AHIP FINAL EXAM, PRACTICE EXAM
AND STUDY GUIDE LATEST 2025/2026
ACTUAL EXAM 135 QUESTIONS WITH
CORRECT ANSWERS 100% VERIFIED
GRADED A+
Mrs.9Shields9is9covered9by9Original9Medicare.9She9sustained9a9hip9fracture9and9is9bei
ng9successfully9treated9for9that9condition.9However,9she9and9her9physicians9feel9that9
after9her9lengthy9hospital9stay,9she9will9need9a9month9or9two9of9nursing9and9rehabilitat
ive9care.9What9should9you9tell9them9about9Original9Medicare's9coverage9of9care9in9a9s
killed9nursing9facility?9-
9ans✔Medicare9will9cover9Mrs.9Shield's9skilled9nursing9services9provided9during9the9fir
st9209days9of9her9stay,9after9which9she9would9have9a9copay9until9she9has9been9in9the
9facility9for91009days.
Mrs.9West9wears9glasses9and9dentures9and9has9enjoyed9considerable9pain9relief9from
9arthritis9through9massage9therapy.9She9is9concerned9about9whether9or9not9Medicare9
will9cover9these9items9and9services.9What9should9you9tell9her?9-
9ans✔Medicare9does9not9cover9massage9therapy,9or,9in9general,9glasses9or9dentures.
Mrs.9Park9is9an9elderly9retiree.9Mrs.9Park9has9a9low9fixed9income.9What9could9you9tell
9Mrs.9Park9that9might9be9of9assistance?9-
9ans✔She9should9contact9her9state9Medicaid9agency9to9see9if9she9qualifies9for9one9of
9several9programs9that9can9help9with9Medicare9costs9for9which9she9is9responsible.
Mr.9Alonso9receives9some9help9paying9for9his9two9generic9prescription9drugs9from9his9
employer's9retiree9coverage,9but9he9wants9to9compare9it9to9a9Part9D9prescription9drug
9plan.9He9asks9you9what9costs9he9would9generally9expect9to9encounter9when9enrolling
9into9a9standard9Medicare9Part9D9prescription9drug9plan.9What9should9you9tell9him?9-
9ans✔He9generally9would9pay9a9monthly9premium,9annual9deductible,9and9per-
prescription9cost-sharing.
Mrs.9Gonzalez9is9enrolled9in9Original9Medicare9and9has9a9Medigap9policy9as9well,9but
9it9provides9no9drug9coverage.9She9would9like9to9keep9the9coverage9she9has9but9repla
ce9her9existing9Medigap9plan9with9one9that9provides9drug9coverage.9What9should9you9
,tell9her?9-
9ans✔Mrs.9Gonzalez9cannot9purchase9a9Medigap9plan9that9covers9drugs,9but9she9cou
ld9keep9her9Medigap9policy9and9enroll9in9a9Part9D9prescription9drug9plan.
Mr.9Davis9is9529years9old9and9has9recently9been9diagnosed9with9end-
stage9renal9disease9(ESRD)9and9will9soon9begin9dialysis.9He9is9wondering9if9he9can9o
btain9coverage9under9Medicare.9What9should9you9tell9him?9-9ans✔He9may9sign-
up9for9Medicare9at9any9time9however9coverage9usually9begins9on9the9fourth9month9aft
er9dialysis9treatments9start.
Mrs.9Duarte9is9enrolled9in9Original9Medicare9Parts9A9and9B.9She9has9recently9reviewe
d9her9Medicare9Summary9Notice9(MSN)9and9disagrees9with9a9determination9that9parti
ally9denied9one9of9her9claims9for9services.9What9advice9would9you9give9her?9-
9ans✔Mrs.9Duarte9should9file9an9appeal9of9this9initial9determination9within91209days9of
9the9date9she9received9the9MSN9in9the9mail.
Mrs.9Geisler's9neighbor9told9her9she9should9look9at9her9Part9D9options9during9the9ann
ual9Medicare9enrollment9period9because9the9features9of9Part9D9might9have9changed.9
Mrs.9Geisler9can't9remember9what9Part9D9is9so9she9called9you9to9ask9what9her9neighb
or9was9talking9about.9What9could9you9tell9her?9-
9ans✔Part9D9covers9prescription9drugs9and9she9should9look9at9her9premiums,9formula
ry,9and9cost-sharing9among9other9factors9to9see9if9they9have9changed.
Mr.9Rainey9is9experiencing9paranoid9delusions9and9his9physician9feels9that9he9should9
be9hospitalized.9What9should9you9tell9Mr.9Rainey9(or9his9representative)9about9the9len
gth9of9an9inpatient9psychiatric9hospital9stay9that9Medicare9will9cover?9-
9ans✔Medicare9will9cover9a9total9of91909days9of9inpatient9psychiatric9care9during9Mr.9
Rainey's9entire9lifetime.
