2025Ahip FinalExamsWithAnswers ss ss ss ss ss
Correct ss
1. Mrs. Shields is covered by Original Medicare. She sustained a hip fracture and is being
ss ss ss ss ss ss ss ss ss ss ss ss ss ss
successfully treated for that condition. However, she and her physicians feel that after her
ss ss ss ss ss ss ss ss ss ss ss ss ss ss
lengthy hospital stay, she will need a month or two of nursing and rehabilitative care. What
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
should you tell them about Original Medicare's
ss ss ss ss ss ss ss ss
coverage of care in a skilled nursing facility?: Medicare will cover Mrs. Shield's skilled nursing
ss ss ss ss ss ss ss ss ss ss ss ss ss ss
services provided during the first 20 days of her stay, after which she would have a copay until
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
she has been in the facility for 100 days.
ss ss ss ss ss ss ss ss ss
2. Mrs. West wears glasses and dentures and has enjoyed considerable pain relief from
ss ss ss ss ss ss ss ss ss ss ss ss
arthritis through massage therapy. She is concerned about whether or not Medicare will
ss ss ss ss ss ss ss ss ss ss ss ss ss
cover these items and services. What should you tell her?: Medicare does not cover
ss ss ss ss ss ss ss ss ss ss ss ss ss ss
massage therapy, or, in general, glasses or dentures.
ss ss ss ss ss ss ss ss
3. Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What could you tell Mrs. Park
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
that might be of assistance?: She should contact her state Medicaid agency to see if she
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
qualifies for one of several programs that can help with Medicare costs for which she is
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
responsible.
ss
4. Mr. Alonso receives some help paying for his two generic prescription drugs from his
ss ss ss ss ss ss ss ss ss ss ss ss ss
employer's retiree coverage, but he wants to compare it to a Part D prescription drug plan.
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
He asks you what costs he would generally expect to encounter when enrolling into a
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
standard Medicare Part D prescription drug
ss ss ss ss ss ss ss
plan. What should you tell him?: He generally would pay a monthly premium, annual
ss ss ss ss ss ss ss ss ss ss ss ss ss
deductible, and per-prescription cost-sharing.
ss ss ss ss
5. Mrs. Gonzalez is enrolled in Original Medicare and has a Medigap policy as well, but it
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
provides no drug coverage. She would like to keep the coverage she has but replace her
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
existing Medigap plan with one that provides drug
ss ss ss ss ss ss ss ss ss
ss ss
,coverage. What should you tell her?: Mrs. Gonzalez cannot purchase a Medigap plan that
ss ss ss ss ss ss ss ss ss ss ss ss ss
covers drugs, but she could keep her Medigap policy and enroll in a Part D prescription drug
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
plan.
ss
6. Mr. Davis is 52 years old and has recently been diagnosed with end-stage renal disease
ss ss ss ss ss ss ss ss ss ss ss ss ss ss
(ESRD) and will soon begin dialysis. He is wondering if he can obtain coverage under
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
Medicare. What should you tell him?: He may sign-up for
ss ss ss ss ss ss ss ss ss ss ss
Medicare at any time however coverage usually begins on the fourth month after dialysis
ss ss ss ss ss ss ss ss ss ss ss ss ss
treatments start.
ss ss
7. Mrs. Duarte is enrolled in Original Medicare Parts A and B. She has recently reviewed her
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
Medicare Summary Notice (MSN) and disagrees with a determination that partially denied
ss ss ss ss ss ss ss ss ss ss ss ss
one of her claims for services. What advice would you give her?: Mrs. Duarte should file an
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
appeal of this initial determination within 120 days of the date she received the MSN in the
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
mail.
ss
8. Mrs. Geisler's neighbor told her she should look at her Part D options during the annual
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
Medicare enrollment period because the features of Part D might have changed. Mrs.
ss ss ss ss ss ss ss ss ss ss ss ss ss
Geisler can't remember what Part D is so she called you to ask what her neighbor was talking
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
about. What could you tell her?: Part D covers
ss ss ss ss ss ss ss ss ss ss
prescription drugs and she should look at her premiums, formulary, and cost-sharing among
ss ss ss ss ss ss ss ss ss ss ss ss
other factors to see if they have changed.
