AHIP FINAL EXAM, PRACTICE
EXAM AND STUDY GUIDE
LATEST 2025/2026 ACTUAL
EXAM 135 QUESTIONS WITH
CORRECT ANSWERS 100%
VERIFIED GRADED A+
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? - 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? - 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? - 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. Alfonso 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? - answer He generally would pay a monthly premium,
annual deductible, and per-prescription 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? -
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? - answer He may sign-up for Medicare at any time
however coverage usually begins on the fourth month after dialysis
treatments start.
Mrs. Quartet 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? - 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? - 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. Rainy
(or his representative) about the length of an inpatient psychiatric
hospital stay that Medicare will cover? - 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? - 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? - answer
Mr. Singh 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.
Mrs. Chen 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? - answer 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.
Mrs. Quinn recently turned 66 and decided after many years of work
to retire and begin receiving Social Security benefits. Shortly
thereafter Mrs. Quinn 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. Quinn? -
answerPart 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. Patel 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? - 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.
What impact, if any, have recent regulatory changes had on
Mediated plans? - answer The Part B deductible is no longer covered
for individuals newly eligible for Medicare starting January 1, 2020.
Mrs. Paterson is concerned about the deductibles and co-payments
associated with Original Medicare. What can you tell her about
Medigap as an option to address this concern? - answerphone plans
do not cover Original Medicare benefits, but they coordinate with
Original Medicare coverage.
Mrs. Turner is comparing her employer's retiree insurance to
Original Medicare and would like to know which of the following
services Original Medicare will cover if the appropriate criteria are
met. What could you tell her? - answer Original Medicare covers
ambulance services.
Ms. Brooks has aggressive cancer and would like to know if
Medicare will cover hospice services in case she needs them. What
should you tell her? - answer Medicare covers hospice services, and
they will be available for her.
Mr. Diaz continued working with his company and was insured under
his employer's group plan until he reached age 68. He has heard
that there is a premium penalty for those who did not sign up for
EXAM AND STUDY GUIDE
LATEST 2025/2026 ACTUAL
EXAM 135 QUESTIONS WITH
CORRECT ANSWERS 100%
VERIFIED GRADED A+
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? - 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? - 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? - 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. Alfonso 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? - answer He generally would pay a monthly premium,
annual deductible, and per-prescription 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? -
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? - answer He may sign-up for Medicare at any time
however coverage usually begins on the fourth month after dialysis
treatments start.
Mrs. Quartet 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? - 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? - 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. Rainy
(or his representative) about the length of an inpatient psychiatric
hospital stay that Medicare will cover? - 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? - 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? - answer
Mr. Singh 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.
Mrs. Chen 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? - answer 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.
Mrs. Quinn recently turned 66 and decided after many years of work
to retire and begin receiving Social Security benefits. Shortly
thereafter Mrs. Quinn 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. Quinn? -
answerPart 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. Patel 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? - 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.
What impact, if any, have recent regulatory changes had on
Mediated plans? - answer The Part B deductible is no longer covered
for individuals newly eligible for Medicare starting January 1, 2020.
Mrs. Paterson is concerned about the deductibles and co-payments
associated with Original Medicare. What can you tell her about
Medigap as an option to address this concern? - answerphone plans
do not cover Original Medicare benefits, but they coordinate with
Original Medicare coverage.
Mrs. Turner is comparing her employer's retiree insurance to
Original Medicare and would like to know which of the following
services Original Medicare will cover if the appropriate criteria are
met. What could you tell her? - answer Original Medicare covers
ambulance services.
Ms. Brooks has aggressive cancer and would like to know if
Medicare will cover hospice services in case she needs them. What
should you tell her? - answer Medicare covers hospice services, and
they will be available for her.
Mr. Diaz continued working with his company and was insured under
his employer's group plan until he reached age 68. He has heard
that there is a premium penalty for those who did not sign up for
