AHIP Final Exam With
Official Questions and
Answers Latest 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
Answer-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 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.
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.
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.
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 Answer-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 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.
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. 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 Answer-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 Answer-He could enroll either in one of the MA plans that
include prescription drug coverage or Original Medicare with a Medigap plan
Official Questions and
Answers Latest 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
Answer-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 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.
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.
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.
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 Answer-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 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.
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. 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 Answer-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 Answer-He could enroll either in one of the MA plans that
include prescription drug coverage or Original Medicare with a Medigap plan
