AHIP Final Exam 2025-2026: Complete
Questions and Expert-Verified Answers
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? - 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? - 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? - 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? - Answer-He generally would pay a monthly premium,
annual deductible, and per-prescription cost-sharing.
,Mrs. 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? - Answer-
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.
Mrs. Burton is a retiree with substantial income. She is enrolled in an MA-PD plan
and was disappointed with the service she received from her primary care
physician because she was told she would have to wait five weeks to get an
appointment when she was feeling ill. She called you to ask what she could do so
she would not have to put up with such poor access to care. What could you tell
her? - Answer-She could file a grievance with her plan to complain about the lack
of timeliness in getting an appointment.
Who is most likely to benefit from the Medicare Prescription Payment Plan? -
Answer-Kevin, who suffered a heart attack at the beginning of the year requiring
him to take an expensive brand name blood thinner on a daily, as well as an
equally expensive injectable cholesterol medication on a bi-weekly basis for which
he incurs high out-of-pocket costs.
, Mr. Rice is 68, actively working, and has coverage for medical services and
medications through his employer's group health plan. He is entitled to premium
free Part A and thinking of enrolling in Part B and switching to an MA-PD because
he is paying a very large part of his group coverage premium, and it does not
provide coverage for a number of his medications. Which of the following is NOT
a consideration when making the change? - Answer-Mr. Rice's retiree plan is
required to take him back if, within 63 days of having voluntarily quit the
employer's plan, he decides that he prefers it to his Medicare Part D plan.
Mrs. Roswell is a new Medicare beneficiary who has just retired from retail work.
She is interested in selecting a Medicare Part D prescription drug plan. She takes
several medications and is concerned that she has not been able to identify a plan
that covers all of her medications. She does not want to make an abrupt change
to new drugs that would be covered and asks what she should do. What should
you tell her? - Answer-Every Part D drug plan is required to cover a single one-
month fill of her existing medications sometime during a 90-day transition period.
Mr. Bickford did not quite qualify for the extra help low-income subsidy under the
Medicare Part D Prescription Drug program and he is wondering if there is any
other option he has for obtaining help with his considerable drug costs. What
should you tell him? - Answer-He could check with the manufacturers of his
medications to see if they offer an assistance program to help people with limited
means to obtain the medications they need. Alternatively, he could check to see
whether his state has a pharmacy assistance program to help him with his
expenses.
Mr. Carlini has heard that Medicare prescription drug plans are only offered
through private companies under a program known as Medicare Advantage (MA),
not by the government. He likes Original Medicare and does not want to sign up
for an MA product, but he also wants prescription drug coverage. What should
you tell him? - Answer-Mr. Carlini can stay with Original Medicare and also enroll
in a Medicare prescription drug plan through a private company that has
Questions and Expert-Verified Answers
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? - 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? - 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? - 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? - Answer-He generally would pay a monthly premium,
annual deductible, and per-prescription cost-sharing.
,Mrs. 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? - Answer-
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.
Mrs. Burton is a retiree with substantial income. She is enrolled in an MA-PD plan
and was disappointed with the service she received from her primary care
physician because she was told she would have to wait five weeks to get an
appointment when she was feeling ill. She called you to ask what she could do so
she would not have to put up with such poor access to care. What could you tell
her? - Answer-She could file a grievance with her plan to complain about the lack
of timeliness in getting an appointment.
Who is most likely to benefit from the Medicare Prescription Payment Plan? -
Answer-Kevin, who suffered a heart attack at the beginning of the year requiring
him to take an expensive brand name blood thinner on a daily, as well as an
equally expensive injectable cholesterol medication on a bi-weekly basis for which
he incurs high out-of-pocket costs.
, Mr. Rice is 68, actively working, and has coverage for medical services and
medications through his employer's group health plan. He is entitled to premium
free Part A and thinking of enrolling in Part B and switching to an MA-PD because
he is paying a very large part of his group coverage premium, and it does not
provide coverage for a number of his medications. Which of the following is NOT
a consideration when making the change? - Answer-Mr. Rice's retiree plan is
required to take him back if, within 63 days of having voluntarily quit the
employer's plan, he decides that he prefers it to his Medicare Part D plan.
Mrs. Roswell is a new Medicare beneficiary who has just retired from retail work.
She is interested in selecting a Medicare Part D prescription drug plan. She takes
several medications and is concerned that she has not been able to identify a plan
that covers all of her medications. She does not want to make an abrupt change
to new drugs that would be covered and asks what she should do. What should
you tell her? - Answer-Every Part D drug plan is required to cover a single one-
month fill of her existing medications sometime during a 90-day transition period.
Mr. Bickford did not quite qualify for the extra help low-income subsidy under the
Medicare Part D Prescription Drug program and he is wondering if there is any
other option he has for obtaining help with his considerable drug costs. What
should you tell him? - Answer-He could check with the manufacturers of his
medications to see if they offer an assistance program to help people with limited
means to obtain the medications they need. Alternatively, he could check to see
whether his state has a pharmacy assistance program to help him with his
expenses.
Mr. Carlini has heard that Medicare prescription drug plans are only offered
through private companies under a program known as Medicare Advantage (MA),
not by the government. He likes Original Medicare and does not want to sign up
for an MA product, but he also wants prescription drug coverage. What should
you tell him? - Answer-Mr. Carlini can stay with Original Medicare and also enroll
in a Medicare prescription drug plan through a private company that has
