AHIP 2025 FINAL EXAM 50 QUESTIONS
AND CORRECT ANSWERS
Mrs. Turner is comparing her employer's retiree insurance to Original Medicare and
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would like to know which of the following services Original Medicare will cover if the
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appropriate criteria are met. What could you tell her? - ANSWERS- gf gf gf gf gf gf gf gf gf gf
Original Medicare covers ambulance services. gf gf gf gf
Mrs. Duarte is enrolled in Original Medicare Parts A and B. She has recently reviewe
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d her Medicare Summary Notice (MSN) and disagrees with a determination that parti
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ally denied one of her claims for services. What advice would you give her? -
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ANSWERS-
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Mrs. Duarte should file an appeal of this initial determination within 120 days of the d
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ate she received the MSN in the mail.
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Mrs. Geisler's neighbor told her she should look at her Part D options during the ann
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ual Medicare enrollment period because the features of Part D might have changed.
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Mrs. Geisler can't remember what Part D is so she called you to ask what her neighb
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or was talking about. What could you tell her? - ANSWERS-
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Part D covers prescription drugs and she should look at her premiums, formulary, an
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d cost-sharing among other factors to see if they have changed.
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Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What could you tell
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Mrs. Park that might be of assistance? - ANSWERS-
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She should contact her state Medicaid agency to see if she qualifies for one of sever
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al programs that can help with Medicare costs for which she is responsible.
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Mrs. Quinn recently turned 66 and decided after many years of work to retire and be
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gin receiving Social Security benefits. Shortly thereafter Mrs. Quinn received a letter i
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nforming her that she had been automatically enrolled in Medicare Part B. She wants
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to understand what this means. What should you tell Mrs. Quinn? - ANSWERS-
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Part B primarily covers physician services. She will be paying a monthly premium an
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d, except for many preventive and screening tests, generally will have 20% co-
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payments for these services, in addition to an annual deductible.
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Anita Magri will turn age 65 in August 2023. Anita intends to enroll in Original Medica
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re Part A and Part B. She would also like to enroll in a Medicare Supplement (Medig
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ap) plan. Anita's older neighbor Mel has told her about the Medigap Plan F in which
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he is enrolled. It not only provides foreign travel emergency benefits but also covers
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his Medicare Part B deductible. Anita comes to you for advice. What should you tell
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her? - ANSWERS- gf gf
You are sorry to disappoint Anita, but a Medigap F plan is no longer available to thos
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e who turn age 65 after January 1, 2020. Anita might instead consider other Medigap
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plans that offer foreign travel benefits but do not cover the Part B deductible.
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Mr. Singh would like drug coverage but does not want to be enrolled in a Medicare A
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dvantage plan. What should you tell him? - ANSWERS- gf gf gf gf gf gf gf gf
, Mr. Singh can enroll in a stand-
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alone prescription drug plan and continue to be covered for Part A and Part B servic
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es through Original Fee-for-Service Medicare.
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Mrs. Chen will be 65 soon, has been a citizen for twelve years, has been employed f
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ull time, and paid taxes during that entire period. She is concerned that she will not q
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ualify for coverage under part A because she was not born in the United States. Wha
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t should you tell her? - ANSWERS-
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Most individuals who are citizens and age 65 or over are covered under Part A by vir
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tue of having paid Medicare taxes while working, though some may be covered as a
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result of paying monthly premiums. gf gf gf gf
Mr. Xi will soon turn age 65 and has come to you for advice as to what services are p
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rovided under Original Medicare. What should you tell Mr. Xi that best describes the
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health coverage provided to Medicare beneficiaries? - ANSWERS-
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Beneficiaries under Original Medicare have no cost- gf gf gf gf gf gf
sharing for most preventive services. gf gf gf gf
Mr. Barker enjoys a comfortable retirement income. He recently had surgery and exp
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ected that he would have certain services and items covered by the plan with minima
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l out-of-pocket costs because his MA-
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PD coverage has been very good. However, when he received the bill, he was surpri
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sed to see large charges in excess of his maximum out-of-
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pocket limit that included some services and items he thought would be fully covered
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. He called you to ask what he could do? What could you tell him? - ANSWERS-
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You can offer to review the plans appeal process to help him ask the plan to review t
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he coverage decision.
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Mr. Lombardi is interested in a Medicare Advantage (MA) PPO plan that you represe
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nt. It is one of three plans operated by the same organization in Mr. Lombardi's area.
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The MA PPO plan does not include drug coverage, but the other two plans do. Mr. L
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ombardi likes the PPO plan that does not include drug coverage and intends to obtai
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n his drug coverage through a stand-
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alone Medicare prescription drug plan. What should you tell him about this situation?
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- ANSWERS-
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He could enroll either in one of the MA plans that include prescription drug coverage
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or Original Medicare with a Medigap plan and standalone Part D prescription drug co
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verage, but he cannot enroll in the MA-only PPO plan and a stand-
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alone prescription drug plan. gf gf gf
Mr. Lopez has heard that he can sign up for a product called "Medicare Advantage"
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but is not sure about what type of plan designs are available through this program. W
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hat should you tell him about the types of health plans that are available through the
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Medicare Advantage program? - ANSWERS- gf gf gf gf
There are Medicare health plans such as HMOs, PPOs, PFFS, and MSAs.
