2025 AHIP Final Exam with verified correct t t t t t t t
answers
Mrs. Shields is covered by Original Medicare. She sustained a hip fracture and is being successfully
t t t t t t t t t t t t t t t t
treated for that condition. However, she and her physicians feel that after her lengthy hospital
t t t t t t t t t t t t t t t
stay, she will need a month or two of nursing and rehabilitative care. What should you tell them
t t t t t t t t t t t t t t t t t t
about Original Medicare's coverage of care in a skilled nursing facility? - correct answer Medicare
t t t t t t t t t t t tt t tt t
will cover Mrs. Shield's skilled nursing services provided during the first 20 days of her stay, after
t t t t t t t t t t t t t t t t t
which she would have a copay until she has been in the facility for 100 days.
t t t t t t t t t t t t t t t
Mrs. West wears glasses and dentures and has enjoyed considerable pain relief from arthritis
t t t t t t t t t t t t t t
through massage therapy. She is concerned about whether or not Medicare will cover these items
t t t t t t t t t t t t t t t
and services. What should you tell her? - correct answer Medicare does not cover massage
t t t t t t t tt t tt t t t t t
therapy, or, in general, glasses or dentures. t t t t t t
Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What could you tell Mrs. Park that
t t t t t t t t t t t t t t t t t t t t
might be of assistance? - correct answer She should contact her state Medicaid agency to see if she
t t t t tt t tt t t t t t t t t t t t
qualifies for one of several programs that can help with Medicare costs for which she is
t t t t t t t t t t t t t t t t
responsible.
Mr. Alonso receives some help paying for his two generic prescription drugs from his employer's
t t t t t t t t t t t t t t t
retiree coverage, but he wants to compare it to a Part D prescription drug plan. He asks you what
t t t t t t t t t t t t t t t t t t t
costs he would generally expect to encounter when enrolling into a standard Medicare Part D
t t t t t t t t t t t t t t t
prescription drug plan. What should you tell him? - correct answer He generally would pay a t t t t t t t t tt t tt t t t t t
monthly premium, annual deductible, and per-prescription cost-sharing.
t t t t t t
,Mrs. Gonzalez is enrolled in Original Medicare and has a Medigap policy as well, but it provides no
t t t t t t t t t t t t t t t t t t
drug coverage. She would like to keep the coverage she has but replace her existing Medigap plan
t t t t t t t t t t t t t t t t t
with one that provides drug coverage. What should you tell her? - correct answer Mrs. Gonzalez
t t t t t t t t t t t tt t tt t t
cannot purchase a Medigap plan that covers drugs, but she could keep her Medigap policy and
t t t t t t t t t t t t t t t t
enroll in a Part D prescription drug plan.
t t t t t t t
Mr. Davis is 52 years old and has recently been diagnosed with end-stage renal disease (ESRD) and
t t t t t t t t t t t t t t t t t
will soon begin dialysis. He is wondering if he can obtain coverage under Medicare. What should
t t t t t t t t t t t t t t t t
you tell him? - correct answer He may sign-up for Medicare at any time however coverage usually
t t t tt t tt t t t t t t t t t t t
begins on the fourth month after dialysis treatments start.
t t t t t t t t
Mrs. Duarte is enrolled in Original Medicare Parts A and B. She has recently reviewed her Medicare
t t t t t t t t t t t t t t t t t
Summary Notice (MSN) and disagrees with a determination that partially denied one of her claims
t t t t t t t t t t t t t t t
for services. What advice would you give her? - correct answer Mrs. Duarte should file an appeal of
t t t t t t t t t t t t t t t t t t t t
this initial determination within 120 days of the date she received the MSN in the mail.
t t t t t t t t t t t t t t t
Mrs. Geisler's neighbor told her she should look at her Part D options during the annual Medicare
t t t t t t t t t t t t t t t t t
enrollment period because the features of Part D might have changed. Mrs. Geisler can't t t t t t t t t t t t t t t
remember what Part D is so she called you to ask what her neighbor was talking about. What could t t t t t t t t t t t t t t t t t t t
you tell her? - correct answer Part D covers prescription drugs and she should look at her
t t t tt t tt t t t t t t t t t t t
premiums, formulary, and cost-sharing among other factors to see if they have changed. t t t t t t t t t t t t
Mr. Rainey is experiencing paranoid delusions and his physician feels that he should be
t t t t t t t t t t t t t t
hospitalized. What should you tell Mr. Rainey (or his representative) about the length of an t t t t t t t t t t t t t t t
inpatient psychiatric hospital stay that Medicare will cover? - correct answer Medicare will cover a
t t t t t t t t tt t tt t t t t
total of 190 days of inpatient psychiatric care during Mr. Rainey's entire lifetime.
