AHIP Final Exam Exam LATEST 2025 UPDATE WITH
COMPLETE QUESTIONS AND CORRECTLY WELL
DEFINED ANSWERS 100%GUARANTEED PASS!!!
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. - answerMrs. 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 does not cover massage therapy, or, in general, glasses or dentures. -
answerMrs. 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?
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. - answerMrs.
Park is an elderly retiree. Mrs. Park has a low fixed income. What could you tell Mrs.
Park that might be of assistance?
He generally would pay a monthly premium, annual deductible, and per-prescription
cost-sharing. - answerMr. 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?
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. - answerMrs.
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?
He may sign-up for Medicare at any time however coverage usually begins on the fourth
month after dialysis treatments start. - answerMr. 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?
Mrs. Duarte should file an appeal of this initial determination within 120 days of the date
she received the MSN in the mail. - answerMrs. 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?
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. - answerMrs. 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?
Medicare will cover a total of 190 days of inpatient psychiatric care during Mr. Rainey's
entire lifetime. - answerMr. 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?
Beneficiaries under Original Medicare have no cost-sharing for most preventive
services. - answerMr. 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?
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. - answerMr.
Singh would like drug coverage but does not want to be enrolled in a Medicare
Advantage plan. What should you tell him?
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. - answerMrs. 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?
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. - answerMrs. 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?
,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. - answerMr. 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 h e
were to require hospitalization because of an illness. In general terms, what could you
tell him about his costs for inpatient hospital services under Original Medicare?
The Part B deductible is no longer covered for individuals newly eligible for Medicare
starting January 1, 2020. - answerWhat impact, if any, have recent regulatory changes
had on Medigap plans?
Medigap plans do not cover Original Medicare benefits, but they coordinate with
Original Medicare coverage. - answerMrs. Paterson is concerned about the deductibles
and co-payments associated with Original Medicare. What can you tell her about
Medigap as an option to address this concern?
Original Medicare covers ambulance services. - answerMrs. 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?
Medicare covers hospice services, and they will be available for her. - answerMs.
Brooks has aggressive cancer and would like to know if Medicare will cover hospice
services in case she needs them. What should you tell her?
Mr. Diaz will not pay any penalty because he had continuous coverage under his
employer's plan. - answerMr. 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?
You are sorry to disappoint Anita, but a Medigap F plan is no longer available to those
who turn age 65 after January 1, 2020. Anita might instead consider other Medigap
plans that offer foreign travel benefits but do not cover the Part B deductible. -
answerAnita Magri will turn age 65 in August 2023. Anita intends to enroll in Original
Medicare Part A and Part B. She would also like to enroll in a Medicare Supplement
(Medigap) plan. Anita's older neigh bor Mel has told her about the Medigap Plan F in
which he is enrolled. It not only provides foreign travel emergency benefits but also
covers his Medicare Part B deductible. Anita comes to you for advice. What should you
tell her?
Hank's can continue to offer William the same employee health benefit plan, or, if
William enrolls in Medicare Part B, it can enroll him in a Medicare Advantage plan that is
, offered to the public. - answerHank's Fish Store, Inc. is a small company with just 15
employees located in Florida. Hank, the store owner, has provided excellent health
benefits to the store's workforce. William, one of the store's long-time employees, will
soon be reaching age 65 and eligible for Medicare. William is in good health. He intends
to remain an active full-time employee, working several years after becoming eligible for
Medicare. What type(s) of retiree health benefit will Hank's Fish Store be able to offer
William?
He will have to enroll in Part B. - answerMr. Sanchez has just turned 65 and is entitled
to Part A but has not enrolled in Part B because he has coverage through an employer
plan. If he wants to enroll in a Medicare Advantage plan, what will he have to do?
There are Programs of All-Inclusive Care for the Elderly (PACE) for frail elderly
beneficiaries certified as needing a nursing home level of care but are able to live safely
in the community at the time of enrolment. - answerMrs. Velasquez cares for her frail
elderly mother, Maria, who lives in North Carolina. She is worried that without additional
support, her mother will need to go into a nursing home. Mrs. Velasquez asks you if
there is any Medicare plan that might allow her mother to remain in the community
rather than going into a nursing home. How should you advise Mrs. Velasquez?
I, II, and IV only - answerWhich of the following statement(s) is/are correct about a
Medicare Savings Account (MSA) Plans?
I. MSAs may have either a partial network, full network, or no network of providers.
II. MSA plans cover Part A and Part B benefits but not Part D prescription drug benefits.
III. An individual who is enrolled in an MSA plan is responsible for a minimal deductible
of $500 indexed for inflation.
IV. Non-network providers must accept the same amount that Original Medicare would
pay them as payment in full.
Mrs. Chi may enroll in a MA MSA plan and remain in her current standalone Part D
prescription drug plan. - answerMrs. Chi is age 75 and enjoys a comfortable but not
extremely high-income level. She wishes to enroll in a MA MSA plan that she heard
about from her neighbor. She also wants to have prescription drug coverage since her
doctor recently prescribed several expensive medications. Curren tly, she is enrolled in
Original Medicare and a standalone Part D plan. How would you advise Mrs. Chi?
All MSAs cover Part A and Part B benefits, but not Part D prescription drug benefits,
which could be obtained by also enrolling in a separate prescription drug plan. -
answerMrs. Lyons is in good health, uses a single prescription, and lives independently
in her own home. She is attracted by the idea of maintaining control over a Medical
Savings Account (MSA) but is not sure if the plan associated with the account will fit her
needs. What specific piece of information about a Medicare MSA plan would it be
important for her to know, prior to enrolling in such a plan?
