2026 AHIP FINAL EXAM
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? - ✔✔ CORRECT ANSWER ✔✔ -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.
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? - ✔✔ CORRECT ANSWER ✔✔ -Medicare
does not cover massage therapy, or, in general, glasses or dentures.
Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income.
What could you tell Mrs.
,Park 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.
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? -
✔✔ CORRECT ANSWER ✔✔ -He generally would pay a monthly
premium, annual deductible, and perprescription cost-sharing.
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? -
✔✔ CORRECT ANSWER ✔✔ -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.
,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? - ✔✔ CORRECT
ANSWER ✔✔ -He may sign-up for Medicare at any time however
coverage usually begins on the fourth month after dialysis
treatments start.
Mrs. Duarte is enrolled in Original Medicare Parts A and B. She has
recently reviewed her Medicare Summary Notice (MSN) and
disagrees with a determination that partially denied one of her
claims for services. What advice would you give her? - ✔✔ CORRECT
ANSWER ✔✔ -Mrs. Duarte should file an appeal of this initial
determination within 120 days of the date she received the MSN in
the mail.
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? - ✔✔ CORRECT ANSWER ✔✔ -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.
Mr. Rainey is experiencing paranoid delusions and his physician feels
that he should be hospitalized. What should you tell Mr. Rainey (or
his representative) about the length of an inpatient psychiatric
hospital stay that Medicare will cover? - ✔✔ CORRECT ANSWER ✔✔
-Medicare will cover a total of 190 days of inpatient psychiatric care
during Mr. Rainey's entire lifetime.
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? - ✔✔ CORRECT ANSWER ✔✔ -Beneficiaries
under Original Medicare have no cost-sharing for most preventive
services.
Mr. Singh would like drug coverage but does not want to be enrolled
in a Medicare Advantage plan. What should you tell him? - ✔✔
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? - ✔✔ CORRECT ANSWER ✔✔ -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.
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? - ✔✔ CORRECT ANSWER ✔✔ -Medicare
does not cover massage therapy, or, in general, glasses or dentures.
Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income.
What could you tell Mrs.
,Park 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.
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? -
✔✔ CORRECT ANSWER ✔✔ -He generally would pay a monthly
premium, annual deductible, and perprescription cost-sharing.
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? -
✔✔ CORRECT ANSWER ✔✔ -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.
,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? - ✔✔ CORRECT
ANSWER ✔✔ -He may sign-up for Medicare at any time however
coverage usually begins on the fourth month after dialysis
treatments start.
Mrs. Duarte is enrolled in Original Medicare Parts A and B. She has
recently reviewed her Medicare Summary Notice (MSN) and
disagrees with a determination that partially denied one of her
claims for services. What advice would you give her? - ✔✔ CORRECT
ANSWER ✔✔ -Mrs. Duarte should file an appeal of this initial
determination within 120 days of the date she received the MSN in
the mail.
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? - ✔✔ CORRECT ANSWER ✔✔ -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.
Mr. Rainey is experiencing paranoid delusions and his physician feels
that he should be hospitalized. What should you tell Mr. Rainey (or
his representative) about the length of an inpatient psychiatric
hospital stay that Medicare will cover? - ✔✔ CORRECT ANSWER ✔✔
-Medicare will cover a total of 190 days of inpatient psychiatric care
during Mr. Rainey's entire lifetime.
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? - ✔✔ CORRECT ANSWER ✔✔ -Beneficiaries
under Original Medicare have no cost-sharing for most preventive
services.
Mr. Singh would like drug coverage but does not want to be enrolled
in a Medicare Advantage plan. What should you tell him? - ✔✔