t t t t t t t t t t t t
Mr. Xi will soon turn age 65 and has come to you for advice as to what services are provided under
t t t t t t t t t t t t t t t t t t t t t
Original Medicare. What should you tell Mr. Xi that best describes the health coverage provided to
t t t t t t t t t t t t t t t t
Medicare beneficiaries? - correct answer Beneficiaries under Original Medicare have no cost-
t t t t t t t t t t t t t
sharing for most preventive services. t t t t
Mr. Singh would like drug coverage but does not want to be enrolled in a Medicare Advantage plan.
t t t t t t t t t t t t t t t t t t
What should you tell him? - correct answer Mr. Singh can enroll in a stand-alone prescription drug
t t t t t t t t t t t t t t t t t t t
, plan and continue to be covered for Part A and Part B services through Original Fee-for-Service
t t t t t t t t t t t t t t t t
Medicare.
Mrs. Chen will be 65 soon, has been a citizen for twelve years, has been employed full time, and
t t t t t t t t t t t t t t t t t t t
paid taxes during that entire period. She is concerned that she will not qualify for coverage under
t t t t t t t t t t t t t t t t t
part A because she was not born in the United States. What should you tell her? - correct answer
t t t t t t t t t t t t t t t t t t t t t
Most individuals who are citizens and age 65 or over are covered under Part A by virtue of having
t t t t t t t t t t t t t t t t t t t
paid Medicare taxes while working, though some may be covered as a result of paying monthly
t t t t t t t t t t t t t t t t
premiums.
Mrs. Quinn recently turned 66 and decided after many years of work to retire and begin receiving
t t t t t t t t t t t t t t t t t
Social Security benefits. Shortly thereafter Mrs. Quinn received a letter informing her that she had
t t t t t t t t t t t t t t t
been automatically enrolled in Medicare Part B. She wants to understand what this means. What
t t t t t t t t t t t t t t t
should you tell Mrs. Quinn? - correct answer Part B primarily covers physician services. She will be
t t t t t t t t t t t t t t t t t t t
paying a monthly premium and, except for many preventive and screening tests, generally will
t t t t t t t t t t t t t t
have 20% co-payments for these services, in addition to an annual deductible.
t t t t t t t t t t t
Mr. Patel is in good health and is preparing a budget in anticipation of his retirement when he turns
t t t t t t t t t t t t t t t t t t t
66. He wants to understand the health care costs he might be exposed to under Medicare if he
t t t t t t t t t t t t t t t t t t
were to require hospitalization because of an illness. In general terms, what could you tell him
t t t t t t t t t t t t t t t t
about his costs for inpatient hospital services under Original Medicare? - correct answer Under
t t t t t t t t t t tt t tt t
Original Medicare, there is a single deductible amount due for the first 60 days of any inpatient
t t t t t t t t t t t t t t t t t
hospital stay, after which it converts into a per-day coinsurance amount through day 90. After day
t t t t t t t t t t t t t t t t
90, he would pay a daily amount up to 60 days over his lifetime, after which he would be
t t t t t t t t t t t t t t t t t t t
responsible for all costs. t t t
What impact, if any, have recent regulatory changes had on Medigap plans? - correct answer The
t t t t t t t t t t t t t t t t t t
Part B deductible is no longer covered for individuals newly eligible for Medicare starting January
t t t t t t t t t t t t t t t
1, 2020.
