AHIP 2025 MODULE 1 QUESTIONS WITH
VERIFIED ANSWERS
Mr. Xi will soon turn age 65 and has come to you for advice as to what services are provided under Origi
nal Medicare. What should you tell Mr. Xi that best describes the health coverage provided to Medicare
beneficiaries? - correct answer-Beneficiaries under Original Medicare have no cost-
sharing for most preventive services
Mrs. Quinn recently turned 66 and decided after many years of work to begin receiving Social Security b
enefits. Shortly thereafter Mrs. Quinn received a letter informing her that she has been automatically en
rolled in Medicare Part B. She wants to understand what this means. What should you tell Mrs. Quinn? -
correct answer-
Part B primarily covers physician services. She will be paying a monthly premium and, except for many p
reventive screening and tests, generally will have 20 percent co-
payments for these services in addition to an annual deductible
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? - correct answer-
He may sign up for Medicare at any time however coverage usually begins on the fourth month after dia
lysis treatment
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 woul
d generally expect to encounter when enrolling into a standard Medicare Part D prescription drug plan.
What should you tell him? - correct answer-
He generally would pay a monthly premium, annual deductible, and per-prescription cost sharing.
Ms. Brooks has an aggressive cancer and would like to know if Medicare will cover hospice services in ca
se she needs them. What should you tell her? - correct answer-
Medicare covers hospice services and they will be available to her.
Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What could you tell Mrs. Park that mig
ht be of assistance? - correct answer-
She should contact her state Medicaid agency to see if she qualifies for one of several programs that ca
n help with Medicare costs for which she is responsible.
, Mrs. LDuarte Lis Lenrolled Lin LOriginal LMedicare LParts LA Land LB. LShe Lhas Lrecently Lreviewed Lher
LMedicare LSum Lmary LNotice L(MSN) Land Ldisagrees Lwith La Ldetermination Lthat Lpartially Ldenied Lone
Lof Lher Lclaims Lfor Lservic Les. LWhat Ladvice Lwould Lyou Lgive Lher? L- Lcorrect Lanswer-
Mrs. LDuarte Lshould Lfile Lan Lappeal Lof Lthis Linitial Ldetermination Lwithin L120 Ldays Lof Lthe Ldate Lshe
Lreceived Lt Lhe LMSN Lin Lthe Lmail.
Mrs. LChen Lwill Lbe L65 Lsoon, Lhas Lbeen La Lcitizen Lfor Ltwelve Lyears, Lhas Lbeen Lemployed Lfull Ltime,
Land Lpaid Lta Lxes Lduring Lthat Lentire Lperiod. LShe Lis Lconcerned Lthat Lshe Lwill Lnot Lqualify Lfor
Lcoverage Lunder Lpart LA Lbecau Lse Lshe Lwas Lnot Lborn Lin Lthe LUnited LStates. LWhat Lshould Lyou Ltell
Lher? L- Lcorrect Lanswer-
Most Lindividuals Lwho Lare Lcitizens Land Lage L65 Lor Lover Lare Lcovered Lunder LPart LA Lby Lvirtue Lof
Lhaving Lpaid LMedicare Ltaxes Lwhile Lworking, Lthough Lsome Lmay Lbe Lcovered Las La Lresult Lof
Lpaying Lmonthly Lpremiums.
Mr. LSingh Lwould Llike Ldrug Lcoverage Lbut Ldoes Lnot LwantRto Lbe Lenrolled Lin La LMedicare LAdvantage
Lplan. LWh Lat Lshould Lyou Ltell Lhim? L- Lcorrect Lanswer-Mr. LSingh Lcan Lenroll Lin La Lstand-
alone Lprescription Ldrug Lplan Land Lcontinue Lto Lbe Lcovered Lfor LPart LA Land LPart LB Lservices
Lthrough LOriginal LFee-for-Service LMedicare.
What Limpact, Lif Lany, Lhave Lrecent Lregulatory Lchanges Lhad Lon LMedigap Lplans? L- Lcorrect Lanswer-
The LPart LB Ldeductible Lis Lno Llonger Lcovered Lfor Lindividuals Lnewly Leligible Lfor LMedicare Lstarting
LJanuary L1, L2020.