Mr.9Xi9will9soon9turn9age9659and9has9come9to9you9for9advice9as9to9what9services9are9
provided9under9Original9Medicare.9What9should9you9tell9Mr.9Xi9that9best9describes9the
9health9coverage9provided9to9Medicare9beneficiaries?9-
9ans✔Beneficiaries9under9Original9Medicare9have9no9cost-
sharing9for9most9preventive9services.
Mr.9Singh9would9like9drug9coverage9but9does9not9want9to9be9enrolled9in9a9Medicare9A
dvantage9plan.9What9should9you9tell9him?9-9ans✔Mr.9Singh9can9enroll9in9a9stand-
alone9prescription9drug9plan9and9continue9to9be9covered9for9Part9A9and9Part9B9servic
es9through9Original9Fee-for-Service9Medicare.
Mrs.9Chen9will9be9659soon,9has9been9a9citizen9for9twelve9years,9has9been9employed9f
ull9time,9and9paid9taxes9during9that9entire9period.9She9is9concerned9that9she9will9not9q
ualify9for9coverage9under9part9A9because9she9was9not9born9in9the9United9States.9Wha
t9should9you9tell9her?9-
9ans✔Most9individuals9who9are9citizens9and9age9659or9over9are9covered9under9Part9A
, 9by9virtue9of9having9paid9Medicare9taxes9while9working,9though9some9may9be9covered
9as9a9result9of9paying9monthly9premiums.
Mrs.9Quinn9recently9turned9669and9decided9after9many9years9of9work9to9retire9and9be
gin9receiving9Social9Security9benefits.9Shortly9thereafter9Mrs.9Quinn9received9a9letter9i
nforming9her9that9she9had9been9automatically9enrolled9in9Medicare9Part9B.9She9wants
9to9understand9what9this9means.9What9should9you9tell9Mrs.9Quinn?9-
9ans✔Part9B9primarily9covers9physician9services.9She9will9be9paying9a9monthly9premiu
m9and,9except9for9many9preventive9and9screening9tests,9generally9will9have920%9co-
payments9for9these9services,9in9addition9to9an9annual9deductible.
Mr.9Patel9is9in9good9health9and9is9preparing9a9budget9in9anticipation9of9his9retirement9
when9he9turns966.9He9wants9to9understand9the9health9care9costs9he9might9be9expose
d9to9under9Medicare9if9he9were9to9require9hospitalization9because9of9an9illness.9In9gen
eral9terms,9what9could9you9tell9him9about9his9costs9for9inpatient9hospital9services9und
er9Original9Medicare?9-
9ans✔Under9Original9Medicare,9there9is9a9single9deductible9amount9due9for9the9first96
09days9of9any9inpatient9hospital9stay,9after9which9it9converts9into9a9per-
day9coinsurance9amount9through9day990.9After9day990,9he9would9pay9a9daily9amount9
up9to9609days9over9his9lifetime,9after9which9he9would9be9responsible9for9all9costs.
What9impact,9if9any,9have9recent9regulatory9changes9had9on9Medigap9plans?9-
9ans✔The9Part9B9deductible9is9no9longer9covered9for9individuals9newly9eligible9for9Me
dicare9starting9January91,92020.
Mrs.9Paterson9is9concerned9about9the9deductibles9and9co-
payments9associated9with9Original9Medicare.9What9can9you9tell9her9about9Medigap9as
9an9option9to9address9this9concern?9-
9ans✔Medigap9plans9do9not9cover9Original9Medicare9benefits,9but9they9coordinate9wit
h9Original9Medicare9coverage.
Mrs.9Turner9is9comparing9her9employer's9retiree9insurance9to9Original9Medicare9and9w
ould9like9to9know9which9of9the9following9services9Original9Medicare9will9cover9if9the9ap
propriate9criteria9are9met.9What9could9you9tell9her?9-
9ans✔Original9Medicare9covers9ambulance9services.
Ms.9Brooks9has9aggressive9cancer9and9would9like9to9know9if9Medicare9will9cover9hosp
ice9services9in9case9she9needs9them.9What9should9you9tell9her?9-
9ans✔Medicare9covers9hospice9services,9and9they9will9be9available9for9her.
Mr.9Diaz9continued9working9with9his9company9and9was9insured9under9his9employer's9
group9plan9until9he9reached9age968.9He9has9heard9that9there9is9a9premium9penalty9for
9those9who9did9not9sign9up9for9Part9B9when9first9eligible9and9wants9to9know9how9muc
h9he9will9have9to9pay.9What9should9you9tell9him?9-
9ans✔Mr.9Diaz9will9not9pay9any9penalty9because9he9had9continuous9coverage9under9h
is9employer's9plan.
