2025 AHIP FINAL EXAM
Mrs. Shields is covered by Original
Medicare. She sustained a hip fracture
and is being successfully treated for that
Medicare will cover Mrs. Shield's skilled
condition. However, she and her physi-
nursing services provided during the first
cians feel that after her lengthy hos-
20 days of her stay, after which she would
pital stay, she will need a month or
have a copay until she has been in the
two of nursing and rehabilitative care.
facility for 100 days.
What should you tell them about Original
Medicare's coverage of care in a skilled
nursing facility?
Mrs. West wears glasses and dentures
and has enjoyed considerable pain relief
from arthritis through massage therapy. Medicare does not cover massage ther-
She is concerned about whether or not apy, or, in general, glasses or dentures.
Medicare will cover these items and ser-
vices. What should you tell her?
She should contact her state Medicaid
Mrs. Park is an elderly retiree. Mrs. Park
agency to see if she qualifies for one
has a low fixed income. What could you
of several programs that can help with
tell Mrs. Park that might be of assis-
Medicare costs for which she is respon-
tance?
sible.
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 pre- He generally would pay a monthly premi-
scription drug plan. He asks you what um, annual deductible, and per-prescrip-
costs he would generally expect to en- tion cost-sharing.
counter when enrolling into a standard
Medicare Part D prescription drug plan.
What should you tell him?
Mrs. Gonzalez is enrolled in Original
Medicare and has a Medigap policy as
Mrs. Gonzalez cannot purchase a Medi-
well, but it provides no drug coverage.
gap plan that covers drugs, but she could
She would like to keep the coverage she
keep her Medigap policy and enroll in a
has but replace her existing Medigap
Part D prescription drug plan.
plan with one that provides drug cover-
age. What should you tell her?
, 2025 AHIP FINAL EXAM
Mr. Davis is 52 years old and has recent-
ly been diagnosed with end-stage renal He may sign-up for Medicare at any time
disease (ESRD) and will soon begin dial- however coverage usually begins on the
ysis. He is wondering if he can obtain fourth month after dialysis treatments
coverage under Medicare. What should start.
you tell him?
Mrs. Duarte is enrolled in Original
Medicare Parts A and B. She has re-
Mrs. Duarte should file an appeal of this
cently reviewed her Medicare Summa-
initial determination within 120 days of
ry Notice (MSN) and disagrees with a
the date she received the MSN in the
determination that partially denied one
mail.
of her claims for services. What advice
would you give her?
Mrs. Geisler's neighbor told her she
should look at her Part D options during
the annual Medicare enrollment period Part D covers prescription drugs and she
because the features of Part D might should look at her premiums, formulary,
have changed. Mrs. Geisler can't remem- and cost-sharing among other factors to
ber what Part D is so she called you to see if they have changed.
ask what her neighbor was talking about.
What could you tell her?
Mr. Rainey is experiencing paranoid
delusions and his physician feels that
he should be hospitalized. What should Medicare will cover a total of 190 days
you tell Mr. Rainey (or his representative) of inpatient psychiatric care during Mr.
about the length of an inpatient psychi- Rainey's entire lifetime.
atric hospital stay that Medicare will cov-
er?
Mr. Xi will soon turn age 65 and has
come to you for advice as to what
Beneficiaries under Original Medicare
services are provided under Original
have no cost-sharing for most preventive
Medicare. What should you tell Mr. Xi
services.
that best describes the health coverage
provided to Medicare beneficiaries?
Mr. Singh can enroll in a stand-alone
Mr. Singh would like drug coverage
prescription drug plan and continue to
but does not want to be enrolled in a
be covered for Part A and Part B ser-
, 2025 AHIP FINAL EXAM
Medicare Advantage plan. What should vices through Original Fee-for-Service
you tell him? Medicare.
Mrs. Chen will be 65 soon, has been a
Most individuals who are citizens and
citizen for twelve years, has been em-
age 65 or over are covered under Part
ployed full time, and paid taxes during
A by virtue of having paid Medicare tax-
that entire period. She is concerned that
es while working, though some may be
she will not qualify for coverage under
covered as a result of paying monthly
part A because she was not born in the
premiums.
United States. What should you tell her?
Mrs. Quinn recently turned 66 and decid-
ed after many years of work to retire and Part B primarily covers physician ser-
begin receiving Social Security benefits. vices. She will be paying a monthly pre-
Shortly thereafter Mrs. Quinn received a mium and, except for many preventive
letter informing her that she had been and screening tests, generally will have
automatically enrolled in Medicare Part 20% co-payments for these services, in
B. She wants to understand what this addition to an annual deductible.
means. What should you tell Mrs. Quinn?
Mr. Patel is in good health and is prepar-
Under Original Medicare, there is a sin-
ing a budget in anticipation of his retire-
gle deductible amount due for the first 60
ment when he turns 66. He wants to un-
days of any inpatient hospital stay, after
derstand the health care costs he might
which it converts into a per-day coinsur-
be exposed to under Medicare if he were
ance amount through day 90. After day
to require hospitalization because of an
90, he would pay a daily amount up to
illness. In general terms, what could you
60 days over his lifetime, after which he
tell him about his costs for inpatient hos-
would be responsible for all costs.
pital services under Original Medicare?
The Part B deductible is no longer cov-
What impact, if any, have recent regula-
ered for individuals newly eligible for
tory changes had on Medigap plans?
Medicare starting January 1, 2020.
Mrs. Paterson is concerned about the
deductibles and co-payments associat- Medigap plans do not cover Original
ed with Original Medicare. What can you Medicare benefits, but they coordinate
tell her about Medigap as an option to with Original Medicare coverage.
address this concern?