She could file a grievance with her plan to complain about the lack of timeliness in
getting an appointment. - answerMrs. Burton is a retiree with substantial income. She is
COMPLETE QUESTIONS AND CORRECTLY WELL
DEFINED ANSWERS 100%GUARANTEED PASS!!!
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. - answerMrs. 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 does not cover massage therapy, or, in general, glasses or dentures. -
answerMrs. 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?
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. - answerMrs.
Park is an elderly retiree. Mrs. Park has a low fixed income. What could you tell Mrs.
Park that might be of assistance?
He generally would pay a monthly premium, annual deductible, and per-prescription
cost-sharing. - answerMr. 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?
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. - answerMrs.
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?
He may sign-up for Medicare at any time however coverage usually begins on the fourth
month after dialysis treatments start. - answerMr. 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?
Mrs. Duarte should file an appeal of this initial determination within 120 days of the date
she received the MSN in the mail. - answerMrs. 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?
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. - answerMrs. 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?
Medicare will cover a total of 190 days of inpatient psychiatric care during Mr. Rainey's
entire lifetime. - answerMr. 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?
Beneficiaries under Original Medicare have no cost-sharing for most preventive
services. - answerMr. 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?
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. - answerMr.
Singh would like drug coverage but does not want to be enrolled in a Medicare
Advantage plan. What should you tell him?
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. - answerMrs. 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?
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. - answerMrs. 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?
,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. - answerMr. 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 h e
were to require hospitalization because of an illness. In general terms, what could you
tell him about his costs for inpatient hospital services under Original Medicare?
The Part B deductible is no longer covered for individuals newly eligible for Medicare
starting January 1, 2020. - answerWhat impact, if any, have recent regulatory changes
had on Medigap plans?
Medigap plans do not cover Original Medicare benefits, but they coordinate with
Original Medicare coverage. - answerMrs. Paterson is concerned about the deductibles
and co-payments associated with Original Medicare. What can you tell her about
Medigap as an option to address this concern?
Original Medicare covers ambulance services. - answerMrs. 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?
Medicare covers hospice services, and they will be available for her. - answerMs.
Brooks has aggressive cancer and would like to know if Medicare will cover hospice
services in case she needs them. What should you tell her?
Mr. Diaz will not pay any penalty because he had continuous coverage under his
employer's plan. - answerMr. 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?
You are sorry to disappoint Anita, but a Medigap F plan is no longer available to those
who turn age 65 after January 1, 2020. Anita might instead consider other Medigap
plans that offer foreign travel benefits but do not cover the Part B deductible. -
answerAnita Magri will turn age 65 in August 2023. Anita intends to enroll in Original
Medicare Part A and Part B. She would also like to enroll in a Medicare Supplement
(Medigap) plan. Anita's older neigh bor Mel has told her about the Medigap Plan F in
which he is enrolled. It not only provides foreign travel emergency benefits but also
covers his Medicare Part B deductible. Anita comes to you for advice. What should you
tell her?
Hank's can continue to offer William the same employee health benefit plan, or, if
William enrolls in Medicare Part B, it can enroll him in a Medicare Advantage plan that is
, offered to the public. - answerHank's Fish Store, Inc. is a small company with just 15
employees located in Florida. Hank, the store owner, has provided excellent health
benefits to the store's workforce. William, one of the store's long-time employees, will
soon be reaching age 65 and eligible for Medicare. William is in good health. He intends
to remain an active full-time employee, working several years after becoming eligible for
Medicare. What type(s) of retiree health benefit will Hank's Fish Store be able to offer
William?
He will have to enroll in Part B. - answerMr. Sanchez has just turned 65 and is entitled
to Part A but has not enrolled in Part B because he has coverage through an employer
plan. If he wants to enroll in a Medicare Advantage plan, what will he have to do?
There are Programs of All-Inclusive Care for the Elderly (PACE) for frail elderly
beneficiaries certified as needing a nursing home level of care but are able to live safely
in the community at the time of enrolment. - answerMrs. Velasquez cares for her frail
elderly mother, Maria, who lives in North Carolina. She is worried that without additional
support, her mother will need to go into a nursing home. Mrs. Velasquez asks you if
there is any Medicare plan that might allow her mother to remain in the community
rather than going into a nursing home. How should you advise Mrs. Velasquez?
I, II, and IV only - answerWhich of the following statement(s) is/are correct about a
Medicare Savings Account (MSA) Plans?
I. MSAs may have either a partial network, full network, or no network of providers.
II. MSA plans cover Part A and Part B benefits but not Part D prescription drug benefits.
III. An individual who is enrolled in an MSA plan is responsible for a minimal deductible
of $500 indexed for inflation.
IV. Non-network providers must accept the same amount that Original Medicare would
pay them as payment in full.
Mrs. Chi may enroll in a MA MSA plan and remain in her current standalone Part D
prescription drug plan. - answerMrs. Chi is age 75 and enjoys a comfortable but not
extremely high-income level. She wishes to enroll in a MA MSA plan that she heard
about from her neighbor. She also wants to have prescription drug coverage since her
doctor recently prescribed several expensive medications. Curren tly, she is enrolled in
Original Medicare and a standalone Part D plan. How would you advise Mrs. Chi?
All MSAs cover Part A and Part B benefits, but not Part D prescription drug benefits,
which could be obtained by also enrolling in a separate prescription drug plan. -
answerMrs. Lyons is in good health, uses a single prescription, and lives independently
in her own home. She is attracted by the idea of maintaining control over a Medical
Savings Account (MSA) but is not sure if the plan associated with the account will fit her
needs. What specific piece of information about a Medicare MSA plan would it be
important for her to know, prior to enrolling in such a plan?
She could file a grievance with her plan to complain about the lack of timeliness in
getting an appointment. - answerMrs. Burton is a retiree with substantial income. She is
