AHIP FINAL EXAM WITH UPGRADED
QUESTIONS AND ANSWERS
2025/2026
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? - CORRECT ANSWERS -Original Medicare covers ambulance services.
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 ANSWERS -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 ANSWERS -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.
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 ANSWERS -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.
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 ANSWERS -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.
Anita 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 neighbor 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? - CORRECT ANSWERS -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.
Mr. Singh would like drug coverage but does not want to be enrolled in a Medicare Advantage plan.
What should you tell him? - CORRECT ANSWERS -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 ANSWERS -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.
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 ANSWERS -Beneficiaries under Original Medicare have no cost-
sharing for most preventive services.
Mr. Barker enjoys a comfortable retirement income. He recently had surgery and expected that he
would have certain services and items covered by the plan with minimal out-of-pocket costs because his
MA-PD coverage has been very good. However, when he received the bill, he was surprised to see large
charges in excess of his maximum out-of-pocket limit that included some services and items he thought
would be fully covered. He called you to ask what he could do? What could you tell him? - CORRECT
ANSWERS -You can offer to review the plans appeal process to help him ask the plan to review the
coverage decision.
Mr. Lombardi is interested in a Medicare Advantage (MA) PPO plan that you represent. It is one of three
plans operated by the same organization in Mr. Lombardi's area. The MA PPO plan does not include
drug coverage, but the other two plans do. Mr. Lombardi likes the PPO plan that does not include drug
coverage and intends to obtain his drug coverage through a stand-alone Medicare prescription drug
plan. What should you tell him about this situation? - CORRECT ANSWERS -He could enroll either in one
QUESTIONS AND ANSWERS
2025/2026
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? - CORRECT ANSWERS -Original Medicare covers ambulance services.
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 ANSWERS -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 ANSWERS -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.
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 ANSWERS -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.
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 ANSWERS -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.
Anita 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 neighbor 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? - CORRECT ANSWERS -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.
Mr. Singh would like drug coverage but does not want to be enrolled in a Medicare Advantage plan.
What should you tell him? - CORRECT ANSWERS -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 ANSWERS -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.
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 ANSWERS -Beneficiaries under Original Medicare have no cost-
sharing for most preventive services.
Mr. Barker enjoys a comfortable retirement income. He recently had surgery and expected that he
would have certain services and items covered by the plan with minimal out-of-pocket costs because his
MA-PD coverage has been very good. However, when he received the bill, he was surprised to see large
charges in excess of his maximum out-of-pocket limit that included some services and items he thought
would be fully covered. He called you to ask what he could do? What could you tell him? - CORRECT
ANSWERS -You can offer to review the plans appeal process to help him ask the plan to review the
coverage decision.
Mr. Lombardi is interested in a Medicare Advantage (MA) PPO plan that you represent. It is one of three
plans operated by the same organization in Mr. Lombardi's area. The MA PPO plan does not include
drug coverage, but the other two plans do. Mr. Lombardi likes the PPO plan that does not include drug
coverage and intends to obtain his drug coverage through a stand-alone Medicare prescription drug
plan. What should you tell him about this situation? - CORRECT ANSWERS -He could enroll either in one
