PROFESSIONAL STUDY EDITION
AHIP 2025 FINAL EXAM 100% VER
ANSWERS
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,AHIP 2025 FINAL EXAM 100% VERIFIED ANSWERS
Ms. Moore plans to retire when she turns 65 in a few months. She is in excellent health
and will have considerable income when she retires. She is concerned that her income
will make it impossible for her to qualify for Medicare. What could you tell her to address
her concern? - Medicare is a program for people age 65 or older and those under age
65 with certain disabilities, end stage renal disease and Lou Gehrig's disease, so she
will be eligible for Medicare.
Mr. Schmidt would like to plan for retirement and has asked you what is covered under
Original Fee-for-Service (FFS) Medicare? What could you tell him? - Part A, which
covers hospital, skilled nursing facility, hospice and home health services and Part B,
which covers professional services such as those provided by a doctor are covered
under Original Medicare.
Mr. Hernandez is concerned that if he signs up for a Medicare Advantage plan, the
health plan may, at some time in the future, reduce his benefits below what is available
in Original Medicare. What should you tell him about his concern? - Medicare health
plans must cover all benefits available under Medicare Part A and Part B. Many also
cover Part D prescription drugs.
Mrs. Roberts has just received a new Medicare identity card in the mail. She is
concerned that it is a forgery since it does not have her Social Security number on it.
What should you tell her? - The card she received is valid, the change has been made
to protect Medicare beneficiaries from identity theft, and she should now destroy her old
card.
Mrs. Willard wants to know generally how the benefits under Original Medicare might
compare to the benefit package of a Medicare Health Plan before she starts looking at
specific plans. What could you tell her? - Medicare Health Plans may offer extra benefits
that Original Medicare does not offer such as vision, hearing, and dental services and
must include a maximum out-of-pocket limit on Part A and Part B services.
Mr. Meoni's wife has a Medicare Advantage plan, but he wants to understand what
coverage Medicare Supplemental Insurance provides since his health care needs are
different from his wife's needs. What could you tell Mr.Meoni? - Medicare Supplemental
Insurance would help cover his Part A and Part B cost sharing in Original Fee-for-
Service (FFS) Medicare as well as possibly some services that Medicare does not
cover.
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? - Most individuals who are citizens and over age 65 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.
2
,AHIP 2025 FINAL EXAM 100% VERIFIED ANSWERS
Mr. Bauer is 49 years old, but eighteen months ago he was declared disabled by the
Social Security Administration and has been receiving disability payments. He is
wondering whether he can obtain coverage under Medicare. What should you tell him? -
After receiving such disability payments for 24 months, he will be automatically enrolled
in Medicare, regardless of age.
Mr. Denton 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? - He may sign-up for Medicare at any time
however coverage usually begins on the fourth month after dialysis treatments start.
Ms. Henderson believes that she will qualify for Medicare coverage when she turns 65,
without paying any premiums, because she has been working for 40 years and paying
Medicare taxes. What should you tell her? - In order to obtain Part B coverage, she
must pay a standard monthly premium, though it is higher for individuals with higher
incomes.
Mr. Diaz continued working with his company and was insured under his employer's
group plan until he reached age 68. He has heard that there is a premium penalty for
those who did not sign up for Part B when first eligible and wants to know how much he
will have to pay. What should you tell him? - Mr. Diaz will not pay any penalty because
he had continuous coverage under his employer's plan.
Mrs. Peňa is 66 years old, has coverage under an employer plan and will retire next
year. She heard she must enroll in Part B at the beginning of the year to ensure no gap
in coverage. What can you tell her? - She may enroll at any time while she is covered
under her employer plan, but she will have a special eight-month enrollment period that
differs from the standard general enrollment period, during which she may enroll in
Medicare Part B.
Mrs. Kelly, age 65, is entitled to Part A, but has not yet enrolled in Part B. She is
considering enrollment in a Medicare health plan (Part C). What should you advise her
to do before she will be able to enroll into a Medicare health plan? - In order to join a
Medicare health plan, she also must enroll in Part B.
Mrs. Park is an elderly retiree. She has a low, fixed income. What could you tell Mrs.
