2025 AHIP FINAL EXAM QUESTIONS
WITH VERIFIED ANSWERS
Mrs. Shields is covered by Original Medicare. She sustained a hip fracture and is being successfully treate d for
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thatcondition.However,sheandherphysiciansfeelthatafterherlengthyhospitalstay,shewillnee d a month or
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two of nursing and rehabilitative care. What shouldyou tell themabout Original Medicare's coverage of care in
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a skilled nursing facility? - correct answer-
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MedicarewillcoverMrs.Shield'sskillednursingservicesprovidedduringthefirst20daysofherstay,afte r which
j j j j j j j j j j j j j j j j j j j
she would have a copay until she has been in the facility for 100Sdays.
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Mrs. West wearsglasses and dentures and has enjoyedconsiderable painrelief from arthritis throughma ssage
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therapy. She is concerned about whetheror notMedicare will cover these items and services. Wha t should you
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tell her? - correct answer-
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Medicaredoesnotcovermassagetherapy,or,ingeneral,glassesordentures. j j j j j j j j j j j
Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What could you tell Mrs. Park that might be of
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assistance? - correct answer-
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She should contact her state Medicaid agency to see if she qualifies for one of several programs that can help
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with Medicare costs for which she is responsible.
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Mr. Alonso receives some help paying for his two generic prescription drugs fromhis employer's retiree c
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overage, but hewants to compare it to aPartD prescription drugplan. He asksyouwhat costshewouldg enerally
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expect toencounter whenenrollinginto a standardMedicarePartD prescription drugSplan. Wha t should you
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tell him? - correct answer-
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He generally would pay a monthly premium, annual deductible, and per-prescription cost-sharing.
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Mrs. Gonzalez is enrolled in Original Medicare and has a Medigap policy as well, but it provides no drug c
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overage. She would like to keep the coverage she has but replace her existing Medigap plan with one that
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provides drugScoverage. What should you tell her? - correct answer-
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Mrs. Gonzalez cannot purchase a Medigap plan that covers drugs, but she could keep her Medigap policy and
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enroll in a Part D prescription drugSplan.
j j j j j j j
Mr.Davisis52yearsoldandhasSrecentlybeendiagnosedwithend-
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stage renaldisease (ESRD)andwillsoonbegindialysis.He is wonderingif he canobtaincoverage under
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Medicare. What should you tell him? - correct answer-He may sign-
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upforMedicareatanytimehowevercoverageusuallybeginsonthefourthmonthafterdialysistreatmen ts
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start.
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,Mrs. Duarte is enrolled in Original Medicare Parts A and B. She has recently reviewed her Medicare Sum mary
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Notice (MSN) anddisagreeswith a determination that partially deniedoneof her claims for service
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s.What advice wouldyougive her? - correct answer-
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Mrs.Duarte shouldfile anappeal of this initialdetermination within120 daysofthe date she received th e MSN
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in the mail.
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Mrs. Geisler's neighbor told her she should look at her Part D options during the annual Medicare enrollm ent
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period because the features of Part D might have changed. Mrs. Geisler can't remember whatSPart D i s so she
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called you to ask what her neighbor was talking about. What could you tell her? - correct answer- Part D covers
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prescription drugs and she should look at her premiums, formulary, and cost-
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sharingamongotherfactorsto seeifthey have changed. j j j j j j j j j
Mr. Rainey is experiencing paranoid delusions and his physician feels that he should be hospitalized. Wha t
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should you tell Mr. Rainey (or his representative) about the length of an inpatient psychiatric hospital sta y that
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Medicare will cover? - correct answer-
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Medicarewillcoveratotalof190daysofinpatientpsychiatriccareduringMr.Rainey'sentirelifetime.
j j j j j j j j j j j j j j j j
Mr. Xi will soon turn age 65 and has come to you for advice as to what services are provided under Origin al
j j j j j j j j j j j j j j j j j j j j j j
Medicare. What should you tell Mr. Xi that best describes the health coverage provided to Medicare be
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neficiaries? - correct answer-Beneficiaries under Original Medicare have no cost-
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sharing for most preventive services. j j j j
Mr.Singhwouldlikedrugcoveragebut doesSnotwanttobeenrolledinaMedicareAdvantageplan.What should
j j j j j j j j j j j j j j j j j j
you tell him? - correct answer-Mr. Singh can enroll in a stand-
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alone prescription drug plan and continue to be covered for Part A and Part B services through Original Fe e-for-
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Service Medicare. j
Mrs. Chenwill be 65 soon,has been a citizen for twelve years, has been employed fulltime, and paidtaxe s during
j j j j j j j j j j j j j j j j j j j j j j
that entire period. She is concerned that she will not qualify for coverage under part A because s he was not
j j j j j j j j j j j j j j j j j j j j j
born in the United States. What should you tell her? - correct answer-
j j j j j j j j j j j j j
Most individuals who are citizens and age 65 or over are covered under Part A by virtue of having paid Me dicare
j j j j j j j j j j j j j j j j j j j j j
taxes while working, though some may be covered as a result of paying monthly premiums.
