2025/2026 AHIP Final Exam Questions with
Revised Rationalized Answers, (A+
Guarantee)
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? - CORRECT ANSWERS Medicare will
cover Mrs. Shield's skilled nursing services provided during the first 20 days of her stay, after which she
would have a copay until she has been in the facility for 100 days.
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? - CORRECT ANSWERS Medicare does not cover massage therapy, or,
in general, glasses or dentures.
Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What could you tell Mrs. Park that
might be of assistance? - CORRECT ANSWERS 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.
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? - CORRECT ANSWERS He generally would pay a monthly
premium, annual deductible, and per-prescription cost-sharing.
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? - CORRECT ANSWERS 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.
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 ANSWERS He may sign-up for Medicare at any time however coverage usually
begins on the fourth month after dialysis treatments start.
Mrs. Duarte is enrolled in Original Medicare Parts A and B. She has recently reviewed her Medicare
Summary Notice (MSN) and disagrees with a determination that partially denied one of her claims for
services. What advice would you give her? - CORRECT ANSWERS Mrs. Duarte should file an
appeal of this initial 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 Medicare
enrollment period because the features of Part D might have changed. Mrs. Geisler can't remember
what Part D is so she called you to ask what her neighbor was talking about. What could you tell her? -
, CORRECT ANSWERS Part D covers prescription drugs and she should look at her premiums,
formulary, and cost-sharing among other factors to see if they have changed.
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? - CORRECT ANSWERS Medicare will cover a total of 190
days of inpatient psychiatric care during Mr. Rainey's entire lifetime.
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? - CORRECT ANSWERS Beneficiaries under Original Medicare have no
cost-sharing for most preventive services.
Mr. Singh would like drug coverage but does not want to be enrolled in a Medicare Advantage plan.
What should you tell him? - CORRECT ANSWERS 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.
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? - CORRECT ANSWERS
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.
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? - CORRECT ANSWERS 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.
Mr. Patel is in good health and is preparing a budget in anticipation of his retirement when he turns 66.
He wants to understand the health care costs he might be exposed to under Medicare if he were to
require hospitalization because of an illness. In general terms, what could you tell him about his costs
for inpatient hospital services under Original Medicare? - CORRECT ANSWERS Under Original
Medicare, there is a single deductible amount due for the first 60 days of any inpatient hospital stay,
after which it converts into a per-day coinsurance amount through day 90. After day 90, he would pay a
daily amount up to 60 days over his lifetime, after which he would be responsible for all costs.
What impact, if any, have recent regulatory changes had on Medigap plans? - CORRECT ANSWERS
The Part B deductible is no longer covered for individuals newly eligible for Medicare starting January 1,
2020.
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? - CORRECT ANSWERS
Medigap plans do not cover Original Medicare benefits, but they coordinate with Original Medicare
coverage.
Revised Rationalized Answers, (A+
Guarantee)
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? - CORRECT ANSWERS Medicare will
cover Mrs. Shield's skilled nursing services provided during the first 20 days of her stay, after which she
would have a copay until she has been in the facility for 100 days.
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? - CORRECT ANSWERS Medicare does not cover massage therapy, or,
in general, glasses or dentures.
Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What could you tell Mrs. Park that
might be of assistance? - CORRECT ANSWERS 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.
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? - CORRECT ANSWERS He generally would pay a monthly
premium, annual deductible, and per-prescription cost-sharing.
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? - CORRECT ANSWERS 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.
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 ANSWERS He may sign-up for Medicare at any time however coverage usually
begins on the fourth month after dialysis treatments start.
Mrs. Duarte is enrolled in Original Medicare Parts A and B. She has recently reviewed her Medicare
Summary Notice (MSN) and disagrees with a determination that partially denied one of her claims for
services. What advice would you give her? - CORRECT ANSWERS Mrs. Duarte should file an
appeal of this initial 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 Medicare
enrollment period because the features of Part D might have changed. Mrs. Geisler can't remember
what Part D is so she called you to ask what her neighbor was talking about. What could you tell her? -
, CORRECT ANSWERS Part D covers prescription drugs and she should look at her premiums,
formulary, and cost-sharing among other factors to see if they have changed.
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? - CORRECT ANSWERS Medicare will cover a total of 190
days of inpatient psychiatric care during Mr. Rainey's entire lifetime.
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? - CORRECT ANSWERS Beneficiaries under Original Medicare have no
cost-sharing for most preventive services.
Mr. Singh would like drug coverage but does not want to be enrolled in a Medicare Advantage plan.
What should you tell him? - CORRECT ANSWERS 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.
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? - CORRECT ANSWERS
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.
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? - CORRECT ANSWERS 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.
Mr. Patel is in good health and is preparing a budget in anticipation of his retirement when he turns 66.
He wants to understand the health care costs he might be exposed to under Medicare if he were to
require hospitalization because of an illness. In general terms, what could you tell him about his costs
for inpatient hospital services under Original Medicare? - CORRECT ANSWERS Under Original
Medicare, there is a single deductible amount due for the first 60 days of any inpatient hospital stay,
after which it converts into a per-day coinsurance amount through day 90. After day 90, he would pay a
daily amount up to 60 days over his lifetime, after which he would be responsible for all costs.
What impact, if any, have recent regulatory changes had on Medigap plans? - CORRECT ANSWERS
The Part B deductible is no longer covered for individuals newly eligible for Medicare starting January 1,
2020.
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? - CORRECT ANSWERS
Medigap plans do not cover Original Medicare benefits, but they coordinate with Original Medicare
coverage.
