2027 AHIP Final Exam – Medicare Certification –
Actual Questions & Answers (AHIP) Guarantee Pass
(Updated Pdf)
QUESTION 1
Larry Miller is an Original Medicare beneficiary with Parts A and B
coverage. Larry is admitted to Good Care Hospital in January with
pneumonia and stays for three days before being discharged. Six
months later in July, Larry takes a bad fall and is admitted to Good
Care Hospital with a broken leg. After emergency surgery to repair
his broken leg, Larry is hospitalized for a week before being
discharged home. In December, Larry is admitted to Mount Wellness
Hospital once again with a serious case of the flu. For how many
Part A deductibles will Larry be responsible for?
A) One Part A deductible
B) Two Part A deductibles
C) Larry will be responsible for three Part A deductibles.
D) Larry will not have to pay any Part A deductibles.
ANSWER: C) Larry will be responsible for three Part A deductibles.
EXPERT RATIONALE: The Medicare Part A hospital deductible applies
to each benefit period, not annually. A benefit period begins the day
,a beneficiary is admitted as an inpatient and ends when they have
not received inpatient care for 60 consecutive days. Larry's three
hospitalizations (January, July, December) each represent separate
benefit periods because they are separated by more than 60 days.
Therefore, he owes three separate Part A deductibles.
QUESTION 2
Kevin Birch enrolled in Original Medicare (Parts A and B). Mr. Birch
has been receiving rehabilitation services in a skilled nursing
facility. He calls you to say that he has just received a notice that
Medicare will no longer cover his stay and he still cannot walk
properly. He thinks they are ending his services too soon. What do
you tell him?
A) He should accept the decision and prepare for discharge immediately.
B) He should follow the directions on the notice to file a fast appeal. Mr.
Birch should file it by noon of the calendar day following receipt of the
provider's notice of termination of services.
C) He should contact his physician to write a new order for continued
stay.
D) He should file a standard appeal within 60 days of discharge.
ANSWER: B) He should follow the directions on the notice to file a
fast appeal. Mr. Birch should file it by noon of the calendar day
following receipt of the provider's notice of termination of services.
,EXPERT RATIONALE: When a skilled nursing facility (SNF) issues a
Notice of Non-Coverage (NNC) stating Medicare will no longer cover
services, beneficiaries have the right to an expedited (fast) appeal
through the Quality Improvement Organization (QIO). The appeal
must be filed by noon the day after receiving the notice. This is
distinct from a standard appeal (D) and does not require a new
physician order (C). Accepting the decision (A) would forfeit appeal
rights.
QUESTION 3
Mr. Ray would like drug coverage but does not want to be enrolled in
a Medicare Advantage plan. What should you tell him?
A) He must enroll in a Medicare Advantage plan to get drug coverage.
B) Mr. Ray can enroll in a stand-alone prescription drug plan and continue
to be covered for Part A and Part B services through Original Fee-for-
Service Medicare.
C) He can only get drug coverage through his employer's plan.
D) He should purchase a Medigap plan that includes drug coverage.
ANSWER: B) Mr. Ray can enroll in a stand-alone prescription drug
plan and continue to be covered for Part A and Part B services
through Original Fee-for-Service Medicare.
EXPERT RATIONALE: Medicare beneficiaries in Original Medicare can
enroll in a stand-alone Prescription Drug Plan (PDP) to obtain Part D
, coverage without joining a Medicare Advantage plan. Option A is
incorrect because MA enrollment is not required for drug coverage.
Option C is incorrect because employer coverage is not the only
avenue. Option D is incorrect because Medigap plans sold today
cannot include prescription drug coverage (this ended in 2006).
QUESTION 4
Mrs. Sanders will be 65 soon, has been a citizen for twelve years,
has been employed full-time, and paid taxes during that entire
period. She is concerned that she will not qualify for coverage under
Part A because she was not born in the United States. What should
you tell her?
A) She must have been born in the United States to qualify for Medicare.
B) Most individuals who are citizens and age 65 or over are covered
under Part A by virtue of having paid Medicare taxes while working,
though some may be covered as a result of paying monthly premiums.
C) She must wait an additional five years after becoming a citizen before
qualifying for Medicare.
D) Only those born in the U.S. who have paid taxes for 20+ years qualify
for premium-free Part A.