Park that might be of assistance? - 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. Wu is eligible for Medicare. He has limited financial resources but failed to qualify
for the Part D low-income subsidy. Where might he turn for help with his prescription
drug costs? - Mr. Wu may still qualify for help in paying Part D costs through his State
Pharmaceutical Assistance Program.
3
, AHIP 2025 FINAL EXAM 100% VERIFIED ANSWERS
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 as a result of an illness. In general
terms, what could you tell him about his costs for inpatient hospital services under
Original Medicare? - 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
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? - Medicare will cover Mrs. Shields' skilled nursing services provided
during the first 20 days of her stay, after which she would have a coinsurance until she
has been in the facility for 100 days
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? - Medicare will cover a
total of 190 days of inpatient psychiatric care during Mr. Rainey's entire lifetime.
Mrs. Quinn has recently turned 66 and decided after many years of work to begin
receiving Social Security benefits. Shortly thereafter Mrs. Quinn received a letter
informing her that she has been automatically enrolled in Medicare Part B. She wants to
understand what this means. What should you tell Mrs. Quinn? - Part B primarily covers
physician services. She will be paying a monthly premium and, with the exception of
many preventive and screening tests, generally will have 20% co-payments for these
services, in addition to an annual deductible.
Mr. Buck has several family members who died from different cancers. He wants to
know if Medicare covers cancer screening. What should you tell him? - Medicare covers
periodic performance of a range of screening tests that are meant to provide early
detection of disease. Mr. Buck will need to check specific tests before obtaining them to
see if they will be covered
Mrs. Turner is comparing her employer's retiree insurance to Original Medicare and
would like to know which of the following services Original Medicare will cover if the
appropriate criteria are met? What could you tell her? - Original Medicare covers
ambulance services.
Mrs. Wolf wears glasses and dentures and has enjoyed considerable pain relief from
arthritis through acupuncture. She is concerned about whether or not Medicare will
cover these items and services. What should you tell her? - Medicare does not cover
acupuncture, or, in general, glasses or dentures.
4
AHIP 2025 FINAL EXAM 100% VER
ANSWERS
Redesigned for clarity, navigation, and comfortable reading
DOCUMENT PROFILE
Pages in source: 34
Content preserved; visual presentation enhanced
Redesigned edition • Original source content retained 1
,AHIP 2025 FINAL EXAM 100% VERIFIED ANSWERS
Ms. Moore plans to retire when she turns 65 in a few months. She is in excellent health
and will have considerable income when she retires. She is concerned that her income
will make it impossible for her to qualify for Medicare. What could you tell her to address
her concern? - Medicare is a program for people age 65 or older and those under age
65 with certain disabilities, end stage renal disease and Lou Gehrig's disease, so she
will be eligible for Medicare.
Mr. Schmidt would like to plan for retirement and has asked you what is covered under
Original Fee-for-Service (FFS) Medicare? What could you tell him? - Part A, which
covers hospital, skilled nursing facility, hospice and home health services and Part B,
which covers professional services such as those provided by a doctor are covered
under Original Medicare.
Mr. Hernandez is concerned that if he signs up for a Medicare Advantage plan, the
health plan may, at some time in the future, reduce his benefits below what is available
in Original Medicare. What should you tell him about his concern? - Medicare health
plans must cover all benefits available under Medicare Part A and Part B. Many also
cover Part D prescription drugs.
Mrs. Roberts has just received a new Medicare identity card in the mail. She is
concerned that it is a forgery since it does not have her Social Security number on it.
What should you tell her? - The card she received is valid, the change has been made
to protect Medicare beneficiaries from identity theft, and she should now destroy her old
card.
Mrs. Willard wants to know generally how the benefits under Original Medicare might
compare to the benefit package of a Medicare Health Plan before she starts looking at
specific plans. What could you tell her? - Medicare Health Plans may offer extra benefits
that Original Medicare does not offer such as vision, hearing, and dental services and
must include a maximum out-of-pocket limit on Part A and Part B services.
