AHIP FINAL EXAM, PRACTICE EXAM
AND STUDY GUIDE LATEST 2025/2026
ACTUAL EXAM 135 QUESTIONS WITH
CORRECT ANSWERS 100% VERIFIED
GRADED A+
1. 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? - ANSWER-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.
2. 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? - ANSWER-Medicare does not cover
massage therapy, or, in general, glasses or dentures.
3. Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What
could you tell Mrs. Park that might be of assistance? - ANSWER-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.
4. 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? - ANSWER-He
generally would pay a monthly premium, annual deductible, and per-
prescription cost-sharing.
5. 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? - ANSWER-
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.
6. 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? - ANSWER-He may sign-up for Medicare at any time however
coverage usually begins on the fourth month after dialysis treatments
start.
7. 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? - ANSWER-Mrs. Duarte
should file an appeal of this initial determination within 120 days of
the date she received the MSN in the mail.
8. 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? - ANSWER-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.
, 9. 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? - ANSWER-Medicare will cover a total of
190 days of inpatient psychiatric care during Mr. Rainey's entire
lifetime.
10. 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? - ANSWER-Beneficiaries under Original
Medicare have no cost-sharing for most preventive services.
11. Mr. Singh would like drug coverage but does not want to be
enrolled in a Medicare Advantage plan. What should you tell him? -
ANSWER-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.
12. 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? - ANSWER-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.
13. 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? -
ANSWER-Part B primarily covers physician services. She will be paying
a monthly premium and, except for many preventive and screening
AND STUDY GUIDE LATEST 2025/2026
ACTUAL EXAM 135 QUESTIONS WITH
CORRECT ANSWERS 100% VERIFIED
GRADED A+
1. 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? - ANSWER-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.
2. 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? - ANSWER-Medicare does not cover
massage therapy, or, in general, glasses or dentures.
3. Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What
could you tell Mrs. Park that might be of assistance? - ANSWER-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.
4. 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? - ANSWER-He
generally would pay a monthly premium, annual deductible, and per-
prescription cost-sharing.
5. 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? - ANSWER-
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.
6. 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? - ANSWER-He may sign-up for Medicare at any time however
coverage usually begins on the fourth month after dialysis treatments
start.
7. 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? - ANSWER-Mrs. Duarte
should file an appeal of this initial determination within 120 days of
the date she received the MSN in the mail.
8. 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? - ANSWER-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.
, 9. 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? - ANSWER-Medicare will cover a total of
190 days of inpatient psychiatric care during Mr. Rainey's entire
lifetime.
10. 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? - ANSWER-Beneficiaries under Original
Medicare have no cost-sharing for most preventive services.
11. Mr. Singh would like drug coverage but does not want to be
enrolled in a Medicare Advantage plan. What should you tell him? -
ANSWER-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.
12. 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? - ANSWER-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.
13. 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? -
ANSWER-Part B primarily covers physician services. She will be paying
a monthly premium and, except for many preventive and screening
