2026 AHIP FINAL EXAM
Actual Ǫuestions and Verified Answers
With 100 Ǫuestions and Answers
1. 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.
2. 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
1/
17
,Ans>> Medicare does not cover massage therapy, or, in general, glasses or dentures.
3. 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 o
several programs that can help with Medicare costs for which she is responsible.
4. 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.
5. 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.
2/
17
,6. 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.
7. Mrs. Duarte is enrolled in Original Medicare Parts A and B. She has
recently reviewed her Medicare Summary Notice (MSN) and disagrees with a
determi- nation 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.
8. 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.
9. Mr. Rainey is experiencing paranoid delusions and his physician feels that he
should be hospitalized. What should you tell Mr. Rainey (or his representa-
tive) about the length of an inpatient psychiatric hospital stay that Medicare
will
3/
17
, cover
Ans>> Medicare will cover a total of 190 days of inpatient psychiatric care during Mr.
Rainey's entire lifetime.
10.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?-
: Beneficiaries under Original Medicare have no cost-sharing for most preventive
services.
11.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.
12.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.
4/
17
Actual Ǫuestions and Verified Answers
With 100 Ǫuestions and Answers
1. 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.
2. 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
1/
17
,Ans>> Medicare does not cover massage therapy, or, in general, glasses or dentures.
3. 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 o
several programs that can help with Medicare costs for which she is responsible.
4. 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.
5. 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.
2/
17
,6. 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.
7. Mrs. Duarte is enrolled in Original Medicare Parts A and B. She has
recently reviewed her Medicare Summary Notice (MSN) and disagrees with a
determi- nation 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.
8. 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.
9. Mr. Rainey is experiencing paranoid delusions and his physician feels that he
should be hospitalized. What should you tell Mr. Rainey (or his representa-
tive) about the length of an inpatient psychiatric hospital stay that Medicare
will
3/
17
, cover
Ans>> Medicare will cover a total of 190 days of inpatient psychiatric care during Mr.
Rainey's entire lifetime.
10.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?-
: Beneficiaries under Original Medicare have no cost-sharing for most preventive
services.
11.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.
12.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.
4/
17