t
Mrs. Paterson is concerned about the deductibles and co-payments associated with Original
t t t t t t t t t t t t
Medicare. What can you tell her about Medigap as an option to address this concern? - correct t t t t t t t t t t t t t t t tt t
answer Medigap plans do not cover Original Medicare benefits, but they coordinate with Original
tt t t t t t t t t t t t t t
Medicare coverage. t
answers
Mrs. Shields is covered by Original Medicare. She sustained a hip fracture and is being successfully
t t t t t t t t t t t t t t t t
treated for that condition. However, she and her physicians feel that after her lengthy hospital
t t t t t t t t t t t t t t t
stay, she will need a month or two of nursing and rehabilitative care. What should you tell them
t t t t t t t t t t t t t t t t t t
about Original Medicare's coverage of care in a skilled nursing facility? - correct answer Medicare
t t t t t t t t t t t tt t tt t
will cover Mrs. Shield's skilled nursing services provided during the first 20 days of her stay, after
t t t t t t t t t t t t t t t t t
which she would have a copay until she has been in the facility for 100 days.
t t t t t t t t t t t t t t t
Mrs. West wears glasses and dentures and has enjoyed considerable pain relief from arthritis
t t t t t t t t t t t t t t
through massage therapy. She is concerned about whether or not Medicare will cover these items
t t t t t t t t t t t t t t t
and services. What should you tell her? - correct answer Medicare does not cover massage
t t t t t t t tt t tt t t t t t
therapy, or, in general, glasses or dentures. t t t t t t
Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What could you tell Mrs. Park that
t t t t t t t t t t t t t t t t t t t t
might be of assistance? - correct answer She should contact her state Medicaid agency to see if she
t t t t tt t tt t t t t t t t t t t t
qualifies for one of several programs that can help with Medicare costs for which she is
t t t t t t t t t t t t t t t t
responsible.
Mr. Alonso receives some help paying for his two generic prescription drugs from his employer's
t t t t t t t t t t t t t t t
retiree coverage, but he wants to compare it to a Part D prescription drug plan. He asks you what
t t t t t t t t t t t t t t t t t t t
costs he would generally expect to encounter when enrolling into a standard Medicare Part D
t t t t t t t t t t t t t t t
prescription drug plan. What should you tell him? - correct answer He generally would pay a t t t t t t t t tt t tt t t t t t
monthly premium, annual deductible, and per-prescription cost-sharing.
t t t t t t
,Mrs. Gonzalez is enrolled in Original Medicare and has a Medigap policy as well, but it provides no
t t t t t t t t t t t t t t t t t t
drug coverage. She would like to keep the coverage she has but replace her existing Medigap plan
t t t t t t t t t t t t t t t t t
with one that provides drug coverage. What should you tell her? - correct answer Mrs. Gonzalez
t t t t t t t t t t t tt t tt t t
cannot purchase a Medigap plan that covers drugs, but she could keep her Medigap policy and
t t t t t t t t t t t t t t t t
enroll in a Part D prescription drug plan.
t t t t t t t
Mr. Davis is 52 years old and has recently been diagnosed with end-stage renal disease (ESRD) and
t t t t t t t t t t t t t t t t t
will soon begin dialysis. He is wondering if he can obtain coverage under Medicare. What should
t t t t t t t t t t t t t t t t
you tell him? - correct answer He may sign-up for Medicare at any time however coverage usually
t t t tt t tt t t t t t t t t t t t
begins on the fourth month after dialysis treatments start.
t t t t t t t t
Mrs. Duarte is enrolled in Original Medicare Parts A and B. She has recently reviewed her Medicare
t t t t t t t t t t t t t t t t t
Summary Notice (MSN) and disagrees with a determination that partially denied one of her claims
t t t t t t t t t t t t t t t
for services. What advice would you give her? - correct answer Mrs. Duarte should file an appeal of
t t t t t t t t t t t t t t t t t t t t
this initial determination within 120 days of the date she received the MSN in the mail.
t t t t t t t t t t t t t t t
Mrs. Geisler's neighbor told her she should look at her Part D options during the annual Medicare
t t t t t t t t t t t t t t t t t
enrollment period because the features of Part D might have changed. Mrs. Geisler can't t t t t t t t t t t t t t t
remember what Part D is so she called you to ask what her neighbor was talking about. What could t t t t t t t t t t t t t t t t t t t
you tell her? - correct answer Part D covers prescription drugs and she should look at her
t t t tt t tt t t t t t t t t t t t
premiums, formulary, and cost-sharing among other factors to see if they have changed. t t t t t t t t t t t t
Mr. Rainey is experiencing paranoid delusions and his physician feels that he should be
t t t t t t t t t t t t t t
hospitalized. What should you tell Mr. Rainey (or his representative) about the length of an t t t t t t t t t t t t t t t
inpatient psychiatric hospital stay that Medicare will cover? - correct answer Medicare will cover a
t t t t t t t t tt t tt t t t t
total of 190 days of inpatient psychiatric care during Mr. Rainey's entire lifetime.
