AHIP 2025-2026 EXAM PREPARATION FOR
NURSES - TAILORED STUDY GUIDE FOR
NURSING AND HEALTHCARE STUDENTS
Mr. Schmidt would like to plan for retirement and has asked you what is covered under Original
Fee-for-Service (FFS) Medicare. What could you tell him? - CORRECT ANSWER-Part A, which
covers hospital, skilled nursing facility, hospice, and home health services and Part B, which
covers professional services such as those provided by a doctor are covered under Original
Medicare.
Anthony Boniface turned 65 in 2024. He was not receiving Social Security or Railroad
Retirement Benefits on his 65th birthday. He was interested in obtaining Medicare coverage and
is eligible for premium-free Part A. Before he could enroll in Medicare, his entire area was
impacted by a hurricane causing massive flooding and severe wind damage. The Federal
government declared this to be a natural disaster which has recently ended. During this period
Anthony's initial enrollment period expired. Anthony asks you how he can now obtain Medicare
coverage. What should you say? - CORRECT ANSWER-Anthony is eligible for a special enrollment
period (SEP) because he missed an enrollment period due to the impact of the Federally
declared disaster. This SEP will allow Anthony to enroll in Part B up to six months after the end
of the emergency declaration. Anthony may enroll in premium-free Part A at any time and his
Part A coverage will be retroactive for up to 6 months.
Mrs. Ellis recently turned 66 and decided after many years of work to retire and begin receiving
Social Security benefits. Shortly thereafter Mrs. Ellis 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. Ellis? - CORRECT ANSWER-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.
Mr. Vasquez 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? -
,CORRECT ANSWER-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.
Mrs. Cook is an elderly retiree. Mrs. Cook has a low fixed income. What could you tell Mrs. Cook
that might be of assistance? - CORRECT ANSWER-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.
Mrs. Thomas is 66 years old, has coverage under an employer plan, and will retire next year. She
heard she must enroll in Part B at the beginning of the year to ensure no gap in coverage. What
can you tell her? - CORRECT ANSWER-She may enroll at any time while she is covered under her
employer plan, but she will have a special eight-month enrollment period after the last month
on her employer plan that differs from the standard general enrollment period, during which
she may enroll in Medicare Part B.
Madeline Martinez was widowed several years ago. Her husband worked for many years and
contributed into the Medicare system. He also left a substantial estate which provides Madeline
with an annual income of approximately $130,000. Madeline, who has only worked part-time
for the last three years, will soon turn age 65 and hopes to enroll in Original Medicare. She
comes to you for advice. What should you tell her? - CORRECT ANSWER-You should tell
Madeline that she will be able to enroll in Medicare Part A without paying monthly premiums
due to her husband's long work record and participation in the Medicare system. You should
also tell Madeline that she will pay Part B premiums at more than the standard lowest rate but
less than the highest rate due her substantial income.
Ms. Kumar plans to retire when she turns 65 in a few months. She is in excellent health and will
have considerable income when she retires. She is concerned that her income will make it
impossible for her to qualify for Medicare. What could you tell her to address her concern? -
CORRECT ANSWER-Medicare is a program for people age 65 or older and those under age 65
with certain disabilities, end-stage renal disease, and Lou Gehrig's disease so she will be eligible
for Medicare.
, Agent John Miller is meeting with Jerry Smith, a new prospect. Jerry is currently enrolled in
Medicare Parts A and B. Jerry has also purchased a Medicare Supplement (Medigap) plan which
he has had for several years. However, the plan does not provide drug benefits. How would you
advise Agent John Miller to proceed? - CORRECT ANSWER-Tell prospect Jerry Smith that he
should consider adding a standalone Part D prescription drug coverage policy to his present
coverage.
Mr. Moy will soon turn age 65. He is slightly younger than his wife. Mr. Moy's wife has a
Medicare Advantage plan, but he wants to understand what coverage Medicare Supplemental
Insurance provides since his health care needs are different from his wife's needs. What could
you tell Mr. Moy? - CORRECT ANSWER-Medicare Supplemental Insurance would cover all of his
IRS approved health care expenditures not covered under Original Fee-for-Service (FFS)
Medicare.
Mildred Savage enrolled in Allcare Medicare Advantage plan several years ago. Mildred recently
learned that she is suffering from inoperable cancer and has just a few months to live. She
would like to spend these final months in hospice care. Mildred's family asks you whether
hospice benefits will be paid for under the Allcare Medicare Advantage plan. What should you
say? - CORRECT ANSWER-Mildred may remain enrolled in Allcare and make a hospice election.
Hospice benefits will be paid for by Original Medicare under Part A and Allcare will continue to
pay for any non-hospice services.
Juan Perez, who is turning age 65 next month, intends to work for several more years at
Smallcap, Incorporated. Smallcap has a workforce of 15 employees and offers employer-
sponsored healthcare coverage. Juan is a naturalized citizen and has contributed to the
Medicare system for over 20 years. Juan asks you if he will be entitled to Medicare and if he
enrolls how that will impact his employer- sponsored healthcare coverage. How would you
respond? - CORRECT ANSWER-Juan is likely to be eligible for Medicare once he turns age 65 and
if he enrolls, Medicare would become the primary payor of his healthcare claims and Smallcap
does not have to continue to offer him coverage comparable to those under age 65 under its
employer-sponsored group health plan and would become a secondary payor.