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Mrs. Quinnrecentlyturned66 anddecidedafter manyyears ofwork to retire andbeginreceiving Social S ecurity
j j j j j j j j j j j j j j j j j j j
benefits. Shortly thereafter Mrs. Quinn received a letter informing her that she had been automat ically
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enrolled inMedicarePart B. She wants to understand what this means. What shouldyoutellMrs. Q
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, uinn? - correct answer- j j j
PartBprimarily coversphysicianservices. Shewillbe payingamonthlypremiumand, except formanypr
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eventive and screening tests, generally will have 20% co-
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paymentsfortheseservices,inadditionto anannualdeductible. j j j j j j j j j
Mr. Patel is in good health and is preparing a budget in anticipation of his retirement when he turns 66. H e wants
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to understandthehealthcare costs he might be exposed to underMedicare if he were torequire hospitalization
j j j j j j j j j j j j j j j j j j j
because of an illness. In general terms, what could you tell him about his costs for inpatie nt hospital services
j j j j j j j j j j j j j j j j j j j j
under Original Medicare? - correct answer-
j j j j j j
Under Original Medicare, there is a single deductible amount due for the first 60 days of any inpatient hos pital
j j j j j j j j j j j j j j j j j j j
stay, after which it converts into a per-
j j j j j j j j
day coinsurance amount through day 90. After day 90, he would pay a daily amount up to 60 days over hi s
j j j j j j j j j j j j j j j j j j j j j
lifetime, after which he would be responsible for all costs.
j j j j j j j j j j
WhatSimpact,ifany,haverecentregulatorychangeshadonMedigapSplans?-correctanswer- j j j j j j j j j j j j
ThePartBdeductible is nolonger coveredforindividuals newlyeligible forMedicarestartingJanuary1,2 020.
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Mrs.Patersonisconcernedaboutthedeductiblesandco-
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payments associatedwithOriginalMedicare.What canyoutellher aboutMedigapas anoptionto addres s this
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concern? - correct answer-
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Medigapplansdo notcoverOriginalMedicarebenefits,buttheycoordinatewithOriginalMedicarecover age.
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Mrs.Turneriscomparingher employer'sretireeinsuranceto OriginalMedicareandwouldliketoknoww hich of
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the following services Original Medicare will cover if the appropriate criteria are met. What could you tell her?
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- correct answer-Original Medicare covers ambulance services.
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Ms. Brooks has aggressive cancer and would like to know if Medicare will cover hospice services in case s he
j j j j j j j j j j j j j j j j j j j
needs them. What should you tell her? - correct answer-
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Medicarecovershospiceservices,andtheywillbeavailableforher. j j j j j j j j j j
Mr. Diazcontinued working with his company and wasSinsured under his employer's group plan until he r
j j j j j j j j j j j j j j j j
eachedage 68. He has heard that there is a premium penalty for those who did not sign upfor Part B whe n first
j j j j j j j j j j j j j j j j j j j j j j j j j
eligible and wants to know how much he will have to pay. What should you tell him? -
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correctanswer- j
Mr.Diazwillnotpayanypenaltybecausehehadcontinuouscoverageunderhisemployer'splan.
j j j j j j j j j j j j j j j
WITH VERIFIED ANSWERS
Mrs. Shields is covered by Original Medicare. She sustained a hip fracture and is being successfully treate d for
j j j j j j j j j j j j j j j j j j
thatcondition.However,sheandherphysiciansfeelthatafterherlengthyhospitalstay,shewillnee d a month or
j j j j j j j j j j j j j j j j j j j j j
two of nursing and rehabilitative care. What shouldyou tell themabout Original Medicare's coverage of care in
j j j j j j j j j j j j j j j j j j
a skilled nursing facility? - correct answer-
j j j j j j j
MedicarewillcoverMrs.Shield'sskillednursingservicesprovidedduringthefirst20daysofherstay,afte r which
j j j j j j j j j j j j j j j j j j j
she would have a copay until she has been in the facility for 100Sdays.
