AHIP 2025/2026 Final Exam
All Questions Carefully Analyzed and Answers highlighted for
your success 100% Rated [A+]
1. 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?: Ben-
Eficiaries Under Original Medicare Have No Cost-Sharing For Most Preventive
Services
2. Mrs. Quinn Recently Turned 66 And Decided After Many Years Of Work To Begin
Receiving Social Security Benefits. Shortly Thereafter Mrs. Quinn Received A
Letter Informing Her That She Has Been Automatically Enrolled In Medicare Part
B. She Wants To Understand What This Means. What Should You Tell Mrs.
Quinn?: Part B Primarily Covers Physician Services. She Will Be Paying A
Monthly Premium And, Except For Many Preventive Screening And Tests,
Generally Will Have 20 Percent Co-Payments For These Services In Addition To
An Annual Deductible
3. 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?: He May Sign Up
For Medicare At Any Time However Coverage Usually Begins On The Fourth
Month After Dialysis Treatment
4. 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?: He Generally Would Pay A Monthly Premium,
Annual Deductible, And Per-Prescription Cost Sharing.
5. Ms. Brooks Has An Aggressive Cancer And Would Like To Know If Medicare
Will Cover Hospice Services In Case She Needs Them. What Should You Tell
Her?: Medicare Covers Hospice Services And They Will Be Available To Her.
6. Mrs. Park Is An Elderly Retiree. Mrs. Park Has A Low Fixed Income. What Could
You Tell Mrs. Park That Might Be Of Assistance?: 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.
,7. Mrs. Duarte Is Enrolled In Original Medicare Parts A And B. She Has Recently
Reviewed Her Medicare Summary Notice (MSN) And Disagrees With A Determi-
Nation That Partially Denied One Of Her Claims For Services. What Advice Would
You Give Her?: Mrs. Duarte Should File An Appeal Of This Initial Determination
Within 120 Days Of The Date She Received The MSN In The Mail.
8. 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?: 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.
9. Mr. Singh Would Like Drug Coverage But Does Not Want To Be Enrolled In A
Medicare Advantage Plan. What Should You Tell Him?: 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.
10. What Impact, If Any, Have Recent Regulatory Changes Had On Medigap
Plans?: The Part B Deductible Is No Longer Covered For Individuals Newly Eligible
For Medicare Starting January 1, 2020.
11. 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?: Medicare Does Not Cover Massage Therapy, Or, In General, Glasses Or
Dentures.
12. 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?: 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.
13. 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?: Medicare Will
Cover Mrs. Shield's Skilled Nursing Services Provided During The First 20 Days O
Her Stay, After Which She Would Have A Copay Until She Has Been In The Facility
For 100 Days.
14. 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?: Original Medicare Covers Ambulance Services.
15. Mr. Diaz Continued Working With His Company And Was Insured Under His
Employer's Group Plan Until He Reached Age 68. He Has Heard That There Is
A Premium Penalty For Those Who Did Not Sign Up For Part B When First
Eligible And Wants To Know How Much He Will Have To Pay. What Should You
Tell Him?: Mr. Diaz Will Not Pay Any Penalty Because He Had Continuous
Coverage Under His Employer's Plan.
16. Mrs. Paterson Is Concerned About The Deductibles And Co-Payments As-
, Sociated With Original Medicare. What Can You Tell Her About Medigap As An
All Questions Carefully Analyzed and Answers highlighted for
your success 100% Rated [A+]
1. 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?: Ben-
Eficiaries Under Original Medicare Have No Cost-Sharing For Most Preventive
Services
2. Mrs. Quinn Recently Turned 66 And Decided After Many Years Of Work To Begin
Receiving Social Security Benefits. Shortly Thereafter Mrs. Quinn Received A
Letter Informing Her That She Has Been Automatically Enrolled In Medicare Part
B. She Wants To Understand What This Means. What Should You Tell Mrs.
Quinn?: Part B Primarily Covers Physician Services. She Will Be Paying A
Monthly Premium And, Except For Many Preventive Screening And Tests,
Generally Will Have 20 Percent Co-Payments For These Services In Addition To
An Annual Deductible
3. 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?: He May Sign Up
For Medicare At Any Time However Coverage Usually Begins On The Fourth
Month After Dialysis Treatment
4. 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?: He Generally Would Pay A Monthly Premium,
Annual Deductible, And Per-Prescription Cost Sharing.
5. Ms. Brooks Has An Aggressive Cancer And Would Like To Know If Medicare
Will Cover Hospice Services In Case She Needs Them. What Should You Tell
Her?: Medicare Covers Hospice Services And They Will Be Available To Her.
6. Mrs. Park Is An Elderly Retiree. Mrs. Park Has A Low Fixed Income. What Could
You Tell Mrs. Park That Might Be Of Assistance?: 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.
,7. Mrs. Duarte Is Enrolled In Original Medicare Parts A And B. She Has Recently
Reviewed Her Medicare Summary Notice (MSN) And Disagrees With A Determi-
Nation That Partially Denied One Of Her Claims For Services. What Advice Would
You Give Her?: Mrs. Duarte Should File An Appeal Of This Initial Determination
Within 120 Days Of The Date She Received The MSN In The Mail.
8. 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?: 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.
9. Mr. Singh Would Like Drug Coverage But Does Not Want To Be Enrolled In A
Medicare Advantage Plan. What Should You Tell Him?: 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.
10. What Impact, If Any, Have Recent Regulatory Changes Had On Medigap
Plans?: The Part B Deductible Is No Longer Covered For Individuals Newly Eligible
For Medicare Starting January 1, 2020.
11. 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?: Medicare Does Not Cover Massage Therapy, Or, In General, Glasses Or
Dentures.
12. 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?: 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.
13. 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?: Medicare Will
Cover Mrs. Shield's Skilled Nursing Services Provided During The First 20 Days O
Her Stay, After Which She Would Have A Copay Until She Has Been In The Facility
For 100 Days.
14. 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?: Original Medicare Covers Ambulance Services.
15. Mr. Diaz Continued Working With His Company And Was Insured Under His
Employer's Group Plan Until He Reached Age 68. He Has Heard That There Is
A Premium Penalty For Those Who Did Not Sign Up For Part B When First
Eligible And Wants To Know How Much He Will Have To Pay. What Should You
Tell Him?: Mr. Diaz Will Not Pay Any Penalty Because He Had Continuous
Coverage Under His Employer's Plan.
16. Mrs. Paterson Is Concerned About The Deductibles And Co-Payments As-
, Sociated With Original Medicare. What Can You Tell Her About Medigap As An
