AHIP FINAL EXAM 2024/2025 WITH 100% CORRECT
ANSWERS
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 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? - 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? - correct 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? - correct 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? - correct 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? - correct 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? - correct 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? - correct
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? - correct 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? - correct 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? - correct 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? - correct answer You are sorry to disappoint Anita, but a Medigap F plan is
ANSWERS
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 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? - 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? - correct 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? - correct 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? - correct 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? - correct 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? - correct 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? - correct
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? - correct 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? - correct 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? - correct 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? - correct answer You are sorry to disappoint Anita, but a Medigap F plan is
