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2025 AHIP Final Exam Questions and Correct Answers

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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? ~~ Medicare does not cover massage therapy, or, in general, glasse...

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  • August 9, 2024
  • 32
  • 2024/2025
  • Exam (elaborations)
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  • AHIP
  • AHIP
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2025 AHIP Final Exam Questions
and Correct Answers

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?

✓✓~~ Medicare does not cover massage therapy, or, in general, glasses or
dentures.




. 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 neMrsed 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?

✓✓~~ 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. Park is an elderly retiree. Mrs. Park has a low fixed income. What could you tell

Mrs. Park that might be of assistance?

✓✓~~ 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?

✓✓~~ 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?

✓✓~~ 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?

✓✓~~ 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?

✓✓~~ 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?

✓✓~~ 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?

✓✓~~ 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?

✓✓~~ 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?

✓✓~~ 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?

✓✓~~ 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?

✓✓~~ Part 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?

✓✓~~ 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 Medigap plans?

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