2025/2026 AHIP FINAL EXAM QUESTIONS WITH CORRECT
ANSWERS
Mrs. Shields is covered by Original Medicare. She sustained a hip fracture and is being suc
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cessfully treated for that condition. However, she and her physicians feel that after her lengt
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hy hospital stay, she will need a month or two of nursing and rehabilitative care. What shoul
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d you tell them about Original Medicare's coverage of care in a skilled nursing facility? - ans-
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Medicare will cover Mrs. Shield's skilled nursing services provided during the first 20 days o
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f her stay, after which she would have a copay until she has been in the facility for 100 days.
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Mrs. West wears glasses and dentures and has enjoyed considerable pain relief from arthri
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tis through massage therapy. She is concerned about whether or not Medicare will cover th
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ese items and services. What should you tell her? - ans-
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Medicare does not cover massage therapy, or, in general, glasses or dentures.
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Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What could you tell Mrs. Pa
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rk that might be of assistance? - ans-
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She should contact her state Medicaid agency to see if she qualifies for one of several progr
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ams that can help with Medicare costs for which she is responsible.
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Mr. Alonso receives some help paying for his two generic prescription drugs from his emplo
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yer's retiree coverage, but he wants to compare it to a Part D prescription drug plan. He ask
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s you what costs he would generally expect to encounter when enrolling into a standard Me
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dicare Part D prescription drug plan. What should you tell him? - ans-
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He generally would pay a monthly premium, annual deductible, and per-prescription cost-
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sharing.
Mrs. Gonzalez is enrolled in Original Medicare and has a Medigap policy as well, but it provi
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des no drug coverage. She would like to keep the coverage she has but replace her existing
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Medigap plan with one that provides drug coverage. What should you tell her? - ans-
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Mrs. Gonzalez cannot purchase a Medigap plan that covers drugs, but she could keep her
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Medigap policy and enroll in a Part D prescription drug plan. zx zx zx zx zx zx zx zx zx zx
Mr. Davis is 52 years old and has recently been diagnosed with end-
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stage renal disease (ESRD) and will soon begin dialysis. He is wondering if he can obtain c
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overage under Medicare. What should you tell him? - ans-He may sign-
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up for Medicare at any time however coverage usually begins on the fourth month after dial
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ysis treatments start. zx zx
Mrs. Duarte is enrolled in Original Medicare Parts A and B. She has recently reviewed her
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Medicare Summary Notice (MSN) and disagrees with a determination that partially denied
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one of her claims for services. What advice would you give her? - ans-
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Mrs. Duarte should file an appeal of this initial determination within 120 days of the date she
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received the MSN in the mail. zx zx zx zx zx
,Mrs. Geisler's neighbor told her she should look at her Part D options during the annual Med
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icare enrollment period because the features of Part D might have changed. Mrs. Geisler c
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an't remember what Part D is so she called you to ask what her neighbor was talking about.
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What could you tell her? - ans- zx zx zx zx zx zx
Part D covers prescription drugs and she should look at her premiums, formulary, and cost-
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sharing among other factors to see if they have changed. zx zx zx zx zx zx zx zx zx
Mr. Rainey is experiencing paranoid delusions and his physician feels that he should be ho
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spitalized. What should you tell Mr. Rainey (or his representative) about the length of an inp
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atient psychiatric hospital stay that Medicare will cover? - ans-
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Medicare will cover a total of 190 days of inpatient psychiatric care during Mr. Rainey's entir
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e lifetime.
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Mr. Xi will soon turn age 65 and has come to you for advice as to what services are provided
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under Original Medicare. What should you tell Mr. Xi that best describes the health coverag
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e provided to Medicare beneficiaries? - ans-
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Beneficiaries under Original Medicare have no cost-sharing for most preventive services. zx zx zx zx zx zx zx zx zx zx
Mr. Singh would like drug coverage but does not want to be enrolled in a Medicare Advanta
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ge plan. What should you tell him? - ans-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 throu
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gh Original Fee-for-Service Medicare.
