2025/2026
2025 AHIP final exam
questions and answers
2025/2026 latest update
100% verified answers
USER
STUVIA
,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.
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. 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? - ✔✔answer Original Medicare covers ambulance services.
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? - ✔✔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.
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.
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. 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? - ✔✔answer Medigap
plans do not cover Original Medicare benefits, but they coordinate with Original Medicare coverage.
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.
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.
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? - ✔✔answer You 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.
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 answers
USER
STUVIA
,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.
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. 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? - ✔✔answer Original Medicare covers ambulance services.
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? - ✔✔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.
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.
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. 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? - ✔✔answer Medigap
plans do not cover Original Medicare benefits, but they coordinate with Original Medicare coverage.
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.
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.
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? - ✔✔answer You 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.
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.
