2025 AHIP Final Exam complete questions
and solutions
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 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’
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
answer 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 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’
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 answer 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 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’
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 answer 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 answer 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 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’
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 answer 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
answer 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 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’
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 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’
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 answer 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’
and solutions
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 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’
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
answer 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 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’
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 answer 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 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’
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 answer 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 answer 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 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’
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 answer 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
answer 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 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’
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 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’
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 answer 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’