ANSWER: B) Most individuals who are citizens and age 65 or over
are covered under Part A by virtue of having paid Medicare taxes
Actual Questions & Answers (AHIP) Guarantee Pass
(Updated Pdf)
QUESTION 1
Larry Miller is an Original Medicare beneficiary with Parts A and B
coverage. Larry is admitted to Good Care Hospital in January with
pneumonia and stays for three days before being discharged. Six
months later in July, Larry takes a bad fall and is admitted to Good
Care Hospital with a broken leg. After emergency surgery to repair
his broken leg, Larry is hospitalized for a week before being
discharged home. In December, Larry is admitted to Mount Wellness
Hospital once again with a serious case of the flu. For how many
Part A deductibles will Larry be responsible for?
A) One Part A deductible
B) Two Part A deductibles
C) Larry will be responsible for three Part A deductibles.
D) Larry will not have to pay any Part A deductibles.
ANSWER: C) Larry will be responsible for three Part A deductibles.
EXPERT RATIONALE: The Medicare Part A hospital deductible applies
to each benefit period, not annually. A benefit period begins the day
,a beneficiary is admitted as an inpatient and ends when they have
not received inpatient care for 60 consecutive days. Larry's three
hospitalizations (January, July, December) each represent separate
benefit periods because they are separated by more than 60 days.
Therefore, he owes three separate Part A deductibles.
QUESTION 2
Kevin Birch enrolled in Original Medicare (Parts A and B). Mr. Birch
has been receiving rehabilitation services in a skilled nursing
facility. He calls you to say that he has just received a notice that
Medicare will no longer cover his stay and he still cannot walk
properly. He thinks they are ending his services too soon. What do
you tell him?
A) He should accept the decision and prepare for discharge immediately.
B) He should follow the directions on the notice to file a fast appeal. Mr.
Birch should file it by noon of the calendar day following receipt of the
provider's notice of termination of services.
C) He should contact his physician to write a new order for continued
stay.
D) He should file a standard appeal within 60 days of discharge.
ANSWER: B) He should follow the directions on the notice to file a
fast appeal. Mr. Birch should file it by noon of the calendar day
following receipt of the provider's notice of termination of services.
,EXPERT RATIONALE: When a skilled nursing facility (SNF) issues a
Notice of Non-Coverage (NNC) stating Medicare will no longer cover
services, beneficiaries have the right to an expedited (fast) appeal
through the Quality Improvement Organization (QIO). The appeal
must be filed by noon the day after receiving the notice. This is
distinct from a standard appeal (D) and does not require a new
physician order (C). Accepting the decision (A) would forfeit appeal
rights.
QUESTION 3
Mr. Ray would like drug coverage but does not want to be enrolled in
a Medicare Advantage plan. What should you tell him?
A) He must enroll in a Medicare Advantage plan to get drug coverage.
B) Mr. Ray can enroll in a stand-alone prescription drug plan and continue
to be covered for Part A and Part B services through Original Fee-for-
Service Medicare.
C) He can only get drug coverage through his employer's plan.
D) He should purchase a Medigap plan that includes drug coverage.
ANSWER: B) Mr. Ray can enroll in a stand-alone prescription drug
plan and continue to be covered for Part A and Part B services
through Original Fee-for-Service Medicare.
EXPERT RATIONALE: Medicare beneficiaries in Original Medicare can
enroll in a stand-alone Prescription Drug Plan (PDP) to obtain Part D
, coverage without joining a Medicare Advantage plan. Option A is
incorrect because MA enrollment is not required for drug coverage.
Option C is incorrect because employer coverage is not the only
avenue. Option D is incorrect because Medigap plans sold today
cannot include prescription drug coverage (this ended in 2006).
QUESTION 4
Mrs. Sanders will be 65 soon, has been a citizen for twelve years,
has been employed full-time, and paid taxes during that entire
period. She is concerned that she will not qualify for coverage under
Part A because she was not born in the United States. What should
you tell her?
A) She must have been born in the United States to qualify for Medicare.
B) Most individuals who are citizens and age 65 or over are covered
under Part A by virtue of having paid Medicare taxes while working,
though some may be covered as a result of paying monthly premiums.
C) She must wait an additional five years after becoming a citizen before
qualifying for Medicare.
D) Only those born in the U.S. who have paid taxes for 20+ years qualify
for premium-free Part A.
ANSWER: B) Most individuals who are citizens and age 65 or over
are covered under Part A by virtue of having paid Medicare taxes