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Mrs. Chen will be 65 soon, has been a citizen for twelve years, has been employed full time,
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and paid taxes during that entire period. She is concerned that she will not qualify for covera
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ge under part A because she was not born in the United States. What should you tell her? -
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ans-
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Most individuals who are citizens and age 65 or over are covered under Part A by virtue of h
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aving paid Medicare taxes while working, though some may be covered as a result of payin
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g monthly premiums.
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Mrs. Quinn recently turned 66 and decided after many years of work to retire and begin rece
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iving Social Security benefits. Shortly thereafter Mrs. Quinn received a letter informing her t
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hat she had been automatically enrolled in Medicare Part B. She wants to understand what
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this means. What should you tell Mrs. Quinn? - ans-
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Part B primarily covers physician services. She will be paying a monthly premium and, exce
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pt for many preventive and screening tests, generally will have 20% co-
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payments for these services, in addition to an annual deductible. zx zx zx zx zx zx zx zx zx
Mr. Patel is in good health and is preparing a budget in anticipation of his retirement when h
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e turns 66. He wants to understand the health care costs he might be exposed to under Med
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icare if he were to require hospitalization because of an illness. In general terms, what could
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you tell him about his costs for inpatient hospital services under Original Medicare? - ans-
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Under Original Medicare, there is a single deductible amount due for the first 60 days of any
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inpatient hospital stay, after which it converts into a per- zx zx zx zx zx zx zx zx zx
, day coinsurance amount through day 90. After day 90, he would pay a daily amount up to 6
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0 days over his lifetime, after which he would be responsible for all costs.
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What impact, if any, have recent regulatory changes had on Medigap plans? - ans-
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The Part B deductible is no longer covered for individuals newly eligible for Medicare startin
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g January 1, 2020.
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Mrs. Paterson is concerned about the deductibles and co-
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payments associated with Original Medicare. What can you tell her about Medigap as an op
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tion to address this concern? - ans-
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Medigap plans do not cover Original Medicare benefits, but they coordinate with Original M
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edicare coverage. zx
Mrs. Turner is comparing her employer's retiree insurance to Original Medicare and would li
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ke to know which of the following services Original Medicare will cover if the appropriate crit
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eria are met. What could you tell her? - ans-Original Medicare covers ambulance services.
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Ms. Brooks has aggressive cancer and would like to know if Medicare will cover hospice ser
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vices in case she needs them. What should you tell her? - ans-
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Medicare covers hospice services, and they will be available for her. zx zx zx zx zx zx zx zx zx zx
Mr. Diaz continued working with his company and was insured under his employer's group
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plan until he reached age 68. He has heard that there is a premium penalty for those who di
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d not sign up for Part B when first eligible and wants to know how much he will have to pay.
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What should you tell him? - ans- zx zx zx zx zx zx
Mr. Diaz will not pay any penalty because he had continuous coverage under his employer'
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s plan.
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Anita Magri will turn age 65 in August 2023. Anita intends to enroll in Original Medicare Part
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A and Part B. She would also like to enroll in a Medicare Supplement (Medigap) plan. Anita'
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s older neighbor Mel has told her about the Medigap Plan F in which he is enrolled. It not onl
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y provides foreign travel emergency benefits but also covers his Medicare Part B deductibl
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e. Anita comes to you for advice. What should you tell her? - ans-
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You are sorry to disappoint Anita, but a Medigap F plan is no longer available to those who t
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urn age 65 after January 1, 2020. Anita might instead consider other Medigap plans that off
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er foreign travel benefits but do not cover the Part B deductible.