AND STUDY GUIDE LATEST 2025/2026
ACTUAL EXAM 135 QUESTIONS WITH
CORRECT ANSWERS 100% VERIFIED
GRADED A+
Mrs.9Shields9is9covered9by9Original9Medicare.9She9sustained9a9hip9fracture9and9is9bei
ng9successfully9treated9for9that9condition.9However,9she9and9her9physicians9feel9that9
after9her9lengthy9hospital9stay,9she9will9need9a9month9or9two9of9nursing9and9rehabilitat
ive9care.9What9should9you9tell9them9about9Original9Medicare's9coverage9of9care9in9a9s
killed9nursing9facility?9-
9ans✔Medicare9will9cover9Mrs.9Shield's9skilled9nursing9services9provided9during9the9fir
st9209days9of9her9stay,9after9which9she9would9have9a9copay9until9she9has9been9in9the
9facility9for91009days.
Mrs.9West9wears9glasses9and9dentures9and9has9enjoyed9considerable9pain9relief9from
9arthritis9through9massage9therapy.9She9is9concerned9about9whether9or9not9Medicare9
will9cover9these9items9and9services.9What9should9you9tell9her?9-
9ans✔Medicare9does9not9cover9massage9therapy,9or,9in9general,9glasses9or9dentures.
Mrs.9Park9is9an9elderly9retiree.9Mrs.9Park9has9a9low9fixed9income.9What9could9you9tell
9Mrs.9Park9that9might9be9of9assistance?9-
9ans✔She9should9contact9her9state9Medicaid9agency9to9see9if9she9qualifies9for9one9of
9several9programs9that9can9help9with9Medicare9costs9for9which9she9is9responsible.
Mr.9Alonso9receives9some9help9paying9for9his9two9generic9prescription9drugs9from9his9
employer's9retiree9coverage,9but9he9wants9to9compare9it9to9a9Part9D9prescription9drug
9plan.9He9asks9you9what9costs9he9would9generally9expect9to9encounter9when9enrolling
9into9a9standard9Medicare9Part9D9prescription9drug9plan.9What9should9you9tell9him?9-
9ans✔He9generally9would9pay9a9monthly9premium,9annual9deductible,9and9per-
prescription9cost-sharing.
Mrs.9Gonzalez9is9enrolled9in9Original9Medicare9and9has9a9Medigap9policy9as9well,9but
9it9provides9no9drug9coverage.9She9would9like9to9keep9the9coverage9she9has9but9repla
ce9her9existing9Medigap9plan9with9one9that9provides9drug9coverage.9What9should9you9
,tell9her?9-
9ans✔Mrs.9Gonzalez9cannot9purchase9a9Medigap9plan9that9covers9drugs,9but9she9cou
ld9keep9her9Medigap9policy9and9enroll9in9a9Part9D9prescription9drug9plan.
Mr.9Davis9is9529years9old9and9has9recently9been9diagnosed9with9end-
stage9renal9disease9(ESRD)9and9will9soon9begin9dialysis.9He9is9wondering9if9he9can9o
btain9coverage9under9Medicare.9What9should9you9tell9him?9-9ans✔He9may9sign-
up9for9Medicare9at9any9time9however9coverage9usually9begins9on9the9fourth9month9aft
er9dialysis9treatments9start.
Mrs.9Duarte9is9enrolled9in9Original9Medicare9Parts9A9and9B.9She9has9recently9reviewe
d9her9Medicare9Summary9Notice9(MSN)9and9disagrees9with9a9determination9that9parti
ally9denied9one9of9her9claims9for9services.9What9advice9would9you9give9her?9-
9ans✔Mrs.9Duarte9should9file9an9appeal9of9this9initial9determination9within91209days9of
9the9date9she9received9the9MSN9in9the9mail.
Mrs.9Geisler's9neighbor9told9her9she9should9look9at9her9Part9D9options9during9the9ann
ual9Medicare9enrollment9period9because9the9features9of9Part9D9might9have9changed.9
Mrs.9Geisler9can't9remember9what9Part9D9is9so9she9called9you9to9ask9what9her9neighb
or9was9talking9about.9What9could9you9tell9her?9-
9ans✔Part9D9covers9prescription9drugs9and9she9should9look9at9her9premiums,9formula
ry,9and9cost-sharing9among9other9factors9to9see9if9they9have9changed.
Mr.9Rainey9is9experiencing9paranoid9delusions9and9his9physician9feels9that9he9should9
be9hospitalized.9What9should9you9tell9Mr.9Rainey9(or9his9representative)9about9the9len
gth9of9an9inpatient9psychiatric9hospital9stay9that9Medicare9will9cover?9-
9ans✔Medicare9will9cover9a9total9of91909days9of9inpatient9psychiatric9care9during9Mr.9
Rainey's9entire9lifetime.
