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AHIP FINAL TEST EXAM (FULL TEST) || 2025
ACTUAL EXAM ALL QUESTIONS AND 100%
CORRECT ANSWERS GRADE A+|| LATEST AND
COMPLETE UPDATED VERSION 2025||
GUARANTEED PASS!!!
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
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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.
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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.
Ms. Edwards is enrolled in a Medicare Advantage plan that includes prescription
drug plan (PDP) coverage. She is traveling and wishes to fill two of her
prescriptions that she has lost. How would you advise her? ANSWER- She may
fill prescriptions for covered drugs at non-network pharmacies, but likely at a
higher cost than paid at an in-network pharmacy.
Mr. Rockwell, age 67, is enrolled in Medicare Part A, but because he continues to
work and is covered by an employer health plan, he has not enrolled in Part B or
Part D. He receives a notice on June 1 that his employer is cutting back on
prescription drug benefits and that as of July 1 his coverage will no longer be
creditable. He has come to you for advice. What advice would you give Mr.
Rockwell about special enrollment periods (SEPs)? ANSWER- Mr. Rockwell is
eligible for a SEP due to his involuntary loss of creditable drug coverage; the SEP
begins in June and ends September 1 - two months after the loss of creditable
coverage.
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.
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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. and Mrs. Nunez attended one of your sales presentations. They've asked you to
come to their home to clear up a few questions. During the presentation, Mrs.
Nunez feels tired and tells you that her husband can finish things up. She goes to
bed. At the end of your discussion, Mr. Nunez says that he wants to enroll both
himself and his wife. What should you do? ANSWER- As long as she is able to do
so, only Mrs. Nunez can sign her enrollment form. Mrs. Nunez will have to wake
up to sign her form or do so at another time.
Mr. Cole has been a Medicaid beneficiary for some time, and recently qualified for
Medicare as well. He is concerned about changes in his cost-sharing. What should
you tell him? ANSWER- He should know that Medicaid will pay cost sharing only
for services provided by Medicaid participating providers.
Mr. Barker enjoys a comfortable retirement income. He recently had surgery and
expected that he would have certain services and items covered by the plan with
minimal out-of-pocket costs because his MA-PD coverage has been very good.
However, when he received the bill, he was surprised to see large charges in excess
of his maximum out-of-pocket limit that included a number of services and items
he thought would be fully covered. He called you to ask what he could do? What
AHIP FINAL TEST EXAM (FULL TEST) || 2025
ACTUAL EXAM ALL QUESTIONS AND 100%
CORRECT ANSWERS GRADE A+|| LATEST AND
COMPLETE UPDATED VERSION 2025||
GUARANTEED PASS!!!
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
,2|Page
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.
,3|Page
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.
Ms. Edwards is enrolled in a Medicare Advantage plan that includes prescription
drug plan (PDP) coverage. She is traveling and wishes to fill two of her
prescriptions that she has lost. How would you advise her? ANSWER- She may
fill prescriptions for covered drugs at non-network pharmacies, but likely at a
higher cost than paid at an in-network pharmacy.
Mr. Rockwell, age 67, is enrolled in Medicare Part A, but because he continues to
work and is covered by an employer health plan, he has not enrolled in Part B or
Part D. He receives a notice on June 1 that his employer is cutting back on
prescription drug benefits and that as of July 1 his coverage will no longer be
creditable. He has come to you for advice. What advice would you give Mr.
Rockwell about special enrollment periods (SEPs)? ANSWER- Mr. Rockwell is
eligible for a SEP due to his involuntary loss of creditable drug coverage; the SEP
begins in June and ends September 1 - two months after the loss of creditable
coverage.
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.
, 4|Page
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. and Mrs. Nunez attended one of your sales presentations. They've asked you to
come to their home to clear up a few questions. During the presentation, Mrs.
Nunez feels tired and tells you that her husband can finish things up. She goes to
bed. At the end of your discussion, Mr. Nunez says that he wants to enroll both
himself and his wife. What should you do? ANSWER- As long as she is able to do
so, only Mrs. Nunez can sign her enrollment form. Mrs. Nunez will have to wake
up to sign her form or do so at another time.
Mr. Cole has been a Medicaid beneficiary for some time, and recently qualified for
Medicare as well. He is concerned about changes in his cost-sharing. What should
you tell him? ANSWER- He should know that Medicaid will pay cost sharing only
for services provided by Medicaid participating providers.
Mr. Barker enjoys a comfortable retirement income. He recently had surgery and
expected that he would have certain services and items covered by the plan with
minimal out-of-pocket costs because his MA-PD coverage has been very good.
However, when he received the bill, he was surprised to see large charges in excess
of his maximum out-of-pocket limit that included a number of services and items
he thought would be fully covered. He called you to ask what he could do? What
