2025/2026 AHIP Final Exam Questions and
Verified Answers, 100% Guarantee Pass
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?
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
ttps://www.stuvia.com/user/Wisdoms
, 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?
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.
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.
ttps://www.stuvia.com/user/Wisdoms
, 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 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?-
Ans>>: 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.
ttps://www.stuvia.com/user/Wisdoms
, 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?
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.
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?
Ans>>: Under Original
ttps://www.stuvia.com/user/Wisdoms
Verified Answers, 100% Guarantee Pass
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?
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
ttps://www.stuvia.com/user/Wisdoms
, 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?
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.
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.
ttps://www.stuvia.com/user/Wisdoms
, 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 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?-
Ans>>: 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.
ttps://www.stuvia.com/user/Wisdoms
, 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?
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.
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?
Ans>>: Under Original
ttps://www.stuvia.com/user/Wisdoms