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Mr. Kelly wants to know whether he is eligible to sign up for a private fee-for-
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service (PFFS) plan. What questions would you need to ask to determine his eligibilit
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y? - ANSWERS- gf gf
AND CORRECT ANSWERS
Mrs. Turner is comparing her employer's retiree insurance to Original Medicare and
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would like to know which of the following services Original Medicare will cover if the
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appropriate criteria are met. What could you tell her? - ANSWERS- gf gf gf gf gf gf gf gf gf gf
Original Medicare covers ambulance services. gf gf gf gf
Mrs. Duarte is enrolled in Original Medicare Parts A and B. She has recently reviewe
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d her Medicare Summary Notice (MSN) and disagrees with a determination that parti
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ally denied one of her claims for services. What advice would you give her? -
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ANSWERS-
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Mrs. Duarte should file an appeal of this initial determination within 120 days of the d
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ate she received the MSN in the mail.
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Mrs. Geisler's neighbor told her she should look at her Part D options during the ann
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ual Medicare enrollment period because the features of Part D might have changed.
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Mrs. Geisler can't remember what Part D is so she called you to ask what her neighb
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or was talking about. What could you tell her? - ANSWERS-
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Part D covers prescription drugs and she should look at her premiums, formulary, an
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d cost-sharing among other factors to see if they have changed.
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Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What could you tell
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Mrs. Park that might be of assistance? - ANSWERS-
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She should contact her state Medicaid agency to see if she qualifies for one of sever
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al programs that can help with Medicare costs for which she is responsible.
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Mrs. Quinn recently turned 66 and decided after many years of work to retire and be
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gin receiving Social Security benefits. Shortly thereafter Mrs. Quinn received a letter i
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nforming her that she had been automatically enrolled in Medicare Part B. She wants
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to understand what this means. What should you tell Mrs. Quinn? - ANSWERS-
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Part B primarily covers physician services. She will be paying a monthly premium an
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d, except for many preventive and screening tests, generally will have 20% co-
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payments for these services, in addition to an annual deductible.
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Anita Magri will turn age 65 in August 2023. Anita intends to enroll in Original Medica
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re Part A and Part B. She would also like to enroll in a Medicare Supplement (Medig
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ap) plan. Anita's older neighbor Mel has told her about the Medigap Plan F in which
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he is enrolled. It not only provides foreign travel emergency benefits but also covers
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his Medicare Part B deductible. Anita comes to you for advice. What should you tell
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her? - ANSWERS- gf gf
You are sorry to disappoint Anita, but a Medigap F plan is no longer available to thos
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e who turn age 65 after January 1, 2020. Anita might instead consider other Medigap
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plans that offer foreign travel benefits but do not cover the Part B deductible.
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Mr. Singh would like drug coverage but does not want to be enrolled in a Medicare A
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dvantage plan. What should you tell him? - ANSWERS- gf gf gf gf gf gf gf gf
, Mr. Singh can enroll in a stand-
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alone prescription drug plan and continue to be covered for Part A and Part B servic
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es through Original Fee-for-Service Medicare.
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Mrs. Chen will be 65 soon, has been a citizen for twelve years, has been employed f
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ull time, and paid taxes during that entire period. She is concerned that she will not q
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ualify for coverage under part A because she was not born in the United States. Wha
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t should you tell her? - ANSWERS-
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Most individuals who are citizens and age 65 or over are covered under Part A by vir
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tue of having paid Medicare taxes while working, though some may be covered as a
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result of paying monthly premiums. gf gf gf gf
Mr. Xi will soon turn age 65 and has come to you for advice as to what services are p
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rovided under Original Medicare. What should you tell Mr. Xi that best describes the
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health coverage provided to Medicare beneficiaries? - ANSWERS-
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Beneficiaries under Original Medicare have no cost- gf gf gf gf gf gf
sharing for most preventive services. gf gf gf gf
Mr. Barker enjoys a comfortable retirement income. He recently had surgery and exp
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ected that he would have certain services and items covered by the plan with minima
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l out-of-pocket costs because his MA-
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PD coverage has been very good. However, when he received the bill, he was surpri
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sed to see large charges in excess of his maximum out-of-
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pocket limit that included some services and items he thought would be fully covered
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. He called you to ask what he could do? What could you tell him? - ANSWERS-
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You can offer to review the plans appeal process to help him ask the plan to review t
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he coverage decision.
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Mr. Lombardi is interested in a Medicare Advantage (MA) PPO plan that you represe
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nt. It is one of three plans operated by the same organization in Mr. Lombardi's area.
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The MA PPO plan does not include drug coverage, but the other two plans do. Mr. L
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ombardi likes the PPO plan that does not include drug coverage and intends to obtai
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n his drug coverage through a stand-
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alone Medicare prescription drug plan. What should you tell him about this situation?
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- ANSWERS-
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He could enroll either in one of the MA plans that include prescription drug coverage
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or Original Medicare with a Medigap plan and standalone Part D prescription drug co
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verage, but he cannot enroll in the MA-only PPO plan and a stand-
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alone prescription drug plan. gf gf gf
Mr. Lopez has heard that he can sign up for a product called "Medicare Advantage"
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but is not sure about what type of plan designs are available through this program. W
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hat should you tell him about the types of health plans that are available through the
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Medicare Advantage program? - ANSWERS- gf gf gf gf
There are Medicare health plans such as HMOs, PPOs, PFFS, and MSAs.
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Mr. Kelly wants to know whether he is eligible to sign up for a private fee-for-
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service (PFFS) plan. What questions would you need to ask to determine his eligibilit
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y? - ANSWERS- gf gf
