AHIP FWA Exam 2026 Questions and
Answers
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 Answer
-Original Medicare covers ambulance 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. 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.
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,Madeline Martinez was widowed several years ago. Her husband worked for many
years and contributed into the Medicare system. He also left a substantial estate
which provides Madeline with an annual income of approximately $130,000.
Madeline, who has only worked part-time for the last three years, will soon turn
age 65 and hopes to enroll in Original Medicare. She comes to you for advice.
What should you tell her? - Correct Answer -You should tell Madeline that she will
be able to enroll in Medicare Part A without paying monthly premiums due to her
husband's long work record and participation in the Medicare system. You should
also tell Madeline that she will pay Part B premiums at more than the standard
lowest rate but less than the highest rate due her substantial income.
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. Quinn 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? - Correct
©COPYRIGHT 2025 ALL RIGHTS RESERVED 2
,Answer -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% coinsurance for these services, in addition to an annual deductible.
Mrs. Geisler's neighbor told her she should look at her Part D options during the
annual Medicare enrollment period because 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.
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.
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.
©COPYRIGHT 2025 ALL RIGHTS RESERVED 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? - 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.
Anita Magri will turn age 65 in August 2022. 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 Part F plan 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 Answer -You are sorry to
disappoint Anita but a Medigap Part 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.
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? - Correct Answer -To obtain
Part B coverage, she must pay a standard monthly premium, though it is higher for
individuals with higher incomes.
©COPYRIGHT 2025 ALL RIGHTS RESERVED 4
Answers
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 Answer
-Original Medicare covers ambulance 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. 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.
©COPYRIGHT 2025 ALL RIGHTS RESERVED 1
,Madeline Martinez was widowed several years ago. Her husband worked for many
years and contributed into the Medicare system. He also left a substantial estate
which provides Madeline with an annual income of approximately $130,000.
Madeline, who has only worked part-time for the last three years, will soon turn
age 65 and hopes to enroll in Original Medicare. She comes to you for advice.
What should you tell her? - Correct Answer -You should tell Madeline that she will
be able to enroll in Medicare Part A without paying monthly premiums due to her
husband's long work record and participation in the Medicare system. You should
also tell Madeline that she will pay Part B premiums at more than the standard
lowest rate but less than the highest rate due her substantial income.
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. Quinn 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? - Correct
©COPYRIGHT 2025 ALL RIGHTS RESERVED 2
,Answer -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% coinsurance for these services, in addition to an annual deductible.
Mrs. Geisler's neighbor told her she should look at her Part D options during the
annual Medicare enrollment period because 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.
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.
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.
©COPYRIGHT 2025 ALL RIGHTS RESERVED 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? - 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.
Anita Magri will turn age 65 in August 2022. 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 Part F plan 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 Answer -You are sorry to
disappoint Anita but a Medigap Part 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.
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? - Correct Answer -To obtain
Part B coverage, she must pay a standard monthly premium, though it is higher for
individuals with higher incomes.
©COPYRIGHT 2025 ALL RIGHTS RESERVED 4
