychiatricnkcoveragenk
isnklimitednktonkthenksamenknumbernkofnkdaysnkcoverednkfornktypicalnkinpatientnkstays.d.Inp
atientnkpsychiatricnkservicesnkarenknotnkcoverednkundernkOriginalnkMedicare.nk-nkanswer--
a
Mrs.nkGeisler'snkneighbornktoldnkhernkshenkshouldnklooknkatnkhernkPartnkDnkoptionsnkduringnk
thenkannualnkMedicarenkenrollmentnkperiodnkbecausenkthenkfeaturesnkofnkPartnkDnkmightnkh
avenkchanged.nkMrs.nkGeislernkcan'tnkremembernkwhatnkPartnkDnkisnksonkshenkcallednkyounkt
onkasknkwhatnkhernkneighbornkwasnktalkingnkabout.nkWhatnkcouldnkyounktellnkher?
Questionnk2Answera.PartnkDnkcoversnkprescriptionnkdrugsnkandnkshenkshouldnklooknkatnkh
ernkpremiums,nkformulary,nkandnkcost-
sharingnkamongnkothernkfactorsnktonkseenkifnktheynkhavenkchanged.b.PartnkDnkcoversnkphys
iciannkandnknon-
physiciannkpractitionernkservicesnkandnkthenkdeductiblenkhasnknotnkchangednkthisnkyear,nkb
utnkthenkphysiciannkchargesnkmaynkgonkup.c.PartnkDnkcoversnklong-
termnkcarenkservices,nkandnkshenkshouldnknotnkworrynkbecausenktherenkhasnkbeennknonkcha
ngenkinnkcoverage.nkd.PartnkDnkcoversnkhospitalnkandnkhomenkhealthnkservicesnkandnkthenk
cost-sharingnkhasnkchangednkthisnkyear.nk-nkanswer--a
Mrs.nkGonzaleznkisnkenrollednkinnkOriginalnkMedicarenkandnkhasnkankMedigapnkpolicynkasnk
well,nkbutnkitnkprovidesnknonkdrugnkcoverage.nkShenkwouldnklikenktonkkeepnkthenkcoveragenks
henkhasnkbutnkreplacenkhernkexistingnkMedigapnkplannkwithnkonenkthatnkprovidesnkdrugnkcov
erage.nkWhatnkshouldnkyounktellnkher?
Questionnk3Answera.MedigapnkisnkankreplacementnkfornkOriginalnkMedicarenkandnkshenkh
asnkbeennkpayingnkfornkdoublenkcoverage.nkShenkshouldnksimplynkdropnkhernkMedigapnkpoli
cy.b.Mrs.nkGonzaleznkcannotnkpurchasenkankMedigapnkplannkthatnkcoversnkdrugs,nkbutnksh
enkcouldnkkeepnkhernkMedigapnkpolicynkandnkenrollnkinnkankPartnkDnkprescriptionnkdrugnkplan
.c.Mrs.nkGonzaleznkcannkpurchasenkankMedigapnkplannkthatnkcoversnkdrugs,nkbutnkitnklikelyn
kwillnknotnkoffernkcoveragenkthatnkisnkequivalentnktonkthatnkprovidednkundernkPartnkD.d.Mrs.nk
GonzaleznkshouldnkpurchasenkankKnkornkLnkMedigapnkplan.nk-nkanswer--b
Mr.nkDavisnkisnk52nkyearsnkoldnkandnkhasnkrecentlynkbeennkdiagnosednkwithnkend-
stagenkrenalnkdiseasenk(ESRD)nkandnkwillnksoonnkbeginnkdialysis.nkHenkisnkwonderingnkifnkh
enkcannkobtainnkcoveragenkundernkMedicare.nkWhatnkshouldnkyounktellnkhim?
Questionnk4Answera.Henkmaynknotnksign-
upnkfornkMedicarenkuntilnkhenkreachesnkagenk62,nkthenkdatenkhenkfirstnkbecomesnkeligiblenkfo
rnkSocialnkSecuritynkbenefits.b.Henkmaynksign-
Mr.nkRaineynkisnkexperiencingnkparanoidnkdelusionsnkandnkhisnkphysiciannkfeelsnkthatnkhenk
shouldnkbenkhospitalized.nkWhatnkshouldnkyounktellnkMr.nkRaineynk(ornkhisnkrepresentative)
nkaboutnkthenklengthnkofnkannkinpatientnkpsychiatricnkhospitalnkstaynkthatnkMedicarenkwillnkco
ver?