t t t t t t t t t t t t
Mr. Xi will soon turn age 65 and has come to you for advice as to what services are provided under
t t t t t t t t t t t t t t t t t t t t t
Original Medicare. What should you tell Mr. Xi that best describes the health coverage provided to
t t t t t t t t t t t t t t t t
Medicare beneficiaries? - correct answer Beneficiaries under Original Medicare have no cost-
t t t t t t t t t t t t t
sharing for most preventive services. t t t t
Mr. Singh would like drug coverage but does not want to be enrolled in a Medicare Advantage plan.
t t t t t t t t t t t t t t t t t t
What should you tell him? - correct answer Mr. Singh can enroll in a stand-alone prescription drug
t t t t t t t t t t t t t t t t t t t
, plan and continue to be covered for Part A and Part B services through Original Fee-for-Service
t t t t t t t t t t t t t t t t
Medicare.
Mrs. Chen will be 65 soon, has been a citizen for twelve years, has been employed full time, and
t t t t t t t t t t t t t t t t t t t
paid taxes during that entire period. She is concerned that she will not qualify for coverage under
t t t t t t t t t t t t t t t t t
part A because she was not born in the United States. What should you tell her? - correct answer
t t t t t t t t t t t t t t t t t t t t t
Most individuals who are citizens and age 65 or over are covered under Part A by virtue of having
t t t t t t t t t t t t t t t t t t t
paid Medicare taxes while working, though some may be covered as a result of paying monthly
t t t t t t t t t t t t t t t t
premiums.
Mrs. Quinn recently turned 66 and decided after many years of work to retire and begin receiving
t t t t t t t t t t t t t t t t t
Social Security benefits. Shortly thereafter Mrs. Quinn received a letter informing her that she had
t t t t t t t t t t t t t t t
been automatically enrolled in Medicare Part B. She wants to understand what this means. What
t t t t t t t t t t t t t t t
should you tell Mrs. Quinn? - correct answer Part B primarily covers physician services. She will be
t t t t t t t t t t t t t t t t t t t
paying a monthly premium and, except for many preventive and screening tests, generally will
t t t t t t t t t t t t t t
have 20% co-payments for these services, in addition to an annual deductible.
t t t t t t t t t t t
Mr. Patel is in good health and is preparing a budget in anticipation of his retirement when he turns
t t t t t t t t t t t t t t t t t t t
66. He wants to understand the health care costs he might be exposed to under Medicare if he
t t t t t t t t t t t t t t t t t t
were to require hospitalization because of an illness. In general terms, what could you tell him
t t t t t t t t t t t t t t t t
about his costs for inpatient hospital services under Original Medicare? - correct answer Under
t t t t t t t t t t tt t tt t
Original Medicare, there is a single deductible amount due for the first 60 days of any inpatient
t t t t t t t t t t t t t t t t t
hospital stay, after which it converts into a per-day coinsurance amount through day 90. After day
t t t t t t t t t t t t t t t t
90, he would pay a daily amount up to 60 days over his lifetime, after which he would be
t t t t t t t t t t t t t t t t t t t
responsible for all costs. t t t
What impact, if any, have recent regulatory changes had on Medigap plans? - correct answer The
t t t t t t t t t t t t t t t t t t
Part B deductible is no longer covered for individuals newly eligible for Medicare starting January
t t t t t t t t t t t t t t t
1, 2020.
t
Mrs. Paterson is concerned about the deductibles and co-payments associated with Original
t t t t t t t t t t t t
Medicare. What can you tell her about Medigap as an option to address this concern? - correct t t t t t t t t t t t t t t t tt t
answer Medigap plans do not cover Original Medicare benefits, but they coordinate with Original
tt t t t t t t t t t t t t t
Medicare coverage. t