Mr. Singh would like drug coverage but does not want to be enrolled in a Medicare Advantage
plan. What should you tell him? - CORRECT ANSWER-Mr. Singh can enroll in a stand-alone
NURSES - TAILORED STUDY GUIDE FOR
NURSING AND HEALTHCARE STUDENTS
Mr. Schmidt would like to plan for retirement and has asked you what is covered under Original
Fee-for-Service (FFS) Medicare. What could you tell him? - CORRECT ANSWER-Part A, which
covers hospital, skilled nursing facility, hospice, and home health services and Part B, which
covers professional services such as those provided by a doctor are covered under Original
Medicare.
Anthony Boniface turned 65 in 2024. He was not receiving Social Security or Railroad
Retirement Benefits on his 65th birthday. He was interested in obtaining Medicare coverage and
is eligible for premium-free Part A. Before he could enroll in Medicare, his entire area was
impacted by a hurricane causing massive flooding and severe wind damage. The Federal
government declared this to be a natural disaster which has recently ended. During this period
Anthony's initial enrollment period expired. Anthony asks you how he can now obtain Medicare
coverage. What should you say? - CORRECT ANSWER-Anthony is eligible for a special enrollment
period (SEP) because he missed an enrollment period due to the impact of the Federally
declared disaster. This SEP will allow Anthony to enroll in Part B up to six months after the end
of the emergency declaration. Anthony may enroll in premium-free Part A at any time and his
Part A coverage will be retroactive for up to 6 months.
Mrs. Ellis recently turned 66 and decided after many years of work to retire and begin receiving
Social Security benefits. Shortly thereafter Mrs. Ellis 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. Ellis? - CORRECT ANSWER-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.
Mr. Vasquez 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? -
,CORRECT ANSWER-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.
Mrs. Cook is an elderly retiree. Mrs. Cook has a low fixed income. What could you tell Mrs. Cook
that might be of assistance? - CORRECT ANSWER-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.
Mrs. Thomas is 66 years old, has coverage under an employer plan, and will retire next year. She
heard she must enroll in Part B at the beginning of the year to ensure no gap in coverage. What
can you tell her? - CORRECT ANSWER-She may enroll at any time while she is covered under her
employer plan, but she will have a special eight-month enrollment period after the last month
on her employer plan that differs from the standard general enrollment period, during which
she may enroll in Medicare Part B.
Madeline Martinez was widowed several years ago. Her husband worked for many years and
contributed into the Medicare system. He also left a substantial estate which provides Madeline
with an annual income of approximately $130,000. Madeline, who has only worked part-time
for the last three years, will soon turn age 65 and hopes to enroll in Original Medicare. She
comes to you for advice. What should you tell her? - CORRECT ANSWER-You should tell
Madeline that she will be able to enroll in Medicare Part A without paying monthly premiums
due to her husband's long work record and participation in the Medicare system. You should
also tell Madeline that she will pay Part B premiums at more than the standard lowest rate but
less than the highest rate due her substantial income.
Ms. Kumar plans to retire when she turns 65 in a few months. She is in excellent health and will
have considerable income when she retires. She is concerned that her income will make it
impossible for her to qualify for Medicare. What could you tell her to address her concern? -
CORRECT ANSWER-Medicare is a program for people age 65 or older and those under age 65
with certain disabilities, end-stage renal disease, and Lou Gehrig's disease so she will be eligible
for Medicare.
, Agent John Miller is meeting with Jerry Smith, a new prospect. Jerry is currently enrolled in
Medicare Parts A and B. Jerry has also purchased a Medicare Supplement (Medigap) plan which
he has had for several years. However, the plan does not provide drug benefits. How would you
advise Agent John Miller to proceed? - CORRECT ANSWER-Tell prospect Jerry Smith that he
should consider adding a standalone Part D prescription drug coverage policy to his present
coverage.
Mr. Moy will soon turn age 65. He is slightly younger than his wife. Mr. Moy's wife has a
Medicare Advantage plan, but he wants to understand what coverage Medicare Supplemental
Insurance provides since his health care needs are different from his wife's needs. What could
you tell Mr. Moy? - CORRECT ANSWER-Medicare Supplemental Insurance would cover all of his
IRS approved health care expenditures not covered under Original Fee-for-Service (FFS)
Medicare.
Mildred Savage enrolled in Allcare Medicare Advantage plan several years ago. Mildred recently
learned that she is suffering from inoperable cancer and has just a few months to live. She
would like to spend these final months in hospice care. Mildred's family asks you whether
hospice benefits will be paid for under the Allcare Medicare Advantage plan. What should you
say? - CORRECT ANSWER-Mildred may remain enrolled in Allcare and make a hospice election.
Hospice benefits will be paid for by Original Medicare under Part A and Allcare will continue to
pay for any non-hospice services.
Juan Perez, who is turning age 65 next month, intends to work for several more years at
Smallcap, Incorporated. Smallcap has a workforce of 15 employees and offers employer-
sponsored healthcare coverage. Juan is a naturalized citizen and has contributed to the
Medicare system for over 20 years. Juan asks you if he will be entitled to Medicare and if he
enrolls how that will impact his employer- sponsored healthcare coverage. How would you
respond? - CORRECT ANSWER-Juan is likely to be eligible for Medicare once he turns age 65 and
if he enrolls, Medicare would become the primary payor of his healthcare claims and Smallcap
does not have to continue to offer him coverage comparable to those under age 65 under its
employer-sponsored group health plan and would become a secondary payor.
Mr. Singh would like drug coverage but does not want to be enrolled in a Medicare Advantage
plan. What should you tell him? - CORRECT ANSWER-Mr. Singh can enroll in a stand-alone
