2025 AHIP Final Exam
1. Mrs. Shields is covered by Original Medicare. She
sustained a hip fracture and is being success-
fully 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...
2025 AHIP Final Exam 1. Mrs. Shields is covered by Original Medicare. She sustained a hip fracture and is being success - fully 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? 2. 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? 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? 4. 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? 5. Mrs. Gonzalez is enrolled in Original Medicare and has a Medigap policy as well, but it provides Medicare will cover Mrs. Shield's skilled nursing services pro - vided 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. Medicare does not cov- er massage therapy, or, in general, glasses or dentures. She should contact her state Medicaid agency to see if she qualifies for one of several pro - grams that can help with Medicare costs for which she is responsi - ble. He generally would pay a monthly premi - um, annual deductible, and per -prescription cost-sharing. Mrs. Gonzalez cannot purchase a Medigap no drug coverage. She would like to keep the cov- plan that covers drugs, erage she has but replace her existing Medigap plan with one that provides drug coverage. What should you tell her? but she could keep her Medigap policy and en- 2025 AHIP Final Exam 6. Mr. Davis is 52 years old and has recently been diagnosed with end-stage renal disease (ESRD) and will soon begin dialysis. He is wondering if he can obtain coverage under Medicare. What should you tell him? 7. Mrs. Duarte is enrolled in Original Medicare Parts roll in a Part D prescrip - tion drug plan. He may sign -up for Medicare at any time however coverage usu- ally begins on the fourth month after dial- ysis treatments start. Mrs. Duarte should file A and B. She has recently reviewed her Medicare an appeal of this ini - Summary Notice (MSN) and disagrees with a determination that partially denied one of her claims for services. What advice would you give her? 8. 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 remem - ber what Part D is so she called you to ask what her neighbor was talking about. What could you tell her? 9. Mr. Rainey is experiencing paranoid delusions and his physician feels that he should be hos - pitalized. What should you tell Mr. Rainey (or his representative) about the length of an inpatient psychiatric hospital stay that Medicare will cov - er? 10. 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? tial determination with - in 120 days of the date she received the MSN in the mail. Part D covers pre - scription drugs and she should look at her premiums, formu - lary, and cost-sharing among other factors to see if they have changed. Medicare will cover a total of 190 days of in - patient psychiatric care during Mr. Rainey's en- tire lifetime. Beneficiaries under Original Medicare have no cost -sharing for most preventive ser - vices. 11. 11. 2025 AHIP Final Exam Mr. Singh would like drug coverage but does not Mr. Singh can enroll want to be enrolled in a Medicare Advantage plan. in a stand -alone pre- What should you tell him? 12. 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? 13. Mrs. Quinn recently turned 66 and decided after many years of work to retire and begin receiving Social Security benefits. Shortly thereafter Mrs. scription drug plan and continue to be covered for Part A and Part B services through Original Fee-for-Ser- vice Medicare. Most individuals who are citizens and age 65 or over are cov - ered under Part A by virtue of having paid Medicare taxes while working, though some may be covered as a result of paying month - ly premiums. Part B primarily cov - ers physician services. She will be paying a Quinn received a letter informing her that she had monthly premium and, been automatically enrolled in Medicare Part B. She wants to understand what this means. What should you tell Mrs. Quinn? 14. Mr. Patel is in good health and is preparing a budget in anticipation of his retirement when he turns 66. He wants to understand the health care costs he might be exposed to under Medicare if he were to require hospitalization because of an illness. In general terms, what could you tell him except for many pre - ventive and screen - ing tests, generally will have 20% co -pay- ments for these ser - vices, in addition to an annual deductible. Under Original Medicare, there is a single deductible amount due for the first 60 days of any inpa - tient hospital stay, af - ter which it converts
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