Questionnk1Answera.Medicarenkwillnkcovernkanktotalnkofnk190nkdaysnkofnkinpatientnkpsychia
tricnkcarenkduringnkMr.nkRainey'snkentirenklifetime.b.Medicarenkwillnkcover,nkatnkitsnkallowabl
enkamount,nkasnkmanynkstaysnkasnkarenkneedednkthroughoutnkMr.nkRainey'snklife,nkasnklongn
kasnknonksinglenkstaynkexceedsnk190nkdays.c.Medicarenkinpatientnkpsychiatricnkcoveragenk
isnklimitednktonkthenksamenknumbernkofnkdaysnkcoverednkfornktypicalnkinpatientnkstays.d.Inp
atientnkpsychiatricnkservicesnkarenknotnkcoverednkundernkOriginalnkMedicare.nk-nkanswer--
a
Mrs.nkGeisler'snkneighbornktoldnkhernkshenkshouldnklooknkatnkhernkPartnkDnkoptionsnkduringnk
thenkannualnkMedicarenkenrollmentnkperiodnkbecausenkthenkfeaturesnkofnkPartnkDnkmightnkh
avenkchanged.nkMrs.nkGeislernkcan'tnkremembernkwhatnkPartnkDnkisnksonkshenkcallednkyounkt
onkasknkwhatnkhernkneighbornkwasnktalkingnkabout.nkWhatnkcouldnkyounktellnkher?
Questionnk2Answera.PartnkDnkcoversnkprescriptionnkdrugsnkandnkshenkshouldnklooknkatnkh
ernkpremiums,nkformulary,nkandnkcost-
sharingnkamongnkothernkfactorsnktonkseenkifnktheynkhavenkchanged.b.PartnkDnkcoversnkphys
iciannkandnknon-
physiciannkpractitionernkservicesnkandnkthenkdeductiblenkhasnknotnkchangednkthisnkyear,nkb
utnkthenkphysiciannkchargesnkmaynkgonkup.c.PartnkDnkcoversnklong-
termnkcarenkservices,nkandnkshenkshouldnknotnkworrynkbecausenktherenkhasnkbeennknonkcha
ngenkinnkcoverage.nkd.PartnkDnkcoversnkhospitalnkandnkhomenkhealthnkservicesnkandnkthenk
cost-sharingnkhasnkchangednkthisnkyear.nk-nkanswer--a
Mrs.nkGonzaleznkisnkenrollednkinnkOriginalnkMedicarenkandnkhasnkankMedigapnkpolicynkasnk
well,nkbutnkitnkprovidesnknonkdrugnkcoverage.nkShenkwouldnklikenktonkkeepnkthenkcoveragenks
henkhasnkbutnkreplacenkhernkexistingnkMedigapnkplannkwithnkonenkthatnkprovidesnkdrugnkcov
erage.nkWhatnkshouldnkyounktellnkher?
Questionnk3Answera.MedigapnkisnkankreplacementnkfornkOriginalnkMedicarenkandnkshenkh
asnkbeennkpayingnkfornkdoublenkcoverage.nkShenkshouldnksimplynkdropnkhernkMedigapnkpoli
cy.b.Mrs.nkGonzaleznkcannotnkpurchasenkankMedigapnkplannkthatnkcoversnkdrugs,nkbutnksh
enkcouldnkkeepnkhernkMedigapnkpolicynkandnkenrollnkinnkankPartnkDnkprescriptionnkdrugnkplan
.c.Mrs.nkGonzaleznkcannkpurchasenkankMedigapnkplannkthatnkcoversnkdrugs,nkbutnkitnklikelyn
kwillnknotnkoffernkcoveragenkthatnkisnkequivalentnktonkthatnkprovidednkundernkPartnkD.d.Mrs.nk
GonzaleznkshouldnkpurchasenkankKnkornkLnkMedigapnkplan.nk-nkanswer--b
Mr.nkDavisnkisnk52nkyearsnkoldnkandnkhasnkrecentlynkbeennkdiagnosednkwithnkend-
stagenkrenalnkdiseasenk(ESRD)nkandnkwillnksoonnkbeginnkdialysis.nkHenkisnkwonderingnkifnkh
enkcannkobtainnkcoveragenkundernkMedicare.nkWhatnkshouldnkyounktellnkhim?
Questionnk4Answera.Henkmaynknotnksign-
upnkfornkMedicarenkuntilnkhenkreachesnkagenk62,nkthenkdatenkhenkfirstnkbecomesnkeligiblenkfo
rnkSocialnkSecuritynkbenefits.b.Henkmaynksign-
