AHIP 2025 Final Exam
50 Questions and ANSWERS
2025\2026 update
50 QUESTIONS
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 coul
you tell her? - ANS>>Original Medicare covers ambulance services.
Mrs. Duarte is enrolled in Original Medicare Parts A and B. She has recently reviewed her Medicar
Summary Notice (MSN) and disagrees with a determination that partially denied one of her claims fo
services. What advice would you give her? - ANS>>Mrs. Duarte should file an appeal of this initia
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 Medicar
enrollment period because the features of Part D might have changed. Mrs. Geisler can't remember wha
Part D is so she called you to ask what her neighbor was talking about. What could you tell her?
ANS>>Part D covers prescription drugs and she should look at her premiums, formulary, and cost-sharin
among other factors to see if they have changed.
Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What could you tell Mrs. Park that migh
be of assistance? - ANS>>She should contact her state Medicaid agency to see if she qualifies for one o
several programs that can help with Medicare costs for which she is responsible.
Mrs. Quinn recently turned 66 and decided after many years of work to retire and begin receiving Socia
Security benefits. Shortly thereafter Mrs. Quinn received a letter informing her that she had bee
automatically enrolled in Medicare Part B. She wants to understand what this means. What should yo
tell Mrs. Quinn? - ANS>>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 thes
services, in addition to an annual deductible.
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 ha
told her about the Medigap Plan F in which he is enrolled. It not only provides foreign travel emergenc
benefits but also covers his Medicare Part B deductible. Anita comes to you for advice. What should yo
tell her? - ANS>>You are sorry to disappoint Anita, but a Medigap F plan is no longer available to thos
who turn age 65 after January 1, 2020. Anita might instead consider other Medigap plans that offer foreig
travel benefits but do not cover the Part B deductible.
Mr. Singh would like drug coverage but does not want to be enrolled in a Medicare Advantage plan. Wha
should you tell him? - ANS>>Mr. Singh can enroll in a stand-alone prescription drug plan and continue t
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 taxe
during that entire period. She is concerned that she will not qualify for coverage under part A becaus
she was not born in the United States. What should you tell her? - ANS>>Most individuals who are citizen
and age 65 or over are covered under Part A by virtue of having paid Medicare taxes while working, thoug
some may be covered as a result of paying monthly premiums.
Mr. Xi will soon turn age 65 and has come to you for advice as to what services are provided under Origina
Medicare. What should you tell Mr. Xi that best describes the health coverage provided to Medicar
beneficiaries? - ANS>>Beneficiaries under Original Medicare have no cost-sharing for most preventiv
services.
Mr. Barker enjoys a comfortable retirement income. He recently had surgery and expected that he woul
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 larg
charges in excess of his maximum out-of-pocket limit that included some services and items he though
would be fully covered. He called you to ask what he could do? What could you tell him? - ANS>>You ca
offer to review the plans appeal process to help him ask the plan to review the coverage decision.
Mr. Lombardi is interested in a Medicare Advantage (MA) PPO plan that you represent. It is one of thre
plans operated by the same organization in Mr. Lombardi's area. The MA PPO plan does not include dru
coverage, but the other two plans do. Mr. Lombardi likes the PPO plan that does not include drug coverag
and intends to obtain his drug coverage through a stand-alone Medicare prescription drug plan. Wha
should you tell him about this situation? - ANS>>He could enroll either in one of the MA plans that includ
prescription drug coverage or Original Medicare with a Medigap plan and standalone Part D prescriptio
drug coverage, but he cannot enroll in the MA-only PPO plan and a stand-alone prescription drug plan.
Mr. Lopez has heard that he can sign up for a product called "Medicare Advantage" but is not sure abou
what type of plan designs are available through this program. What should you tell him about the type
50 Questions and ANSWERS
2025\2026 update
50 QUESTIONS
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 coul
you tell her? - ANS>>Original Medicare covers ambulance services.
Mrs. Duarte is enrolled in Original Medicare Parts A and B. She has recently reviewed her Medicar
Summary Notice (MSN) and disagrees with a determination that partially denied one of her claims fo
services. What advice would you give her? - ANS>>Mrs. Duarte should file an appeal of this initia
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 Medicar
enrollment period because the features of Part D might have changed. Mrs. Geisler can't remember wha
Part D is so she called you to ask what her neighbor was talking about. What could you tell her?
ANS>>Part D covers prescription drugs and she should look at her premiums, formulary, and cost-sharin
among other factors to see if they have changed.
Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What could you tell Mrs. Park that migh
be of assistance? - ANS>>She should contact her state Medicaid agency to see if she qualifies for one o
several programs that can help with Medicare costs for which she is responsible.
Mrs. Quinn recently turned 66 and decided after many years of work to retire and begin receiving Socia
Security benefits. Shortly thereafter Mrs. Quinn received a letter informing her that she had bee
automatically enrolled in Medicare Part B. She wants to understand what this means. What should yo
tell Mrs. Quinn? - ANS>>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 thes
services, in addition to an annual deductible.
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 ha
told her about the Medigap Plan F in which he is enrolled. It not only provides foreign travel emergenc
benefits but also covers his Medicare Part B deductible. Anita comes to you for advice. What should yo
tell her? - ANS>>You are sorry to disappoint Anita, but a Medigap F plan is no longer available to thos
who turn age 65 after January 1, 2020. Anita might instead consider other Medigap plans that offer foreig
travel benefits but do not cover the Part B deductible.
Mr. Singh would like drug coverage but does not want to be enrolled in a Medicare Advantage plan. Wha
should you tell him? - ANS>>Mr. Singh can enroll in a stand-alone prescription drug plan and continue t
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 taxe
during that entire period. She is concerned that she will not qualify for coverage under part A becaus
she was not born in the United States. What should you tell her? - ANS>>Most individuals who are citizen
and age 65 or over are covered under Part A by virtue of having paid Medicare taxes while working, thoug
some may be covered as a result of paying monthly premiums.
Mr. Xi will soon turn age 65 and has come to you for advice as to what services are provided under Origina
Medicare. What should you tell Mr. Xi that best describes the health coverage provided to Medicar
beneficiaries? - ANS>>Beneficiaries under Original Medicare have no cost-sharing for most preventiv
services.
Mr. Barker enjoys a comfortable retirement income. He recently had surgery and expected that he woul
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 larg
charges in excess of his maximum out-of-pocket limit that included some services and items he though
would be fully covered. He called you to ask what he could do? What could you tell him? - ANS>>You ca
offer to review the plans appeal process to help him ask the plan to review the coverage decision.
Mr. Lombardi is interested in a Medicare Advantage (MA) PPO plan that you represent. It is one of thre
plans operated by the same organization in Mr. Lombardi's area. The MA PPO plan does not include dru
coverage, but the other two plans do. Mr. Lombardi likes the PPO plan that does not include drug coverag
and intends to obtain his drug coverage through a stand-alone Medicare prescription drug plan. Wha
should you tell him about this situation? - ANS>>He could enroll either in one of the MA plans that includ
prescription drug coverage or Original Medicare with a Medigap plan and standalone Part D prescriptio
drug coverage, but he cannot enroll in the MA-only PPO plan and a stand-alone prescription drug plan.
Mr. Lopez has heard that he can sign up for a product called "Medicare Advantage" but is not sure abou
what type of plan designs are available through this program. What should you tell him about the type