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Hank's Fish Store, Inc. is a small company with just 15 employees located in Florida. Hank,
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the store owner, has provided excellent health benefits to the store's workforce. William, on
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e of the store's long-
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time employees, will soon be reaching age 65 and eligible for Medicare. William is in good h
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ealth. He intends to remain an active full-
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time employee, working several years after becoming eligible for Medicare. What type(s) of
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retiree health benefit will Hank's Fish Store be able to offer William? - ans-
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Hank's can continue to offer William the same employee health benefit plan, or, if William e
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ANSWERS
Mrs. Shields is covered by Original Medicare. She sustained a hip fracture and is being suc
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cessfully treated for that condition. However, she and her physicians feel that after her lengt
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hy hospital stay, she will need a month or two of nursing and rehabilitative care. What shoul
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d you tell them about Original Medicare's coverage of care in a skilled nursing facility? - ans-
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Medicare will cover Mrs. Shield's skilled nursing services provided during the first 20 days o
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f her stay, after which she would have a copay until she has been in the facility for 100 days.
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Mrs. West wears glasses and dentures and has enjoyed considerable pain relief from arthri
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tis through massage therapy. She is concerned about whether or not Medicare will cover th
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ese items and services. What should you tell her? - ans-
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Medicare does not cover massage therapy, or, in general, glasses or dentures.
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Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What could you tell Mrs. Pa
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rk that might be of assistance? - ans-
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She should contact her state Medicaid agency to see if she qualifies for one of several progr
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ams that can help with Medicare costs for which she is responsible.
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Mr. Alonso receives some help paying for his two generic prescription drugs from his emplo
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yer's retiree coverage, but he wants to compare it to a Part D prescription drug plan. He ask
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s you what costs he would generally expect to encounter when enrolling into a standard Me
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dicare Part D prescription drug plan. What should you tell him? - ans-
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He generally would pay a monthly premium, annual deductible, and per-prescription cost-
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sharing.
Mrs. Gonzalez is enrolled in Original Medicare and has a Medigap policy as well, but it provi
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des no drug coverage. She would like to keep the coverage she has but replace her existing
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Medigap plan with one that provides drug coverage. What should you tell her? - ans-
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Mrs. Gonzalez cannot purchase a Medigap plan that covers drugs, but she could keep her
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Medigap policy and enroll in a Part D prescription drug plan. zx zx zx zx zx zx zx zx zx zx
Mr. Davis is 52 years old and has recently been diagnosed with end-
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stage renal disease (ESRD) and will soon begin dialysis. He is wondering if he can obtain c
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overage under Medicare. What should you tell him? - ans-He may sign-
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up for Medicare at any time however coverage usually begins on the fourth month after dial
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ysis treatments start. zx zx
Mrs. Duarte is enrolled in Original Medicare Parts A and B. She has recently reviewed her
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Medicare Summary Notice (MSN) and disagrees with a determination that partially denied
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one of her claims for services. What advice would you give her? - ans-
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Mrs. Duarte should file an appeal of this initial determination within 120 days of the date she
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received the MSN in the mail. zx zx zx zx zx
,Mrs. Geisler's neighbor told her she should look at her Part D options during the annual Med
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icare enrollment period because the features of Part D might have changed. Mrs. Geisler c
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an't remember what Part D is so she called you to ask what her neighbor was talking about.
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What could you tell her? - ans- zx zx zx zx zx zx
Part D covers prescription drugs and she should look at her premiums, formulary, and cost-
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sharing among other factors to see if they have changed. zx zx zx zx zx zx zx zx zx
Mr. Rainey is experiencing paranoid delusions and his physician feels that he should be ho
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spitalized. What should you tell Mr. Rainey (or his representative) about the length of an inp
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atient psychiatric hospital stay that Medicare will cover? - ans-
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Medicare will cover a total of 190 days of inpatient psychiatric care during Mr. Rainey's entir
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e lifetime.
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Mr. Xi will soon turn age 65 and has come to you for advice as to what services are provided
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under Original Medicare. What should you tell Mr. Xi that best describes the health coverag
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e provided to Medicare beneficiaries? - ans-
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Beneficiaries under Original Medicare have no cost-sharing for most preventive services. zx zx zx zx zx zx zx zx zx zx
Mr. Singh would like drug coverage but does not want to be enrolled in a Medicare Advanta
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ge plan. What should you tell him? - ans-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 throu
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gh Original Fee-for-Service Medicare.
