2025 AHIP Final Exam
Study online at https://quizlet.com/_fzi650
1. Mrs. Shields is covered by Original Medicare. She Medicare will cover Mrs. Shield's
sustained a hip fracture and is being successful- skilled nursing services provided
ly treated for that condition. However, she and during the first 20 days of her
her physicians feel that after her lengthy hospital stay, after which she would have
stay, she will need a month or two of nursing a copay until she has been in the
and rehabilitative care. What should you tell them facility for 100 days.
about Original Medicare's coverage of care in a
skilled nursing facility?
2. Mrs. West wears glasses and dentures and has Medicare does not cover mas-
enjoyed considerable pain relief from arthri- sage therapy, or, in general,
tis through massage therapy. She is concerned glasses or dentures.
about whether or not Medicare will cover these
items and services. What should you tell her?
3. Mrs. Park is an elderly retiree. Mrs. Park has a low She should contact her state
fixed income. What could you tell Mrs. Park that Medicaid agency to see if she
might be of assistance? qualifies for one of several
programs that can help with
Medicare costs for which she is
responsible.
4. Mr. Alonso receives some help paying for his two He generally would pay a month-
generic prescription drugs from his employer's ly premium, annual deductible,
retiree coverage, but he wants to compare it to a and per-prescription cost-shar-
Part D prescription drug plan. He asks you what ing.
costs he would generally expect to encounter
when enrolling into a standard Medicare Part D
prescription drug plan. What should you tell him?
5. Mrs. Gonzalez is enrolled in Original Medicare Mrs. Gonzalez cannot purchase a
and has a Medigap policy as well, but it provides Medigap plan that covers drugs,
, 2025 AHIP Final Exam
Study online at https://quizlet.com/_fzi650
no drug coverage. She would like to keep the cov- but she could keep her Medigap
erage she has but replace her existing Medigap policy and enroll in a Part D pre-
plan with one that provides drug coverage. What scription drug plan.
should you tell her?
6. Mr. Davis is 52 years old and has recently been He may sign-up for Medicare at
diagnosed with end-stage renal disease (ESRD) any time however coverage usu-
and will soon begin dialysis. He is wondering if ally begins on the fourth month
he can obtain coverage under Medicare. What after dialysis treatments start.
should you tell him?
7. Mrs. Duarte is enrolled in Original Medicare Parts Mrs. Duarte should file an ap-
A and B. She has recently reviewed her Medicare peal of this initial determination
Summary Notice (MSN) and disagrees with a within 120 days of the date she
determination that partially denied one of her received the MSN in the mail.
claims for services. What advice would you give
her?
8. Mrs. Geisler's neighbor told her she should look Part D covers prescription
at her Part D options during the annual Medicare drugs and she should look at
enrollment period because the features of Part D her premiums, formulary, and
might have changed. Mrs. Geisler can't remem- cost-sharing among other fac-
ber what Part D is so she called you to ask what tors to see if they have changed.
her neighbor was talking about. What could you
tell her?
9. Mr. Rainey is experiencing paranoid delusions and Medicare will cover a total of 190
his physician feels that he should be hospitalized. days of inpatient psychiatric care
What should you tell Mr. Rainey (or his represen- during Mr. Rainey's entire life-
tative) about the length of an inpatient psychiatric time.
hospital stay that Medicare will cover?
10.
, 2025 AHIP Final Exam
Study online at https://quizlet.com/_fzi650
Mr. Xi will soon turn age 65 and has come to you Beneficiaries under Original
for advice as to what services are provided under Medicare have no cost-sharing
Original Medicare. What should you tell Mr. Xi that for most preventive services.
best describes the health coverage provided to
Medicare beneficiaries?
11. Mr. Singh would like drug coverage but does not Mr. Singh can enroll in a
want to be enrolled in a Medicare Advantage plan. stand-alone prescription drug
What should you tell him? plan and continue to be covered
for Part A and Part B services
through Original Fee-for-Service
Medicare.
12. Mrs. Chen will be 65 soon, has been a citizen Most individuals who are citizens
for twelve years, has been employed full time, and age 65 or over are covered
and paid taxes during that entire period. She is under Part A by virtue of having
concerned that she will not qualify for coverage paid Medicare taxes while work-
under part A because she was not born in the ing, though some may be cov-
United States. What should you tell her? ered as a result of paying month-
ly premiums.
13. Mrs. Quinn recently turned 66 and decided after Part B primarily covers physi-
many years of work to retire and begin receiving cian services. She will be paying
Social Security benefits. Shortly thereafter Mrs. a monthly premium and, except
Quinn received a letter informing her that she for many preventive and screen-
had been automatically enrolled in Medicare Part ing tests, generally will have 20%
B. She wants to understand what this means. co-payments for these services,
What should you tell Mrs. Quinn? in addition to an annual de-
ductible.