ss ss ss ss ss ss ss ss
9. Mr. Rainey is experiencing paranoid delusions and his physician feels that he should be
ss ss ss ss ss ss ss ss ss ss ss ss ss
hospitalized. What should you tell Mr. Rainey (or his representative) about the length of an
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
inpatient psychiatric hospital stay that Medicare will cover?: Medicare will cover a total of
ss ss ss ss ss ss ss ss ss ss ss ss ss ss
190 days of inpatient psychiatric care during Mr. Rainey's entire lifetime.
ss ss ss ss ss ss ss ss ss ss ss
10. Mr. Xi will soon turn age 65 and has come to you for advice as to what services are
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
provided under Original Medicare. What should you tell Mr. Xi that best describes the
ss ss ss ss ss ss ss ss ss ss ss ss ss ss
health coverage provided to Medicare beneficiaries?: Beneficiaries under Original
ss ss ss ss ss ss ss ss ss
Medicare have no cost-sharing for most preventive services.
ss ss ss ss ss ss ss ss
11. Mr. Singh would like drug coverage but does not want to be enrolled in a
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
Medicare Advantage plan. What should you tell him?: Mr. Singh can enroll in a stand-alone
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
prescription drug plan and continue to be covered for Part A and Part B services through ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
Original Fee-for-Service Medicare.
ss ss ss
ss ss
, 12. Mrs. Chen will be 65 soon, has been a citizen for twelve years, has been employed full ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
time, and paid taxes during that entire period. She is concerned that she will not qualify for
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
coverage under part A because she was not born
ss ss ss ss ss ss ss ss ss ss
in the United States. What should you tell her?: Most individuals who are citizens and age 65
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
or over are covered under Part A by virtue of having paid Medicare taxes while working, though
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
some may be covered as a result of paying monthly premiums.
ss ss ss ss ss ss ss ss ss ss ss
13. Mrs. Quinn recently turned 66 and decided after many years of work to retire and begin ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
receiving Social Security benefits. Shortly thereafter Mrs. Quinn received a letter informing
ss ss ss ss ss ss ss ss ss ss ss ss
her that she had been automatically enrolled in Medicare Part B. She wants to understand
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
what this means. What should you
ss ss ss ss ss ss ss
tell Mrs. Quinn?: Part B primarily covers physician services. She will be paying a monthly
ss ss ss ss ss ss ss ss ss ss ss ss ss ss
premium and, except for many preventive and screening tests, generally will have 20% co-
ss ss ss ss ss ss ss ss ss ss ss ss ss ss
payments for these services, in addition to an annual deductible. ss ss ss ss ss ss ss ss ss
14. Mr. Patel is in good health and is preparing a budget in anticipation of his retirement ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
when he turns 66. He wants to understand the health care costs he might be exposed to
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
under Medicare if he were to require hospitalization because of an illness. In general terms,
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
what could you tell him about his costs for inpatient hospital services under Original
ss ss ss ss ss ss ss ss ss ss ss ss ss ss
Medicare?: Under Original Medicare, there is a single deductible amount due for the first 60
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
days of any inpatient hospital stay, after which it converts into a per-day coinsurance
ss ss ss ss ss ss ss ss ss ss ss ss ss ss
amount through day 90. After day 90, he would pay a daily amount up to 60 days over his
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
lifetime, after which he would be responsible for all costs.
ss ss ss ss ss ss ss ss ss ss
15. What impact, if any, have recent regulatory changes had on Medigap plans?- ss ss ss ss ss ss ss ss ss ss ss
: The Part B deductible is no longer covered for individuals newly eligible for Medicare starting
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
January 1, 2020.
ss ss ss
16. Mrs. Paterson is concerned about the deductibles and co-payments associated with ss ss ss ss ss ss ss ss ss ss
Original Medicare. What can you tell her about Medigap as an option
ss ss ss ss ss ss ss ss ss ss ss ss ss
to address this concern?: Medigap plans do not cover Original Medicare benefits, but they
ss ss ss ss ss ss ss ss ss ss ss ss ss
coordinate with Original Medicare coverage.
ss ss ss ss ss
17. Mrs. Turner is comparing her employer's retiree insurance to Original ss ss ss ss ss ss ss ss ss ss
Medicare and would like to know which of the following services Original Medicare will ss ss ss ss ss ss ss ss ss ss ss ss ss
cover if the appropriate criteria are met. What could you tell her?: Original Medicare
ss ss ss ss ss ss ss ss ss ss ss ss ss ss
covers ambulance services.
