AHIP 2025 Final Exam Questions and Answers (2024 /
2025
Mrs. 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? - ANSWER Medigap plans help beneficiaries cover Original Medicare
benefits, but they coordinate with Original Medicare coverage.
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? - 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.
What impact, if any, have recent regulatory changes had on Medigap plans? -
ANSWER b.
The Part B deductible is no longer covered for individuals newly eligible for Medicare
starting January 1, 2020.
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? - ANSWER
Medicare will cover a total of 190 days of inpatient psychiatric care during Mr.
Rainey's entire lifetime.
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
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.
Ms. Gibson recently lost her employer group health and drug coverage and now she
wants to enroll in a PPO that does not include drug coverage. What should you tell
her about obtaining drug coverage? - ANSWER She can enroll in the PPO, but she
will not be able to purchase a stand-alone Medicare Part D prescription drug plan.
Mrs. Radford asks whether there are any special eligibility requirements for Medicare
Advantage. What should you tell her? - ANSWER Mrs. Radford must be entitled to
Part A and enrolled in Part B to enroll in Medicare Advantage.
, 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? - ANSWER You can offer to review the plans appeal process to help him ask
the plan to review the coverage decision.
Mr. 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? - ANSWER He will have to
enroll in Part B.
Dr. Elizabeth Brennan does not contract with the ABC PFFS plan but accepts the
plan's terms and conditions for payment. Mary Rodgers sees Dr. Brennan for
treatment. How much may Dr. Brennan charge? - ANSWER
Mrs. Chou likes a Private Fee-for-Service (PFFS) plan available in her area that
does not include drug coverage. She wants to enroll in the plan and enroll in a stand-
alone prescription drug plan. What should you tell her? - ANSWER She could enroll
in a PFFS plan and a stand-alone Medicare prescription drug plan.
Mr. Kelly wants to know whether he is eligible to sign up for a Private fee-for-service
(PFFS) plan. What questions would you need to ask to determine his eligibility? -
ANSWER You would need to ask Mr. Kelly if he is enrolled in Part A and Part B and
if he lives in the PFFS plan's service area.
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.
Who is most likely to benefit from the Medicare Prescription Payment Plan? -
ANSWER
Mrs. Mulcahy, age 65, is concerned that she may not qualify for enrollment in a
Medicare prescription drug plan because, although she is entitled to Part A, she is
not enrolled under Medicare Part B. What should you tell her? - ANSWER An
individual who is entitled to Part A or enrolled under Part B is eligible to enroll in a
Medicare prescription drug plan. As long as Mrs. Mulcahy is entitled to Part A, she
does not need to enroll under Part B before enrolling in a prescription drug plan.
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
2025
Mrs. 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? - ANSWER Medigap plans help beneficiaries cover Original Medicare
benefits, but they coordinate with Original Medicare coverage.
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? - 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.
What impact, if any, have recent regulatory changes had on Medigap plans? -
ANSWER b.
The Part B deductible is no longer covered for individuals newly eligible for Medicare
starting January 1, 2020.
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? - ANSWER
Medicare will cover a total of 190 days of inpatient psychiatric care during Mr.
Rainey's entire lifetime.
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
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.
Ms. Gibson recently lost her employer group health and drug coverage and now she
wants to enroll in a PPO that does not include drug coverage. What should you tell
her about obtaining drug coverage? - ANSWER She can enroll in the PPO, but she
will not be able to purchase a stand-alone Medicare Part D prescription drug plan.
Mrs. Radford asks whether there are any special eligibility requirements for Medicare
Advantage. What should you tell her? - ANSWER Mrs. Radford must be entitled to
Part A and enrolled in Part B to enroll in Medicare Advantage.
, 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? - ANSWER You can offer to review the plans appeal process to help him ask
the plan to review the coverage decision.
Mr. 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? - ANSWER He will have to
enroll in Part B.
Dr. Elizabeth Brennan does not contract with the ABC PFFS plan but accepts the
plan's terms and conditions for payment. Mary Rodgers sees Dr. Brennan for
treatment. How much may Dr. Brennan charge? - ANSWER
Mrs. Chou likes a Private Fee-for-Service (PFFS) plan available in her area that
does not include drug coverage. She wants to enroll in the plan and enroll in a stand-
alone prescription drug plan. What should you tell her? - ANSWER She could enroll
in a PFFS plan and a stand-alone Medicare prescription drug plan.
Mr. Kelly wants to know whether he is eligible to sign up for a Private fee-for-service
(PFFS) plan. What questions would you need to ask to determine his eligibility? -
ANSWER You would need to ask Mr. Kelly if he is enrolled in Part A and Part B and
if he lives in the PFFS plan's service area.
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.
Who is most likely to benefit from the Medicare Prescription Payment Plan? -
ANSWER
Mrs. Mulcahy, age 65, is concerned that she may not qualify for enrollment in a
Medicare prescription drug plan because, although she is entitled to Part A, she is
not enrolled under Medicare Part B. What should you tell her? - ANSWER An
individual who is entitled to Part A or enrolled under Part B is eligible to enroll in a
Medicare prescription drug plan. As long as Mrs. Mulcahy is entitled to Part A, she
does not need to enroll under Part B before enrolling in a prescription drug plan.
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
