2025 AHIP Final Exam
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? -
ANSMedicare 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? - ANSMedicare 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? - ANSShe 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? - ANSHe 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? - ANSMrs.
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? - ANSHe 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? - ANSMrs. 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? - ANSPart 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? - ANSMedicare 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? - ANSBeneficiaries 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? - ANSMr. 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? -
ANSMost 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? - ANSPart 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? - ANSUnder
, 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? - ANSThe 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? -
ANSMedigap 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? - ANSOriginal 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? - ANSMedicare 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? - ANSMr. 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? - ANSYou 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? - ANSHank's can continue to offer William the same employee health
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? -
ANSMedicare 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? - ANSMedicare 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? - ANSShe 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? - ANSHe 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? - ANSMrs.
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? - ANSHe 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? - ANSMrs. 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? - ANSPart 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? - ANSMedicare 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? - ANSBeneficiaries 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? - ANSMr. 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? -
ANSMost 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? - ANSPart 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? - ANSUnder
, 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? - ANSThe 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? -
ANSMedigap 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? - ANSOriginal 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? - ANSMedicare 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? - ANSMr. 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? - ANSYou 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? - ANSHank's can continue to offer William the same employee health