j j j j j j j j j j j j j j
Mrs. West wearsglasses and dentures and has enjoyedconsiderable painrelief from arthritis throughma ssage
j j j j j j j j j j j j j j j j
therapy. She is concerned about whetheror notMedicare will cover these items and services. Wha t should you
j j j j j j j j j j j j j j j j j j j
tell her? - correct answer-
j j j j j
Medicaredoesnotcovermassagetherapy,or,ingeneral,glassesordentures. j j j j j j j j j j j
Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What could you tell Mrs. Park that might be of
j j j j j j j j j j j j j j j j j j j j j j
assistance? - correct answer-
j j j j
She should contact her state Medicaid agency to see if she qualifies for one of several programs that can help
j j j j j j j j j j j j j j j j j j j
with Medicare costs for which she is responsible.
j j j j j j j j
Mr. Alonso receives some help paying for his two generic prescription drugs fromhis employer's retiree c
j j j j j j j j j j j j j j j j
overage, but hewants to compare it to aPartD prescription drugplan. He asksyouwhat costshewouldg enerally
j j j j j j j j j j j j j j j j j j j j j j j
expect toencounter whenenrollinginto a standardMedicarePartD prescription drugSplan. Wha t should you
j j j j j j j j j j j j j j j j j
tell him? - correct answer-
j j j j j
He generally would pay a monthly premium, annual deductible, and per-prescription cost-sharing.
j j j j j j j j j j j
Mrs. Gonzalez is enrolled in Original Medicare and has a Medigap policy as well, but it provides no drug c
j j j j j j j j j j j j j j j j j j j
overage. She would like to keep the coverage she has but replace her existing Medigap plan with one that
j j j j j j j j j j j j j j j j j j j
provides drugScoverage. What should you tell her? - correct answer-
j j j j j j j j j j
Mrs. Gonzalez cannot purchase a Medigap plan that covers drugs, but she could keep her Medigap policy and
j j j j j j j j j j j j j j j j j
enroll in a Part D prescription drugSplan.
j j j j j j j
Mr.Davisis52yearsoldandhasSrecentlybeendiagnosedwithend-
j j j j j j j j j j j
stage renaldisease (ESRD)andwillsoonbegindialysis.He is wonderingif he canobtaincoverage under
j j j j j j j j j j j j j j j j j
Medicare. What should you tell him? - correct answer-He may sign-
j j j j j j j j j j j
upforMedicareatanytimehowevercoverageusuallybeginsonthefourthmonthafterdialysistreatmen ts
j j j j j j j j j j j j j j j j j
start.
j
,Mrs. Duarte is enrolled in Original Medicare Parts A and B. She has recently reviewed her Medicare Sum mary
j j j j j j j j j j j j j j j j j j
Notice (MSN) anddisagreeswith a determination that partially deniedoneof her claims for service
j j j j j j j j j j j j j j j j
s.What advice wouldyougive her? - correct answer-
j j j j j j j j j
Mrs.Duarte shouldfile anappeal of this initialdetermination within120 daysofthe date she received th e MSN
j j j j j j j j j j j j j j j j j j j j
in the mail.
j j j
Mrs. Geisler's neighbor told her she should look at her Part D options during the annual Medicare enrollm ent
j j j j j j j j j j j j j j j j j j
period because the features of Part D might have changed. Mrs. Geisler can't remember whatSPart D i s so she
j j j j j j j j j j j j j j j j j j j j
called you to ask what her neighbor was talking about. What could you tell her? - correct answer- Part D covers
j j j j j j j j j j j j j j j j j j j j j
prescription drugs and she should look at her premiums, formulary, and cost-
j j j j j j j j j j j j
sharingamongotherfactorsto seeifthey have changed. j j j j j j j j j
Mr. Rainey is experiencing paranoid delusions and his physician feels that he should be hospitalized. Wha t
j j j j j j j j j j j j j j j j
should you tell Mr. Rainey (or his representative) about the length of an inpatient psychiatric hospital sta y that
j j j j j j j j j j j j j j j j j j j
Medicare will cover? - correct answer-
j j j j j j
Medicarewillcoveratotalof190daysofinpatientpsychiatriccareduringMr.Rainey'sentirelifetime.