ss ss ss
ss ss
Correct ss
1. Mrs. Shields is covered by Original Medicare. She sustained a hip fracture and is being
ss ss ss ss ss ss ss ss ss ss ss ss ss ss
successfully treated for that condition. However, she and her physicians feel that after her
ss ss ss ss ss ss ss ss ss ss ss ss ss ss
lengthy hospital stay, she will need a month or two of nursing and rehabilitative care. What
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
should you tell them about Original Medicare's
ss ss ss ss ss ss ss ss
coverage of care in a skilled nursing facility?: Medicare will cover Mrs. Shield's skilled nursing
ss ss ss ss ss ss ss ss ss ss ss ss ss ss
services provided during the first 20 days of her stay, after which she would have a copay until
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
she has been in the facility for 100 days.
ss ss ss ss ss ss ss ss ss
2. Mrs. West wears glasses and dentures and has enjoyed considerable pain relief from
ss ss ss ss ss ss ss ss ss ss ss ss
arthritis through massage therapy. She is concerned about whether or not Medicare will
ss ss ss ss ss ss ss ss ss ss ss ss ss
cover these items and services. What should you tell her?: Medicare does not cover
ss ss ss ss ss ss ss ss ss ss ss ss ss ss
massage therapy, or, in general, glasses or dentures.
ss ss ss ss ss ss ss ss
3. Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What could you tell Mrs. Park
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
that might be of assistance?: She should contact her state Medicaid agency to see if she
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
qualifies for one of several programs that can help with Medicare costs for which she is
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
responsible.
ss
4. Mr. Alonso receives some help paying for his two generic prescription drugs from his
ss ss ss ss ss ss ss ss ss ss ss ss ss
employer's retiree coverage, but he wants to compare it to a Part D prescription drug plan.
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
He asks you what costs he would generally expect to encounter when enrolling into a
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
standard Medicare Part D prescription drug
ss ss ss ss ss ss ss
plan. What should you tell him?: He generally would pay a monthly premium, annual
ss ss ss ss ss ss ss ss ss ss ss ss ss
deductible, and per-prescription cost-sharing.
ss ss ss ss
5. Mrs. Gonzalez is enrolled in Original Medicare and has a Medigap policy as well, but it
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
provides no drug coverage. She would like to keep the coverage she has but replace her
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
existing Medigap plan with one that provides drug
ss ss ss ss ss ss ss ss ss
ss ss
,coverage. What should you tell her?: Mrs. Gonzalez cannot purchase a Medigap plan that
ss ss ss ss ss ss ss ss ss ss ss ss ss
covers drugs, but she could keep her Medigap policy and enroll in a Part D prescription drug
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
plan.
ss
6. Mr. Davis is 52 years old and has recently been diagnosed with end-stage renal disease
ss ss ss ss ss ss ss ss ss ss ss ss ss ss
(ESRD) and will soon begin dialysis. He is wondering if he can obtain coverage under
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
Medicare. What should you tell him?: He may sign-up for
ss ss ss ss ss ss ss ss ss ss ss
Medicare at any time however coverage usually begins on the fourth month after dialysis
ss ss ss ss ss ss ss ss ss ss ss ss ss
treatments start.
ss ss
7. Mrs. Duarte is enrolled in Original Medicare Parts A and B. She has recently reviewed her
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
Medicare Summary Notice (MSN) and disagrees with a determination that partially denied
ss ss ss ss ss ss ss ss ss ss ss ss
one of her claims for services. What advice would you give her?: Mrs. Duarte should file an
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
appeal of this initial determination within 120 days of the date she received the MSN in the
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
mail.
ss
8. Mrs. Geisler's neighbor told her she should look at her Part D options during the annual
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
Medicare enrollment period because the features of Part D might have changed. Mrs.
ss ss ss ss ss ss ss ss ss ss ss ss ss
Geisler can't remember what Part D is so she called you to ask what her neighbor was talking
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
about. What could you tell her?: Part D covers
ss ss ss ss ss ss ss ss ss ss
prescription drugs and she should look at her premiums, formulary, and cost-sharing among
ss ss ss ss ss ss ss ss ss ss ss ss
other factors to see if they have changed.