Mr. Meoni's wife has a Medicare Advantage plan, but he wants to understand what
coverage Medicare Supplemental Insurance provides since his health care needs are
different from his wife's needs. What could you tell Mr.Meoni? - Medicare Supplemental
Insurance would help cover his Part A and Part B cost sharing in Original Fee-for-
Service (FFS) Medicare as well as possibly some services that Medicare does not
cover.
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? - Most individuals who are citizens and over age 65 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.
2
,AHIP 2025 FINAL EXAM 100% VERIFIED ANSWERS
Mr. Bauer is 49 years old, but eighteen months ago he was declared disabled by the
Social Security Administration and has been receiving disability payments. He is
wondering whether he can obtain coverage under Medicare. What should you tell him? -
After receiving such disability payments for 24 months, he will be automatically enrolled
in Medicare, regardless of age.
Mr. Denton 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? - He may sign-up for Medicare at any time
however coverage usually begins on the fourth month after dialysis treatments start.
Ms. Henderson believes that she will qualify for Medicare coverage when she turns 65,
without paying any premiums, because she has been working for 40 years and paying
Medicare taxes. What should you tell her? - In order to obtain Part B coverage, she
must pay a standard monthly premium, though it is higher for individuals with higher
incomes.
Mr. Diaz continued working with his company and was insured under his employer's
group plan until he reached age 68. He has heard that there is a premium penalty for
those who did not sign up for Part B when first eligible and wants to know how much he
will have to pay. What should you tell him? - Mr. Diaz will not pay any penalty because
he had continuous coverage under his employer's plan.
Mrs. Peňa is 66 years old, has coverage under an employer plan and will retire next
year. She heard she must enroll in Part B at the beginning of the year to ensure no gap
in coverage. What can you tell her? - She may enroll at any time while she is covered
under her employer plan, but she will have a special eight-month enrollment period that
differs from the standard general enrollment period, during which she may enroll in
Medicare Part B.
Mrs. Kelly, age 65, is entitled to Part A, but has not yet enrolled in Part B. She is
considering enrollment in a Medicare health plan (Part C). What should you advise her
to do before she will be able to enroll into a Medicare health plan? - In order to join a
Medicare health plan, she also must enroll in Part B.
Mrs. Park is an elderly retiree. She has a low, fixed income. What could you tell Mrs.
Park that might be of assistance? - 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. Wu is eligible for Medicare. He has limited financial resources but failed to qualify
for the Part D low-income subsidy. Where might he turn for help with his prescription
drug costs? - Mr. Wu may still qualify for help in paying Part D costs through his State
Pharmaceutical Assistance Program.
3
, AHIP 2025 FINAL EXAM 100% VERIFIED ANSWERS
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 as a result of an illness. In general
terms, what could you tell him about his costs for inpatient hospital services under
Original Medicare? - 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
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? - Medicare will cover Mrs. Shields' skilled nursing services provided
during the first 20 days of her stay, after which she would have a coinsurance until she
has been in the facility for 100 days
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? - Medicare will cover a
total of 190 days of inpatient psychiatric care during Mr. Rainey's entire lifetime.
Mrs. Quinn has recently turned 66 and decided after many years of work to begin
receiving Social Security benefits. Shortly thereafter Mrs. Quinn received a letter
informing her that she has been automatically enrolled in Medicare Part B. She wants to
understand what this means. What should you tell Mrs. Quinn? - Part B primarily covers
physician services. She will be paying a monthly premium and, with the exception of
many preventive and screening tests, generally will have 20% co-payments for these
services, in addition to an annual deductible.
Mr. Buck has several family members who died from different cancers. He wants to
know if Medicare covers cancer screening. What should you tell him? - Medicare covers
periodic performance of a range of screening tests that are meant to provide early
detection of disease. Mr. Buck will need to check specific tests before obtaining them to
see if they will be covered
Mrs. Turner is comparing her employer's retiree insurance to Original Medicare and
would like to know which of the following services Original Medicare will cover if the
appropriate criteria are met? What could you tell her? - Original Medicare covers
ambulance services.
Mrs. Wolf wears glasses and dentures and has enjoyed considerable pain relief from
arthritis through acupuncture. She is concerned about whether or not Medicare will
cover these items and services. What should you tell her? - Medicare does not cover
acupuncture, or, in general, glasses or dentures.
4