j j j j j j j j j j j j j j j j
Mr. Xi will soon turn age 65 and has come to you for advice as to what services are provided under Origin al
j j j j j j j j j j j j j j j j j j j j j j
Medicare. What should you tell Mr. Xi that best describes the health coverage provided to Medicare be
j j j j j j j j j j j j j j j j j
neficiaries? - correct answer-Beneficiaries under Original Medicare have no cost-
j j j j j j j j j j
sharing for most preventive services. j j j j
Mr.Singhwouldlikedrugcoveragebut doesSnotwanttobeenrolledinaMedicareAdvantageplan.What should
j j j j j j j j j j j j j j j j j j
you tell him? - correct answer-Mr. Singh can enroll in a stand-
j j j j j j j j j j j j
alone prescription drug plan and continue to be covered for Part A and Part B services through Original Fe e-for-
j j j j j j j j j j j j j j j j j j j
Service Medicare. j
Mrs. Chenwill be 65 soon,has been a citizen for twelve years, has been employed fulltime, and paidtaxe s during
j j j j j j j j j j j j j j j j j j j j j j
that entire period. She is concerned that she will not qualify for coverage under part A because s he was not
j j j j j j j j j j j j j j j j j j j j j
born in the United States. What should you tell her? - correct answer-
j j j j j j j j j j j j j
Most individuals who are citizens and age 65 or over are covered under Part A by virtue of having paid Me dicare
j j j j j j j j j j j j j j j j j j j j j
taxes while working, though some may be covered as a result of paying monthly premiums.
j j j j j j j j j j j j j j j
Mrs. Quinnrecentlyturned66 anddecidedafter manyyears ofwork to retire andbeginreceiving Social S ecurity
j j j j j j j j j j j j j j j j j j j
benefits. Shortly thereafter Mrs. Quinn received a letter informing her that she had been automat ically
j j j j j j j j j j j j j j j j
enrolled inMedicarePart B. She wants to understand what this means. What shouldyoutellMrs. Q
j j j j j j j j j j j j j j j j j j
, uinn? - correct answer- j j j
PartBprimarily coversphysicianservices. Shewillbe payingamonthlypremiumand, except formanypr
j j j j j j j j j j j j j j j j j
eventive and screening tests, generally will have 20% co-
j j j j j j j j j
paymentsfortheseservices,inadditionto anannualdeductible. j j j j j j j j j
Mr. Patel is in good health and is preparing a budget in anticipation of his retirement when he turns 66. H e wants
j j j j j j j j j j j j j j j j j j j j j j
to understandthehealthcare costs he might be exposed to underMedicare if he were torequire hospitalization
j j j j j j j j j j j j j j j j j j j
because of an illness. In general terms, what could you tell him about his costs for inpatie nt hospital services
j j j j j j j j j j j j j j j j j j j j
under Original Medicare? - correct answer-
j j j j j j
Under Original Medicare, there is a single deductible amount due for the first 60 days of any inpatient hos pital
j j j j j j j j j j j j j j j j j j j
stay, after which it converts into a per-
j j j j j j j j
day coinsurance amount through day 90. After day 90, he would pay a daily amount up to 60 days over hi s
j j j j j j j j j j j j j j j j j j j j j
lifetime, after which he would be responsible for all costs.
j j j j j j j j j j
WhatSimpact,ifany,haverecentregulatorychangeshadonMedigapSplans?-correctanswer- j j j j j j j j j j j j
ThePartBdeductible is nolonger coveredforindividuals newlyeligible forMedicarestartingJanuary1,2 020.
j j j j j j j j j j j j j j j j j j
Mrs.Patersonisconcernedaboutthedeductiblesandco-
j j j j j j j j
payments associatedwithOriginalMedicare.What canyoutellher aboutMedigapas anoptionto addres s this
j j j j j j j j j j j j j j j j j j
concern? - correct answer-
j j j j
Medigapplansdo notcoverOriginalMedicarebenefits,buttheycoordinatewithOriginalMedicarecover age.
j j j j j j j j j j j j j j j
Mrs.Turneriscomparingher employer'sretireeinsuranceto OriginalMedicareandwouldliketoknoww hich of
j j j j j j j j j j j j j j j j j j
the following services Original Medicare will cover if the appropriate criteria are met. What could you tell her?
j j j j j j j j j j j j j j j j j j
- correct answer-Original Medicare covers ambulance services.
j j j j j j j
Ms. Brooks has aggressive cancer and would like to know if Medicare will cover hospice services in case s he
j j j j j j j j j j j j j j j j j j j
needs them. What should you tell her? - correct answer-
j j j j j j j j j j
Medicarecovershospiceservices,andtheywillbeavailableforher. j j j j j j j j j j
Mr. Diazcontinued working with his company and wasSinsured under his employer's group plan until he r
j j j j j j j j j j j j j j j j
eachedage 68. He has heard that there is a premium penalty for those who did not sign upfor Part B whe n first
j j j j j j j j j j j j j j j j j j j j j j j j j
eligible and wants to know how much he will have to pay. What should you tell him? -
j j j j j j j j j j j j j j j j j j
correctanswer- j
Mr.Diazwillnotpayanypenaltybecausehehadcontinuouscoverageunderhisemployer'splan.
j j j j j j j j j j j j j j j
