2025 Ahip Final Exams With Answers Correct
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?: 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?: 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?: 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.
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?: 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?: 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.
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?: 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 determination that partially
denied one of her claims for services. What advice would you give her?: 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?: 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 representative) about the length
of an inpatient psychiatric hospital stay that Medicare will cover?: 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?: 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?: 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.
13. 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?: 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.
14. 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?: 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.
15. What impact, if any, have recent regulatory changes had on Medigap plans?-
: The Part B deductible is no longer covered for individuals newly eligible for Medicare
starting January 1, 2020.
16. Mrs. Paterson is concerned about the deductibles and co-payments associated with
Original Medicare. What can you tell her about Medigap as an option
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?: 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?: 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?: 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.
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?: 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?: 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.
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?: 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 determination that partially
denied one of her claims for services. What advice would you give her?: 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?: 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 representative) about the length
of an inpatient psychiatric hospital stay that Medicare will cover?: 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?: 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?: 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.
13. 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?: 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.
14. 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?: 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.
15. What impact, if any, have recent regulatory changes had on Medigap plans?-
: The Part B deductible is no longer covered for individuals newly eligible for Medicare
starting January 1, 2020.
16. Mrs. Paterson is concerned about the deductibles and co-payments associated with
Original Medicare. What can you tell her about Medigap as an option
