AHIP 2025\2026
Module 1,2,3,4$5
QUESTIONS AND ANSWERS
20 QUESTIONS AND ANSWERS IN EACH MODULE ALL
100% VERIFIRED 2025\2026 UPDATE
TABLE OF CONTENT
MODULE 1…………………….5
MODULE 2…………………….8
MODULE 3…………………….11
MODULE 4…………………….14
MODULE 5 ……………………18
Ahip 2025 Module 1
Mr. Xi will soon turn age 65 and has come to you for advice as to what services are provided unde
Original Medicare. What should you tell Mr. Xi that best describes the health coverage provided t
Medicare beneficiaries? - ANS>>Beneficiaries under Original Medicare have no cost-sharing for mos
preventive services
,Mrs. Quinn recently turned 66 and decided after many years of work to begin receiving Social Securit
benefits. Shortly thereafter Mrs. Quinn received a letter informing her that she has been automaticall
enrolled in Medicare Part B. She wants to understand what this means. What should you tell Mrs
Quinn? - ANS>>Part B primarily covers physician services. She will be paying a monthly premium and
except for many preventive screening and tests, generally will have 20 percent co-payments for thes
services in addition to an annual deductible
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 te
him? - ANS>>He may sign up for Medicare at any time however coverage usually begins on the fourt
month after dialysis treatment
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 h
would generally expect to encounter when enrolling into a standard Medicare Part D prescription dru
plan. What should you tell him? - ANS>>He generally would pay a monthly premium, annual deductible
and per-prescription cost sharing.
Ms. Brooks has an aggressive cancer and would like to know if Medicare will cover hospice services i
case she needs them. What should you tell her? - ANS>>Medicare covers hospice services and the
will be available to her.
Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What could you tell Mrs. Park tha
might be of assistance? - ANS>>She should contact her state Medicaid agency to see if she qualifie
for one of several programs that can help with Medicare costs for which she is responsible.
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. Chen will be 65 soon, has been a citizen for twelve years, has been employed full time, and pai
taxes during that entire period. She is concerned that she will not qualify for coverage under part
because she was not born in the United States. What should you tell her? - ANS>>Most individuals wh
are 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.
, Mr. Singh would like drug coverage but does not want to be enrolled in a Medicare Advantage plan
What should you tell him? - ANS>>Mr. Singh can enroll in a stand-alone prescription drug plan an
continue to be covered for Part A and Part B services through Original Fee-for-Service Medicare.
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. 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. 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
prescription drug plan.
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'
skilled nursing services provided during the first 20 days of her stay, after which she would have
copay until she has been in the facility for 100 days.
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. Wha
could you tell her? - ANS>>Original Medicare covers ambulance services.
Mr. Diaz continued working with his company and was insured under his employer's group plan unt
he reached age 68. He has heard that there is a premium penalty for those who did not sign up for Pa
B when first eligible and wants to know how much he will have to pay. What should you tell him?
ANS>>Mr. Diaz will not pay any penalty because he had continuous coverage under his employer'
plan.
Module 1,2,3,4$5
QUESTIONS AND ANSWERS
20 QUESTIONS AND ANSWERS IN EACH MODULE ALL
100% VERIFIRED 2025\2026 UPDATE
TABLE OF CONTENT
MODULE 1…………………….5
MODULE 2…………………….8
MODULE 3…………………….11
MODULE 4…………………….14
MODULE 5 ……………………18
Ahip 2025 Module 1
Mr. Xi will soon turn age 65 and has come to you for advice as to what services are provided unde
Original Medicare. What should you tell Mr. Xi that best describes the health coverage provided t
Medicare beneficiaries? - ANS>>Beneficiaries under Original Medicare have no cost-sharing for mos
preventive services
,Mrs. Quinn recently turned 66 and decided after many years of work to begin receiving Social Securit
benefits. Shortly thereafter Mrs. Quinn received a letter informing her that she has been automaticall
enrolled in Medicare Part B. She wants to understand what this means. What should you tell Mrs
Quinn? - ANS>>Part B primarily covers physician services. She will be paying a monthly premium and
except for many preventive screening and tests, generally will have 20 percent co-payments for thes
services in addition to an annual deductible
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 te
him? - ANS>>He may sign up for Medicare at any time however coverage usually begins on the fourt
month after dialysis treatment
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 h
would generally expect to encounter when enrolling into a standard Medicare Part D prescription dru
plan. What should you tell him? - ANS>>He generally would pay a monthly premium, annual deductible
and per-prescription cost sharing.
Ms. Brooks has an aggressive cancer and would like to know if Medicare will cover hospice services i
case she needs them. What should you tell her? - ANS>>Medicare covers hospice services and the
will be available to her.
Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What could you tell Mrs. Park tha
might be of assistance? - ANS>>She should contact her state Medicaid agency to see if she qualifie
for one of several programs that can help with Medicare costs for which she is responsible.
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. Chen will be 65 soon, has been a citizen for twelve years, has been employed full time, and pai
taxes during that entire period. She is concerned that she will not qualify for coverage under part
because she was not born in the United States. What should you tell her? - ANS>>Most individuals wh
are 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.
, Mr. Singh would like drug coverage but does not want to be enrolled in a Medicare Advantage plan
What should you tell him? - ANS>>Mr. Singh can enroll in a stand-alone prescription drug plan an
continue to be covered for Part A and Part B services through Original Fee-for-Service Medicare.
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. 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. 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
prescription drug plan.
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'
skilled nursing services provided during the first 20 days of her stay, after which she would have
copay until she has been in the facility for 100 days.
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. Wha
could you tell her? - ANS>>Original Medicare covers ambulance services.
Mr. Diaz continued working with his company and was insured under his employer's group plan unt
he reached age 68. He has heard that there is a premium penalty for those who did not sign up for Pa
B when first eligible and wants to know how much he will have to pay. What should you tell him?
ANS>>Mr. Diaz will not pay any penalty because he had continuous coverage under his employer'
plan.