Mr.9Xi9will9soon9turn9age9659and9has9come9to9you9for9advice9as9to9what9services9are9
provided9under9Original9Medicare.9What9should9you9tell9Mr.9Xi9that9best9describes9the
9health9coverage9provided9to9Medicare9beneficiaries?9-
9ans✔Beneficiaries9under9Original9Medicare9have9no9cost-
sharing9for9most9preventive9services.
Mr.9Singh9would9like9drug9coverage9but9does9not9want9to9be9enrolled9in9a9Medicare9A
dvantage9plan.9What9should9you9tell9him?9-9ans✔Mr.9Singh9can9enroll9in9a9stand-
alone9prescription9drug9plan9and9continue9to9be9covered9for9Part9A9and9Part9B9servic
es9through9Original9Fee-for-Service9Medicare.
Mrs.9Chen9will9be9659soon,9has9been9a9citizen9for9twelve9years,9has9been9employed9f
ull9time,9and9paid9taxes9during9that9entire9period.9She9is9concerned9that9she9will9not9q
ualify9for9coverage9under9part9A9because9she9was9not9born9in9the9United9States.9Wha
t9should9you9tell9her?9-
9ans✔Most9individuals9who9are9citizens9and9age9659or9over9are9covered9under9Part9A
, 9by9virtue9of9having9paid9Medicare9taxes9while9working,9though9some9may9be9covered
9as9a9result9of9paying9monthly9premiums.
Mrs.9Quinn9recently9turned9669and9decided9after9many9years9of9work9to9retire9and9be
gin9receiving9Social9Security9benefits.9Shortly9thereafter9Mrs.9Quinn9received9a9letter9i
nforming9her9that9she9had9been9automatically9enrolled9in9Medicare9Part9B.9She9wants
9to9understand9what9this9means.9What9should9you9tell9Mrs.9Quinn?9-
9ans✔Part9B9primarily9covers9physician9services.9She9will9be9paying9a9monthly9premiu
m9and,9except9for9many9preventive9and9screening9tests,9generally9will9have920%9co-
payments9for9these9services,9in9addition9to9an9annual9deductible.
Mr.9Patel9is9in9good9health9and9is9preparing9a9budget9in9anticipation9of9his9retirement9
when9he9turns966.9He9wants9to9understand9the9health9care9costs9he9might9be9expose
d9to9under9Medicare9if9he9were9to9require9hospitalization9because9of9an9illness.9In9gen
eral9terms,9what9could9you9tell9him9about9his9costs9for9inpatient9hospital9services9und
er9Original9Medicare?9-
9ans✔Under9Original9Medicare,9there9is9a9single9deductible9amount9due9for9the9first96
09days9of9any9inpatient9hospital9stay,9after9which9it9converts9into9a9per-
day9coinsurance9amount9through9day990.9After9day990,9he9would9pay9a9daily9amount9
up9to9609days9over9his9lifetime,9after9which9he9would9be9responsible9for9all9costs.
What9impact,9if9any,9have9recent9regulatory9changes9had9on9Medigap9plans?9-
9ans✔The9Part9B9deductible9is9no9longer9covered9for9individuals9newly9eligible9for9Me
dicare9starting9January91,92020.
Mrs.9Paterson9is9concerned9about9the9deductibles9and9co-
payments9associated9with9Original9Medicare.9What9can9you9tell9her9about9Medigap9as
9an9option9to9address9this9concern?9-
9ans✔Medigap9plans9do9not9cover9Original9Medicare9benefits,9but9they9coordinate9wit
h9Original9Medicare9coverage.
Mrs.9Turner9is9comparing9her9employer's9retiree9insurance9to9Original9Medicare9and9w
ould9like9to9know9which9of9the9following9services9Original9Medicare9will9cover9if9the9ap
propriate9criteria9are9met.9What9could9you9tell9her?9-
9ans✔Original9Medicare9covers9ambulance9services.
Ms.9Brooks9has9aggressive9cancer9and9would9like9to9know9if9Medicare9will9cover9hosp
ice9services9in9case9she9needs9them.9What9should9you9tell9her?9-
9ans✔Medicare9covers9hospice9services,9and9they9will9be9available9for9her.
Mr.9Diaz9continued9working9with9his9company9and9was9insured9under9his9employer's9
group9plan9until9he9reached9age968.9He9has9heard9that9there9is9a9premium9penalty9for
9those9who9did9not9sign9up9for9Part9B9when9first9eligible9and9wants9to9know9how9muc
h9he9will9have9to9pay.9What9should9you9tell9him?9-
9ans✔Mr.9Diaz9will9not9pay9any9penalty9because9he9had9continuous9coverage9under9h
is9employer's9plan.