ss ss ss ss ss ss ss ss
9. Mr. Rainey is experiencing paranoid delusions and his physician feels that he should be
ss ss ss ss ss ss ss ss ss ss ss ss ss
hospitalized. What should you tell Mr. Rainey (or his representative) about the length of an
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
inpatient psychiatric hospital stay that Medicare will cover?: Medicare will cover a total of
ss ss ss ss ss ss ss ss ss ss ss ss ss ss
190 days of inpatient psychiatric care during Mr. Rainey's entire lifetime.
ss ss ss ss ss ss ss ss ss ss ss
10. Mr. Xi will soon turn age 65 and has come to you for advice as to what services are
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
provided under Original Medicare. What should you tell Mr. Xi that best describes the
ss ss ss ss ss ss ss ss ss ss ss ss ss ss
health coverage provided to Medicare beneficiaries?: Beneficiaries under Original
ss ss ss ss ss ss ss ss ss
Medicare have no cost-sharing for most preventive services.
ss ss ss ss ss ss ss ss
11. Mr. Singh would like drug coverage but does not want to be enrolled in a
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
Medicare Advantage plan. What should you tell him?: Mr. Singh can enroll in a stand-alone
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
prescription drug plan and continue to be covered for Part A and Part B services through ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
Original Fee-for-Service Medicare.
ss ss ss
ss ss
, 12. Mrs. Chen will be 65 soon, has been a citizen for twelve years, has been employed full ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
time, and paid taxes during that entire period. She is concerned that she will not qualify for
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
coverage under part A because she was not born
ss ss ss ss ss ss ss ss ss ss
in the United States. What should you tell her?: Most individuals who are citizens and age 65
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
or over are covered under Part A by virtue of having paid Medicare taxes while working, though
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
some may be covered as a result of paying monthly premiums.
ss ss ss ss ss ss ss ss ss ss ss
13. Mrs. Quinn recently turned 66 and decided after many years of work to retire and begin ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
receiving Social Security benefits. Shortly thereafter Mrs. Quinn received a letter informing
ss ss ss ss ss ss ss ss ss ss ss ss
her that she had been automatically enrolled in Medicare Part B. She wants to understand
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
what this means. What should you
ss ss ss ss ss ss ss
tell Mrs. Quinn?: Part B primarily covers physician services. She will be paying a monthly
ss ss ss ss ss ss ss ss ss ss ss ss ss ss
premium and, except for many preventive and screening tests, generally will have 20% co-
ss ss ss ss ss ss ss ss ss ss ss ss ss ss
payments for these services, in addition to an annual deductible. ss ss ss ss ss ss ss ss ss
14. Mr. Patel is in good health and is preparing a budget in anticipation of his retirement ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
when he turns 66. He wants to understand the health care costs he might be exposed to
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
under Medicare if he were to require hospitalization because of an illness. In general terms,
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
what could you tell him about his costs for inpatient hospital services under Original
ss ss ss ss ss ss ss ss ss ss ss ss ss ss
Medicare?: Under Original Medicare, there is a single deductible amount due for the first 60
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
days of any inpatient hospital stay, after which it converts into a per-day coinsurance
ss ss ss ss ss ss ss ss ss ss ss ss ss ss
amount through day 90. After day 90, he would pay a daily amount up to 60 days over his
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
lifetime, after which he would be responsible for all costs.
ss ss ss ss ss ss ss ss ss ss
15. What impact, if any, have recent regulatory changes had on Medigap plans?- ss ss ss ss ss ss ss ss ss ss ss
: The Part B deductible is no longer covered for individuals newly eligible for Medicare starting
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
January 1, 2020.
ss ss ss
16. Mrs. Paterson is concerned about the deductibles and co-payments associated with ss ss ss ss ss ss ss ss ss ss
Original Medicare. What can you tell her about Medigap as an option
ss ss ss ss ss ss ss ss ss ss ss ss ss
to address this concern?: Medigap plans do not cover Original Medicare benefits, but they
ss ss ss ss ss ss ss ss ss ss ss ss ss
coordinate with Original Medicare coverage.
ss ss ss ss ss
17. Mrs. Turner is comparing her employer's retiree insurance to Original ss ss ss ss ss ss ss ss ss ss
Medicare and would like to know which of the following services Original Medicare will ss ss ss ss ss ss ss ss ss ss ss ss ss
cover if the appropriate criteria are met. What could you tell her?: Original Medicare
ss ss ss ss ss ss ss ss ss ss ss ss ss ss
covers ambulance services.
ss ss ss
ss ss