14. Mr. Patel is in good health and is preparing a Under Original Medicare, there
budget in anticipation of his retirement when he is a single deductible amount
turns 66. He wants to understand the health care due for the first 60 days of any in-
Study online at https://quizlet.com/_fzi650
1. Mrs. Shields is covered by Original Medicare. She Medicare will cover Mrs. Shield's
sustained a hip fracture and is being successful- skilled nursing services provided
ly treated for that condition. However, she and during the first 20 days of her
her physicians feel that after her lengthy hospital stay, after which she would have
stay, she will need a month or two of nursing a copay until she has been in the
and rehabilitative care. What should you tell them facility for 100 days.
about Original Medicare's coverage of care in a
skilled nursing facility?
2. Mrs. West wears glasses and dentures and has Medicare does not cover mas-
enjoyed considerable pain relief from arthri- sage therapy, or, in general,
tis through massage therapy. She is concerned glasses or dentures.
about whether or not Medicare will cover these
items and services. What should you tell her?
3. Mrs. Park is an elderly retiree. Mrs. Park has a low She should contact her state
fixed income. What could you tell Mrs. Park that Medicaid agency to see if she
might be of assistance? qualifies for one of several
programs that can help with
Medicare costs for which she is
responsible.
4. Mr. Alonso receives some help paying for his two He generally would pay a month-
generic prescription drugs from his employer's ly premium, annual deductible,
retiree coverage, but he wants to compare it to a and per-prescription cost-shar-
Part D prescription drug plan. He asks you what ing.
costs he would generally expect to encounter
when enrolling into a standard Medicare Part D
prescription drug plan. What should you tell him?
5. Mrs. Gonzalez is enrolled in Original Medicare Mrs. Gonzalez cannot purchase a
and has a Medigap policy as well, but it provides Medigap plan that covers drugs,
, 2025 AHIP Final Exam
Study online at https://quizlet.com/_fzi650
no drug coverage. She would like to keep the cov- but she could keep her Medigap
erage she has but replace her existing Medigap policy and enroll in a Part D pre-
plan with one that provides drug coverage. What scription drug plan.
should you tell her?
6. Mr. Davis is 52 years old and has recently been He may sign-up for Medicare at
diagnosed with end-stage renal disease (ESRD) any time however coverage usu-
and will soon begin dialysis. He is wondering if ally begins on the fourth month
he can obtain coverage under Medicare. What after dialysis treatments start.
should you tell him?
7. Mrs. Duarte is enrolled in Original Medicare Parts Mrs. Duarte should file an ap-
A and B. She has recently reviewed her Medicare peal of this initial determination
Summary Notice (MSN) and disagrees with a within 120 days of the date she
determination that partially denied one of her received the MSN in the mail.
claims for services. What advice would you give
her?
8. Mrs. Geisler's neighbor told her she should look Part D covers prescription
at her Part D options during the annual Medicare drugs and she should look at
enrollment period because the features of Part D her premiums, formulary, and
might have changed. Mrs. Geisler can't remem- cost-sharing among other fac-
ber what Part D is so she called you to ask what tors to see if they have changed.
her neighbor was talking about. What could you
tell her?
9. Mr. Rainey is experiencing paranoid delusions and Medicare will cover a total of 190
his physician feels that he should be hospitalized. days of inpatient psychiatric care
What should you tell Mr. Rainey (or his represen- during Mr. Rainey's entire life-
tative) about the length of an inpatient psychiatric time.
hospital stay that Medicare will cover?
10.
, 2025 AHIP Final Exam
Study online at https://quizlet.com/_fzi650
Mr. Xi will soon turn age 65 and has come to you Beneficiaries under Original
for advice as to what services are provided under Medicare have no cost-sharing
Original Medicare. What should you tell Mr. Xi that for most preventive services.
best describes the health coverage provided to
Medicare beneficiaries?
11. Mr. Singh would like drug coverage but does not Mr. Singh can enroll in a
want to be enrolled in a Medicare Advantage plan. stand-alone prescription drug
What should you tell him? plan and continue to be covered
for Part A and Part B services
through Original Fee-for-Service
Medicare.
12. Mrs. Chen will be 65 soon, has been a citizen Most individuals who are citizens
for twelve years, has been employed full time, and age 65 or over are covered
and paid taxes during that entire period. She is under Part A by virtue of having
concerned that she will not qualify for coverage paid Medicare taxes while work-
under part A because she was not born in the ing, though some may be cov-
United States. What should you tell her? ered as a result of paying month-
ly premiums.
13. Mrs. Quinn recently turned 66 and decided after Part B primarily covers physi-
many years of work to retire and begin receiving cian services. She will be paying
Social Security benefits. Shortly thereafter Mrs. a monthly premium and, except
Quinn received a letter informing her that she for many preventive and screen-
had been automatically enrolled in Medicare Part ing tests, generally will have 20%
B. She wants to understand what this means. co-payments for these services,
What should you tell Mrs. Quinn? in addition to an annual de-
ductible.
14. Mr. Patel is in good health and is preparing a Under Original Medicare, there
budget in anticipation of his retirement when he is a single deductible amount
turns 66. He wants to understand the health care due for the first 60 days of any in-
