AHIP 2025 Final Exam Questions and Answers (2024 /
2025
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. 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? -
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. 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?
- 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. Rainey (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? - ANSWER
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? - 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 Medigap 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? - ANSWER Medigap 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 Part B when first eligible and wants to know how much
he will have to pay. What should you tell him? - ANSWER Mr. Diaz will not pay any
penalty because he had continuous coverage under his employer's plan.
Anita Magri will turn age 65 in August 2023. Anita intends to enroll in Original
Medicare Part A and Part B. She would also like to enroll in a Medicare Supplement
(Medigap) plan. Anita's older neighbor Mel has told her about the Medigap Plan F in
which he is enrolled. It not only provides foreign travel emergency benefits but also
covers his Medicare Part B deductible. Anita comes to you for advice. What should
you tell her? - ANSWER You are sorry to disappoint Anita, but a Medigap F plan is
no longer available to those who turn age 65 after January 1, 2020. Anita might
instead consider other Medigap plans that offer foreign travel benefits but do not
cover the Part B deductible.
Hank's Fish Store, Inc. is a small company with just 15 employees located in Florida.
Hank, the store owner, has provided excellent health benefits to the store's
workforce. William, one of the store's long-time employees, will soon be reaching
age 65 and eligible for Medicare. William is in good health. He intends to remain an
active full-time employee, working several years after becoming eligible for
Medicare. What type(s) of retiree health benefit will Hank's Fish Store be able to offer
William? - ANSWER Hank's can continue to offer William the same employee health
benefit plan, or, if William enrolls in Medicare Part B, it can enroll him in a Medicare
Advantage plan that is offered to the public.
Mr. Sanchez has just turned 65 and is entitled to Part A but has not enrolled in Part
B because he has coverage through an employer plan. If he wants to enroll in a
Medicare Advantage plan, what will he have to do? - ANSWER He will have to
enroll in Part B.
2025
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. 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? -
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. 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?
- 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. Rainey (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? - ANSWER
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? - 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 Medigap 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? - ANSWER Medigap 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 Part B when first eligible and wants to know how much
he will have to pay. What should you tell him? - ANSWER Mr. Diaz will not pay any
penalty because he had continuous coverage under his employer's plan.
Anita Magri will turn age 65 in August 2023. Anita intends to enroll in Original
Medicare Part A and Part B. She would also like to enroll in a Medicare Supplement
(Medigap) plan. Anita's older neighbor Mel has told her about the Medigap Plan F in
which he is enrolled. It not only provides foreign travel emergency benefits but also
covers his Medicare Part B deductible. Anita comes to you for advice. What should
you tell her? - ANSWER You are sorry to disappoint Anita, but a Medigap F plan is
no longer available to those who turn age 65 after January 1, 2020. Anita might
instead consider other Medigap plans that offer foreign travel benefits but do not
cover the Part B deductible.
Hank's Fish Store, Inc. is a small company with just 15 employees located in Florida.
Hank, the store owner, has provided excellent health benefits to the store's
workforce. William, one of the store's long-time employees, will soon be reaching
age 65 and eligible for Medicare. William is in good health. He intends to remain an
active full-time employee, working several years after becoming eligible for
Medicare. What type(s) of retiree health benefit will Hank's Fish Store be able to offer
William? - ANSWER Hank's can continue to offer William the same employee health
benefit plan, or, if William enrolls in Medicare Part B, it can enroll him in a Medicare
Advantage plan that is offered to the public.
Mr. Sanchez has just turned 65 and is entitled to Part A but has not enrolled in Part
B because he has coverage through an employer plan. If he wants to enroll in a
Medicare Advantage plan, what will he have to do? - ANSWER He will have to
enroll in Part B.