Mrs. LWest Lwears Lglasses Land Ldentures Land Lhas Lenjoyed Lconsiderable Lpain Lrelief Lfrom Larthritis
Lthrough Lm Lassage Ltherapy. LShe Lis Lconcerned Labout Lwhether Lor Lnot LMedicare Lwill Lcover Lthese
Litems Land Lservices. LW Lhat Lshould Lyou Ltell Lher? L- Lcorrect Lanswer-
Medicare Ldoes Lnot Lcover Lmassage Ltherapy, Lor, Lin Lgeneral, Lglasses Lor Ldentures.
Mrs. LGonzalez Lis Lenrolled Lin LOriginal LMedicare Land Lhas La LMedigap Lpolicy Las Lwell, Lbut Lit
Lprovides Lno Ldrug Lcoverage. LShe Lwould Llike Lto LkeepRthe Lcoverage Lshe Lhas Lbut Lreplace Lher
Lexisting LMedigap Lplan Lwith Lone Lt Lhat Lprovides Ldrug Lcoverage. LWhat Lshould Lyou Ltell Lher? L-
Lcorrect Lanswer-
Mrs. LGonzalez Lcannot Lpurchase La LMedigap Lplan Lthat Lcovers Ldrugs, Lbut Lshe Lcould Lkeep Lher
LMedigap Lpolic Ly Land Lenroll Lin La LPart LD Lprescription Ldrug Lplan.
Mrs. LShields Lis Lcovered Lby LOriginal LMedicare. LShe Lsustained La Lhip Lfracture Land Lis Lbeing
Lsuccessfully Ltreat Led Lfor Lthat Lcondition. LHowever, Lshe Land Lher Lphysicians Lfeel Lthat Lafter Lher
Llengthy Lhospital Lstay, Lshe Lwill Ln Leed La Lmonth Lor Ltwo Lof Lnursing Land Lrehabilitative Lcare. LWhat
Lshould Lyou Ltell Lthem Labout LOriginal LMedica Lre's Lcoverage Lof Lcare Lin La Lskilled Lnursing Lfacility? L-
Lcorrect Lanswer-
Medicare Lwill Lcover LMrs. LShield's Lskilled Lnursing Lservices Lprovided Lduring Lthe Lfirst L20 LdaysRof Lher
Lstay, Laft Ler Lwhich Lshe Lwould Lhave La Lcopay Luntil Lshe Lhas Lbeen Lin Lthe Lfacility Lfor L100 Ldays.
VERIFIED ANSWERS
Mr. Xi will soon turn age 65 and has come to you for advice as to what services are provided under Origi
nal Medicare. What should you tell Mr. Xi that best describes the health coverage provided to Medicare
beneficiaries? - correct answer-Beneficiaries under Original Medicare have no cost-
sharing for most preventive services
Mrs. Quinn recently turned 66 and decided after many years of work to begin receiving Social Security b
enefits. Shortly thereafter Mrs. Quinn received a letter informing her that she has been automatically en
rolled in Medicare Part B. She wants to understand what this means. What should you tell Mrs. Quinn? -
correct answer-
Part B primarily covers physician services. She will be paying a monthly premium and, except for many p
reventive screening and tests, generally will have 20 percent co-
payments for these services in addition to an annual deductible
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? - correct answer-
He may sign up for Medicare at any time however coverage usually begins on the fourth month after dia
lysis treatment
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 woul
d generally expect to encounter when enrolling into a standard Medicare Part D prescription drug plan.
What should you tell him? - correct answer-
He generally would pay a monthly premium, annual deductible, and per-prescription cost sharing.
Ms. Brooks has an aggressive cancer and would like to know if Medicare will cover hospice services in ca
se she needs them. What should you tell her? - correct answer-
Medicare covers hospice services and they will be available to her.
Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What could you tell Mrs. Park that mig
ht be of assistance? - correct answer-
She should contact her state Medicaid agency to see if she qualifies for one of several programs that ca
n help with Medicare costs for which she is responsible.
, Mrs. LDuarte Lis Lenrolled Lin LOriginal LMedicare LParts LA Land LB. LShe Lhas Lrecently Lreviewed Lher
LMedicare LSum Lmary LNotice L(MSN) Land Ldisagrees Lwith La Ldetermination Lthat Lpartially Ldenied Lone
Lof Lher Lclaims Lfor Lservic Les. LWhat Ladvice Lwould Lyou Lgive Lher? L- Lcorrect Lanswer-
Mrs. LDuarte Lshould Lfile Lan Lappeal Lof Lthis Linitial Ldetermination Lwithin L120 Ldays Lof Lthe Ldate Lshe
Lreceived Lt Lhe LMSN Lin Lthe Lmail.
