AHIP 2025 Exam Questions with
Verified Solutions
He may sign-up for Medicare at any time however coverage usually begins on the fourth
month after dialysis treatments start. - ANSWER-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?
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. - ANSWER-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?
Medigap plans help beneficiaries cover coinsurance, co-payments, and/or deductibles
for medically necessary services. - ANSWER-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?
Beneficiaries under Original Medicare have no cost-sharing for most preventive services
which include immunizations such as annual flu shots. - ANSWER-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?
Medicare will cover a total of 190 days of inpatient psychiatric care during Mr. Rainey's
entire lifetime. - ANSWER-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-Mr. Lombardi is interested in a Medicare Advantage (MA) PPO plan that
you represent. It is one of three plans operated by the same organization in Mr.
Lombardi's area. The MA PPO plan does not include drug coverage, but the other two
plans do. Mr. Lombardi likes the PPO plan that does not include drug coverage and
intends to obtain his drug coverage through a stand-alone Medicare prescription drug
plan. What should you tell him about this situation?
, Hank's can continue to offer William the same employee health benefit plan, or, if
William enrolls in Medicare Part B, it can enroll him in a Medicare Advantage plan that is
offered to the public. - ANSWER-Hank's Fish Store, Inc. is a small company with just 15
employees located in Florida. Hank, the store owner, has provided excellent health
benefits to the store's workforce. William, one of the store's long-time employees, will
soon be reaching age 65 and eligible for Medicare. William is in good health. He intends
to remain an active full-time employee, working several years after becoming eligible for
Medicare. What type(s) of retiree health benefit will Hank's Fish Store be able to offer
William?
She could file a grievance with her plan to complain about the lack of timeliness in
getting an appointment. - ANSWER-Mrs. Burton is a retiree with substantial income.
She is enrolled in an MA-PD plan and was disappointed with the service she received
from her primary care physician because she was told she would have to wait five
weeks to get an appointment when she was feeling ill. She called you to ask what she
could do so she would not have to put up with such poor access to care. What could
you tell her?
You would need to ask Mr. Kelly if he is enrolled in Part A and Part B and if he lives in
the PFFS plan's service area. - ANSWER-Mr. Kelly wants to know whether he is eligible
to sign up for a Private fee-for-service (PFFS) plan. What questions would you need to
ask to determine his eligibility?
The extra help is available to beneficiaries whose income and assets do not exceed
annual limits specified by the government. - ANSWER-Mr. Shapiro gets by on a very
small amount of fixed income. He has heard there may be extra help paying for Part D
prescription drugs for Medicare beneficiaries with limited income. He wants to know
whether he might qualify. What should you tell him?
TrOOP stands for true out-of-pocket expenses that count toward the Medicare Part D
catastrophic limit and include not only expenses paid by a beneficiary but also in some
instances drug manufacturer discounts. - ANSWER-One of your clients, Lauren Nichols,
has heard about a Medicare concept from one of her neighbors called TrOOP. She asks
you to explain it. What do you say?
In general, he must select a single Part D premium payment mechanism that will be
used throughout the year. - ANSWER-Mr. Torres has a small savings account. He
would like to pay for his monthly Part D premiums with an automatic monthly withdrawal
from his savings account until it is exhausted, and then have his premiums withheld
from his Social Security check. What should you tell him?
He could check with the manufacturers of his medications to see if they offer an
assistance program to help people with limited means to obtain the medications they
need. Alternatively, he could check to see whether his state has a pharmacy assistance
program to help him with his expenses. - ANSWER-Mr. Bickford did not quite qualify for
the extra help low-income subsidy under the Medicare Part D Prescription Drug
Verified Solutions
He may sign-up for Medicare at any time however coverage usually begins on the fourth
month after dialysis treatments start. - ANSWER-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?
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. - ANSWER-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?
Medigap plans help beneficiaries cover coinsurance, co-payments, and/or deductibles
for medically necessary services. - ANSWER-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?
Beneficiaries under Original Medicare have no cost-sharing for most preventive services
which include immunizations such as annual flu shots. - ANSWER-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?
Medicare will cover a total of 190 days of inpatient psychiatric care during Mr. Rainey's
entire lifetime. - ANSWER-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-Mr. Lombardi is interested in a Medicare Advantage (MA) PPO plan that
you represent. It is one of three plans operated by the same organization in Mr.
Lombardi's area. The MA PPO plan does not include drug coverage, but the other two
plans do. Mr. Lombardi likes the PPO plan that does not include drug coverage and
intends to obtain his drug coverage through a stand-alone Medicare prescription drug
plan. What should you tell him about this situation?
, Hank's can continue to offer William the same employee health benefit plan, or, if
William enrolls in Medicare Part B, it can enroll him in a Medicare Advantage plan that is
offered to the public. - ANSWER-Hank's Fish Store, Inc. is a small company with just 15
employees located in Florida. Hank, the store owner, has provided excellent health
benefits to the store's workforce. William, one of the store's long-time employees, will
soon be reaching age 65 and eligible for Medicare. William is in good health. He intends
to remain an active full-time employee, working several years after becoming eligible for
Medicare. What type(s) of retiree health benefit will Hank's Fish Store be able to offer
William?
She could file a grievance with her plan to complain about the lack of timeliness in
getting an appointment. - ANSWER-Mrs. Burton is a retiree with substantial income.
She is enrolled in an MA-PD plan and was disappointed with the service she received
from her primary care physician because she was told she would have to wait five
weeks to get an appointment when she was feeling ill. She called you to ask what she
could do so she would not have to put up with such poor access to care. What could
you tell her?
You would need to ask Mr. Kelly if he is enrolled in Part A and Part B and if he lives in
the PFFS plan's service area. - ANSWER-Mr. Kelly wants to know whether he is eligible
to sign up for a Private fee-for-service (PFFS) plan. What questions would you need to
ask to determine his eligibility?
The extra help is available to beneficiaries whose income and assets do not exceed
annual limits specified by the government. - ANSWER-Mr. Shapiro gets by on a very
small amount of fixed income. He has heard there may be extra help paying for Part D
prescription drugs for Medicare beneficiaries with limited income. He wants to know
whether he might qualify. What should you tell him?
TrOOP stands for true out-of-pocket expenses that count toward the Medicare Part D
catastrophic limit and include not only expenses paid by a beneficiary but also in some
instances drug manufacturer discounts. - ANSWER-One of your clients, Lauren Nichols,
has heard about a Medicare concept from one of her neighbors called TrOOP. She asks
you to explain it. What do you say?
In general, he must select a single Part D premium payment mechanism that will be
used throughout the year. - ANSWER-Mr. Torres has a small savings account. He
would like to pay for his monthly Part D premiums with an automatic monthly withdrawal
from his savings account until it is exhausted, and then have his premiums withheld
from his Social Security check. What should you tell him?
He could check with the manufacturers of his medications to see if they offer an
assistance program to help people with limited means to obtain the medications they
need. Alternatively, he could check to see whether his state has a pharmacy assistance
program to help him with his expenses. - ANSWER-Mr. Bickford did not quite qualify for
the extra help low-income subsidy under the Medicare Part D Prescription Drug