Mrs. Turner is comparing her employer's
retiree insurance to Original Medicare
and would like to know which of the
Mrs. Shields is covered by Original
Medicare. She sustained a hip fracture
and is being successfully treated for that
Medicare will cover Mrs. Shield's skilled
condition. However, she and her physi-
nursing services provided during the first
cians feel that after her lengthy hos-
20 days of her stay, after which she would
pital stay, she will need a month or
have a copay until she has been in the
two of nursing and rehabilitative care.
facility for 100 days.
What should you tell them about Original
Medicare's coverage of care in a skilled
nursing facility?
Mrs. West wears glasses and dentures
and has enjoyed considerable pain relief
from arthritis through massage therapy. Medicare does not cover massage ther-
She is concerned about whether or not apy, or, in general, glasses or dentures.
Medicare will cover these items and ser-
vices. What should you tell her?
She should contact her state Medicaid
Mrs. Park is an elderly retiree. Mrs. Park
agency to see if she qualifies for one
has a low fixed income. What could you
of several programs that can help with
tell Mrs. Park that might be of assis-
Medicare costs for which she is respon-
tance?
sible.
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 pre- He generally would pay a monthly premi-
scription drug plan. He asks you what um, annual deductible, and per-prescrip-
costs he would generally expect to en- tion cost-sharing.
counter when enrolling into a standard
Medicare Part D prescription drug plan.
What should you tell him?
Mrs. Gonzalez is enrolled in Original
Medicare and has a Medigap policy as
Mrs. Gonzalez cannot purchase a Medi-
well, but it provides no drug coverage.
gap plan that covers drugs, but she could
She would like to keep the coverage she
keep her Medigap policy and enroll in a
has but replace her existing Medigap
Part D prescription drug plan.
plan with one that provides drug cover-
age. What should you tell her?
, 2025 AHIP FINAL EXAM
Mr. Davis is 52 years old and has recent-
ly been diagnosed with end-stage renal He may sign-up for Medicare at any time
disease (ESRD) and will soon begin dial- however coverage usually begins on the
ysis. He is wondering if he can obtain fourth month after dialysis treatments
coverage under Medicare. What should start.
you tell him?
Mrs. Duarte is enrolled in Original
Medicare Parts A and B. She has re-
Mrs. Duarte should file an appeal of this
cently reviewed her Medicare Summa-
initial determination within 120 days of
ry Notice (MSN) and disagrees with a
the date she received the MSN in the
determination that partially denied one
mail.
of her claims for services. What advice
would you give her?
Mrs. Geisler's neighbor told her she
should look at her Part D options during
the annual Medicare enrollment period Part D covers prescription drugs and she
because the features of Part D might should look at her premiums, formulary,
have changed. Mrs. Geisler can't remem- and cost-sharing among other factors to
ber what Part D is so she called you to see if they have changed.
ask what her neighbor was talking about.
What could you tell her?
Mr. Rainey is experiencing paranoid
delusions and his physician feels that
he should be hospitalized. What should Medicare will cover a total of 190 days
you tell Mr. Rainey (or his representative) of inpatient psychiatric care during Mr.
about the length of an inpatient psychi- Rainey's entire lifetime.
atric hospital stay that Medicare will cov-
er?
Mr. Xi will soon turn age 65 and has
come to you for advice as to what
Beneficiaries under Original Medicare
services are provided under Original
have no cost-sharing for most preventive
Medicare. What should you tell Mr. Xi
services.
that best describes the health coverage
provided to Medicare beneficiaries?
Mr. Singh can enroll in a stand-alone
Mr. Singh would like drug coverage
prescription drug plan and continue to
but does not want to be enrolled in a
be covered for Part A and Part B ser-
, 2025 AHIP FINAL EXAM
Medicare Advantage plan. What should vices through Original Fee-for-Service
you tell him? Medicare.
Mrs. Chen will be 65 soon, has been a
Most individuals who are citizens and
citizen for twelve years, has been em-
age 65 or over are covered under Part
ployed full time, and paid taxes during
A by virtue of having paid Medicare tax-
that entire period. She is concerned that
es while working, though some may be
she will not qualify for coverage under
covered as a result of paying monthly
part A because she was not born in the
premiums.
United States. What should you tell her?
Mrs. Quinn recently turned 66 and decid-
ed after many years of work to retire and Part B primarily covers physician ser-
begin receiving Social Security benefits. vices. She will be paying a monthly pre-
Shortly thereafter Mrs. Quinn received a mium and, except for many preventive
letter informing her that she had been and screening tests, generally will have
automatically enrolled in Medicare Part 20% co-payments for these services, in
B. She wants to understand what this addition to an annual deductible.
means. What should you tell Mrs. Quinn?
Mr. Patel is in good health and is prepar-
Under Original Medicare, there is a sin-
ing a budget in anticipation of his retire-
gle deductible amount due for the first 60
ment when he turns 66. He wants to un-
days of any inpatient hospital stay, after
derstand the health care costs he might
which it converts into a per-day coinsur-
be exposed to under Medicare if he were
ance amount through day 90. After day
to require hospitalization because of an
90, he would pay a daily amount up to
illness. In general terms, what could you
60 days over his lifetime, after which he
tell him about his costs for inpatient hos-
would be responsible for all costs.
pital services under Original Medicare?
The Part B deductible is no longer cov-
What impact, if any, have recent regula-
ered for individuals newly eligible for
tory changes had on Medigap plans?
Medicare starting January 1, 2020.
Mrs. Paterson is concerned about the
deductibles and co-payments associat- Medigap plans do not cover Original
ed with Original Medicare. What can you Medicare benefits, but they coordinate
tell her about Medigap as an option to with Original Medicare coverage.
address this concern?
Mrs. Turner is comparing her employer's
retiree insurance to Original Medicare
and would like to know which of the
