2025/2026
2025 AHIP Final Exam
questions and answers
2025/2026 latest update
100% verified
USER
STUVIA
, 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.
2025 AHIP Final Exam
questions and answers
2025/2026 latest update
100% verified
USER
STUVIA
, 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.