Mrs. LChen Lwill Lbe L65 Lsoon, Lhas Lbeen La Lcitizen Lfor Ltwelve Lyears, Lhas Lbeen Lemployed Lfull Ltime,
Land Lpaid Lta Lxes Lduring Lthat Lentire Lperiod. LShe Lis Lconcerned Lthat Lshe Lwill Lnot Lqualify Lfor
Lcoverage Lunder Lpart LA Lbecau Lse Lshe Lwas Lnot Lborn Lin Lthe LUnited LStates. LWhat Lshould Lyou Ltell
Lher? L- Lcorrect Lanswer-
Most Lindividuals Lwho Lare Lcitizens Land Lage L65 Lor Lover Lare Lcovered Lunder LPart LA Lby Lvirtue Lof
Lhaving Lpaid LMedicare Ltaxes Lwhile Lworking, Lthough Lsome Lmay Lbe Lcovered Las La Lresult Lof
Lpaying Lmonthly Lpremiums.
Mr. LSingh Lwould Llike Ldrug Lcoverage Lbut Ldoes Lnot LwantRto Lbe Lenrolled Lin La LMedicare LAdvantage
Lplan. LWh Lat Lshould Lyou Ltell Lhim? L- Lcorrect Lanswer-Mr. LSingh Lcan Lenroll Lin La Lstand-
alone Lprescription Ldrug Lplan Land Lcontinue Lto Lbe Lcovered Lfor LPart LA Land LPart LB Lservices
Lthrough LOriginal LFee-for-Service LMedicare.
What Limpact, Lif Lany, Lhave Lrecent Lregulatory Lchanges Lhad Lon LMedigap Lplans? L- Lcorrect Lanswer-
The LPart LB Ldeductible Lis Lno Llonger Lcovered Lfor Lindividuals Lnewly Leligible Lfor LMedicare Lstarting
LJanuary L1, L2020.
Mrs. LWest Lwears Lglasses Land Ldentures Land Lhas Lenjoyed Lconsiderable Lpain Lrelief Lfrom Larthritis
Lthrough Lm Lassage Ltherapy. LShe Lis Lconcerned Labout Lwhether Lor Lnot LMedicare Lwill Lcover Lthese
Litems Land Lservices. LW Lhat Lshould Lyou Ltell Lher? L- Lcorrect Lanswer-
Medicare Ldoes Lnot Lcover Lmassage Ltherapy, Lor, Lin Lgeneral, Lglasses Lor Ldentures.
Mrs. LGonzalez Lis Lenrolled Lin LOriginal LMedicare Land Lhas La LMedigap Lpolicy Las Lwell, Lbut Lit
Lprovides Lno Ldrug Lcoverage. LShe Lwould Llike Lto LkeepRthe Lcoverage Lshe Lhas Lbut Lreplace Lher
Lexisting LMedigap Lplan Lwith Lone Lt Lhat Lprovides Ldrug Lcoverage. LWhat Lshould Lyou Ltell Lher? L-
Lcorrect Lanswer-
Mrs. LGonzalez Lcannot Lpurchase La LMedigap Lplan Lthat Lcovers Ldrugs, Lbut Lshe Lcould Lkeep Lher
LMedigap Lpolic Ly Land Lenroll Lin La LPart LD Lprescription Ldrug Lplan.
Mrs. LShields Lis Lcovered Lby LOriginal LMedicare. LShe Lsustained La Lhip Lfracture Land Lis Lbeing
Lsuccessfully Ltreat Led Lfor Lthat Lcondition. LHowever, Lshe Land Lher Lphysicians Lfeel Lthat Lafter Lher
Llengthy Lhospital Lstay, Lshe Lwill Ln Leed La Lmonth Lor Ltwo Lof Lnursing Land Lrehabilitative Lcare. LWhat
Lshould Lyou Ltell Lthem Labout LOriginal LMedica Lre's Lcoverage Lof Lcare Lin La Lskilled Lnursing Lfacility? L-
Lcorrect Lanswer-
Medicare Lwill Lcover LMrs. LShield's Lskilled Lnursing Lservices Lprovided Lduring Lthe Lfirst L20 LdaysRof Lher
Lstay, Laft Ler Lwhich Lshe Lwould Lhave La Lcopay Luntil Lshe Lhas Lbeen Lin Lthe Lfacility Lfor L100 Ldays.
