AHIP STUDY QUESTIONS AND CORRECT ANSWERS 2025.
PASS GUARANTEE. GRADE A+
QUESTION: 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.
QUESTION: Juan Perez, who is turning age 65 next month, intends to work for several more years at
Smallcap, Incorporated. Smallcap has a workforce of15 employees and offers employer-sponsored
healthcare coverage. Juan is a naturalized citizen and has contributed to the Medicare system for over 20
years. Juan asks you if he will be entitled to Medicare and if he enrolls how that will impact his employer-
sponsored healthcare coverage. How would you respond? - ANSWER-Juan is likely to be eligible for
Medicare once he turns age 65 and if he enrolls Medicare would become the primary payor of his
healthcare claims and Smallcap does not have to continue to offer him coverage comparable to those
under age 65 under its employer-sponsored group health plan.
QUESTION: Mr. Moy's wife has a Medicare Advantage plan, but he wants to understand what coverage
Medicare Supplemental Insurance provides since his health care needs are different from his wife's
needs. What could you tell Mr. Moy? - ANSWER-Medicare Supplemental Insurance would help cover his
Part A and Part B deductibles or coinsurance in Original Fee-for-Service (FFS) Medicare as well as possibly
some services that Medicare does not cover.
,QUESTION: Mrs. Peňa is 66 years old, has coverage under an employer plan, and will retire next year.
She heard she must enroll in Part B at the beginning of the year to ensure no gap in coverage. What can
you tell her? - ANSWER-She may enroll at any time while she is covered under her employer plan, but
she will have a special eight-month enrollment period after the last month on her employer plan that
differs from the standard general enrollment period, during which she may enroll in Medicare Part B.
QUESTION: 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.
QUESTION: 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.
QUESTION: 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.
QUESTION: 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 as a result 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.
QUESTION: Ms. Henderson believes that she will qualify for Medicare Coverage when she turns 65,
without paying any premiums, because she has been working for 40 years and paying Medicare taxes.
What should you tell her? - ANSWER-To obtain Part B coverage, she must pay a standard monthly
premium, though it is higher for individuals with higher incomes.
QUESTION: 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 MedicarePart D
prescription drug plan. What should you tell him? - ANSWER-He generally would pay a monthly
premium, annual deductible, and per-prescription cost-sharing.
QUESTION: Ms. Moore plans to retire when she turns 65 in a few months. She is in excellent health and
will have considerable income when she retires. She is concerned that her income will make it
impossible for her to qualify for Medicare. What could you tell her to address her concern? - ANSWER-
Medicare is a program for people age 65 or older and those under age 65 with certain disabilities, end-
stage renal disease, and Lou Gehrig's disease so she will be eligible for Medicare.
QUESTION: 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 which include immunizations such as annual flu shots.
, QUESTION: 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.
QUESTION: Mr. Capadona would like to purchase a Medicare Advantage (MA) plan and a Medigap plan
to pick up costs not covered by that plan.
What should you tell him? - ANSWER-It is illegal for you to sell Mr. Capadona a Medigap plan if he is
enrolled in an MA plan, and besides, Medigap only works with Original Medicare.
QUESTION: 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.
QUESTION: 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.
QUESTION: Mr. Schmidt would like to plan for retirement and has asked you what is covered under
Original Fee-for-Service (FFS) Medicare? What could you tell him? - ANSWER-Part A, which covers
hospital, skilled nursing facility, hospice, and home health services and Part B, which covers professional
services such as those provided by a doctor are covered under Original Medicare.
PASS GUARANTEE. GRADE A+
QUESTION: 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.
QUESTION: Juan Perez, who is turning age 65 next month, intends to work for several more years at
Smallcap, Incorporated. Smallcap has a workforce of15 employees and offers employer-sponsored
healthcare coverage. Juan is a naturalized citizen and has contributed to the Medicare system for over 20
years. Juan asks you if he will be entitled to Medicare and if he enrolls how that will impact his employer-
sponsored healthcare coverage. How would you respond? - ANSWER-Juan is likely to be eligible for
Medicare once he turns age 65 and if he enrolls Medicare would become the primary payor of his
healthcare claims and Smallcap does not have to continue to offer him coverage comparable to those
under age 65 under its employer-sponsored group health plan.
QUESTION: Mr. Moy's wife has a Medicare Advantage plan, but he wants to understand what coverage
Medicare Supplemental Insurance provides since his health care needs are different from his wife's
needs. What could you tell Mr. Moy? - ANSWER-Medicare Supplemental Insurance would help cover his
Part A and Part B deductibles or coinsurance in Original Fee-for-Service (FFS) Medicare as well as possibly
some services that Medicare does not cover.
,QUESTION: Mrs. Peňa is 66 years old, has coverage under an employer plan, and will retire next year.
She heard she must enroll in Part B at the beginning of the year to ensure no gap in coverage. What can
you tell her? - ANSWER-She may enroll at any time while she is covered under her employer plan, but
she will have a special eight-month enrollment period after the last month on her employer plan that
differs from the standard general enrollment period, during which she may enroll in Medicare Part B.
QUESTION: 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.
QUESTION: 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.
QUESTION: 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.
QUESTION: 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 as a result 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.
QUESTION: Ms. Henderson believes that she will qualify for Medicare Coverage when she turns 65,
without paying any premiums, because she has been working for 40 years and paying Medicare taxes.
What should you tell her? - ANSWER-To obtain Part B coverage, she must pay a standard monthly
premium, though it is higher for individuals with higher incomes.
QUESTION: 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 MedicarePart D
prescription drug plan. What should you tell him? - ANSWER-He generally would pay a monthly
premium, annual deductible, and per-prescription cost-sharing.
QUESTION: Ms. Moore plans to retire when she turns 65 in a few months. She is in excellent health and
will have considerable income when she retires. She is concerned that her income will make it
impossible for her to qualify for Medicare. What could you tell her to address her concern? - ANSWER-
Medicare is a program for people age 65 or older and those under age 65 with certain disabilities, end-
stage renal disease, and Lou Gehrig's disease so she will be eligible for Medicare.
QUESTION: 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 which include immunizations such as annual flu shots.
, QUESTION: 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.
QUESTION: Mr. Capadona would like to purchase a Medicare Advantage (MA) plan and a Medigap plan
to pick up costs not covered by that plan.
What should you tell him? - ANSWER-It is illegal for you to sell Mr. Capadona a Medigap plan if he is
enrolled in an MA plan, and besides, Medigap only works with Original Medicare.
QUESTION: 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.
QUESTION: 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.
QUESTION: Mr. Schmidt would like to plan for retirement and has asked you what is covered under
Original Fee-for-Service (FFS) Medicare? What could you tell him? - ANSWER-Part A, which covers
hospital, skilled nursing facility, hospice, and home health services and Part B, which covers professional
services such as those provided by a doctor are covered under Original Medicare.