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Mrs. Chen will be 65 soon, has been a citizen for twelve years, has been employed full time,
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and paid taxes during that entire period. She is concerned that she will not qualify for covera
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ge under part A because she was not born in the United States. What should you tell her? -
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ans-
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Most individuals who are citizens and age 65 or over are covered under Part A by virtue of h
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aving paid Medicare taxes while working, though some may be covered as a result of payin
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g monthly premiums.
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Mrs. Quinn recently turned 66 and decided after many years of work to retire and begin rece
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iving Social Security benefits. Shortly thereafter Mrs. Quinn received a letter informing her t
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hat she had been automatically enrolled in Medicare Part B. She wants to understand what
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this means. What should you tell Mrs. Quinn? - ans-
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Part B primarily covers physician services. She will be paying a monthly premium and, exce
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pt for many preventive and screening tests, generally will have 20% co-
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payments for these services, in addition to an annual deductible. zx zx zx zx zx zx zx zx zx
Mr. Patel is in good health and is preparing a budget in anticipation of his retirement when h
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e turns 66. He wants to understand the health care costs he might be exposed to under Med
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icare if he were to require hospitalization because of an illness. In general terms, what could
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you tell him about his costs for inpatient hospital services under Original Medicare? - ans-
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Under Original Medicare, there is a single deductible amount due for the first 60 days of any
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inpatient hospital stay, after which it converts into a per- zx zx zx zx zx zx zx zx zx
, day coinsurance amount through day 90. After day 90, he would pay a daily amount up to 6
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0 days over his lifetime, after which he would be responsible for all costs.
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What impact, if any, have recent regulatory changes had on Medigap plans? - ans-
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The Part B deductible is no longer covered for individuals newly eligible for Medicare startin
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g January 1, 2020.
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Mrs. Paterson is concerned about the deductibles and co-
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payments associated with Original Medicare. What can you tell her about Medigap as an op
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tion to address this concern? - ans-
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Medigap plans do not cover Original Medicare benefits, but they coordinate with Original M
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edicare coverage. zx
Mrs. Turner is comparing her employer's retiree insurance to Original Medicare and would li
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ke to know which of the following services Original Medicare will cover if the appropriate crit
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eria are met. What could you tell her? - ans-Original Medicare covers ambulance services.
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Ms. Brooks has aggressive cancer and would like to know if Medicare will cover hospice ser
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vices in case she needs them. What should you tell her? - ans-
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Medicare covers hospice services, and they will be available for her. zx zx zx zx zx zx zx zx zx zx
Mr. Diaz continued working with his company and was insured under his employer's group
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plan until he reached age 68. He has heard that there is a premium penalty for those who di
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d not sign up for Part B when first eligible and wants to know how much he will have to pay.
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What should you tell him? - ans- zx zx zx zx zx zx
Mr. Diaz will not pay any penalty because he had continuous coverage under his employer'
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s plan.
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Anita Magri will turn age 65 in August 2023. Anita intends to enroll in Original Medicare Part
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A and Part B. She would also like to enroll in a Medicare Supplement (Medigap) plan. Anita'
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s older neighbor Mel has told her about the Medigap Plan F in which he is enrolled. It not onl
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y provides foreign travel emergency benefits but also covers his Medicare Part B deductibl
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e. Anita comes to you for advice. What should you tell her? - ans-
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You are sorry to disappoint Anita, but a Medigap F plan is no longer available to those who t
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urn age 65 after January 1, 2020. Anita might instead consider other Medigap plans that off
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er foreign travel benefits but do not cover the Part B deductible.
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Hank's Fish Store, Inc. is a small company with just 15 employees located in Florida. Hank,
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the store owner, has provided excellent health benefits to the store's workforce. William, on
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e of the store's long-
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time employees, will soon be reaching age 65 and eligible for Medicare. William is in good h
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ealth. He intends to remain an active full-
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time employee, working several years after becoming eligible for Medicare. What type(s) of
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retiree health benefit will Hank's Fish Store be able to offer William? - ans-
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Hank's can continue to offer William the same employee health benefit plan, or, if William e
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