2025 AHIP FINAL EXAM
VERIFIED QUESTIONS AND
ANSWERS 100% GUARANTEED
PASS
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? \- \ANS-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? \- \ANS-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? \- \ANS-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? \- \ANS-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? \- \ANS-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? \- \ANS-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? \- \ANS-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? \- \ANS-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? \- \ANS-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? \- \ANS-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? \- \ANS-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? \- \ANS-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? \- \ANS-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? \- \ANS-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? \- \ANS-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? \- \ANS-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? \- \ANS-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? \- \ANS-Medicare \covers \hospice \services, \and \they \will \
be \available \for \her.
VERIFIED QUESTIONS AND
ANSWERS 100% GUARANTEED
PASS
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? \- \ANS-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? \- \ANS-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? \- \ANS-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? \- \ANS-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? \- \ANS-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? \- \ANS-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? \- \ANS-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? \- \ANS-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? \- \ANS-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? \- \ANS-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? \- \ANS-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? \- \ANS-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? \- \ANS-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? \- \ANS-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? \- \ANS-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? \- \ANS-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? \- \ANS-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? \- \ANS-Medicare \covers \hospice \services, \and \they \will \
be \available \for \her.
