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AHIP Final Exam Questions and answers | With complete solution | NEWEST 2024/25
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AHIP Final Exam Questions and answers| With complete solution | NEWEST
2024/25
Mrs. Shields is covered by Original Medicare. She sustained a hip fracture and is being
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successfully treated for that condition. However, she and her physicians feel that after her
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lengthy hospital stay, she will need a month or two of nursing and rehabilitative care. What
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should you tell them about Original Medicare's coverage of care in a skilled nursing
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facility? - Medicare will cover Mrs. Shield's skilled nursing services provided during the
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first 20 days of her stay, after which she would have a copay until she has been in the
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facility for 100 days.
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Mrs. West wears glasses and dentures and has enjoyed considerable pain relief from
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arthritis through massage therapy. She is concerned about whether or not Medicare will
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cover these items and services. What should you tell her? - Medicare does not cover
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massage therapy, or, in general, glasses or dentures.
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Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What could you tell Mrs.
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Park that might be of assistance? - She should contact her state Medicaid agency to see if
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she qualifies for one of several programs that can help with Medicare costs for which she is
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responsible.
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Mr. Alonso receives some help paying for his two generic prescription drugs from his
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employer's retiree coverage, but he wants to compare it to a Part D prescription drug plan.
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He asks you what costs he would generally expect to encounter when enrolling into a
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standard Medicare Part D prescription drug plan. What should you tell him? - He generally
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would pay a monthly premium, annual deductible, and per-prescription cost-sharing.
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Mrs. Gonzalez is enrolled in Original Medicare and has a Medigap policy as well, but it
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provides no drug coverage. She would like to keep the coverage she has but replace her
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existing Medigap plan with one that provides drug coverage. What should you tell her? -
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Mrs. Gonzalez cannot purchase a Medigap plan that covers drugs, but she could keep her
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Medigap policy and enroll in a Part D prescription drug plan.
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Mr. Davis is 52 years old and has recently been diagnosed with end-stage renal disease
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(ESRD) and will soon begin dialysis. He is wondering if he can obtain coverage under
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Medicare. What should you tell him? - He may sign-up for Medicare at any time however
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coverage usually begins on the fourth month after dialysis treatments start.
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Mrs. Duarte is enrolled in Original Medicare Parts A and B. She has recently reviewed her
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Medicare Summary Notice (MSN) and disagrees with a determination that partially denied
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one of her claims for services. What advice would you give her? - Mrs. Duarte should file
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, an appeal of this initial determination within 120 days of the date she received the MSN in
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the mail.
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Mrs. Geisler's neighbor told her she should look at her Part D options during the annual
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Medicare enrollment period because the features of Part D might have changed. Mrs.
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Geisler can't remember what Part D is so she called you to ask what her neighbor was
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talking about. What could you tell her? - Part D covers prescription drugs and she should
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look at her premiums, formulary, and cost-sharing among other factors to see if they have
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changed.
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Mr. Rainey is experiencing paranoid delusions and his physician feels that he should be
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hospitalized. What should you tell Mr. Rainey (or his representative) about the length of an
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inpatient psychiatric hospital stay that Medicare will cover? - Medicare will cover a total of
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190 days of inpatient psychiatric care during Mr. Rainey's entire lifetime.
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Mr. Xi will soon turn age 65 and has come to you for advice as to what services are
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provided under Original Medicare. What should you tell Mr. Xi that best describes the
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health coverage provided to Medicare beneficiaries? - Beneficiaries under Original
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Medicare have no cost-sharing for most preventive services.
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Mr. Singh would like drug coverage but does not want to be enrolled in a Medicare
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Advantage plan. What should you tell him? - Mr. Singh can enroll in a stand-alone
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prescription drug plan and continue to be covered for Part A and Part B services through
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Original Fee-for-Service Medicare.
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Mrs. Chen will be 65 soon, has been a citizen for twelve years, has been employed full
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time, and paid taxes during that entire period. She is concerned that she will not qualify for
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coverage under part A because she was not born in the United States. What should you tell
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her? - Most individuals who are citizens and age 65 or over are covered under Part A by
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virtue of having paid Medicare taxes while working, though some may be covered as a
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result of paying monthly premiums.
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Mrs. Quinn recently turned 66 and decided after many years of work to retire and begin
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receiving Social Security benefits. Shortly thereafter Mrs. Quinn received a letter informing
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her that she had been automatically enrolled in Medicare Part B. She wants to understand
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what this means. What should you tell Mrs. Quinn? - Part B primarily covers physician
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services. She will be paying a monthly premium and, except for many preventive and
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screening tests, generally will have 20% co-payments for these services, in addition to an
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annual deductible.
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Mr. Patel is in good health and is preparing a budget in anticipation of his retirement when
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he turns 66. He wants to understand the health care costs he might be exposed to under
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Medicare if he were to require hospitalization because of an illness. In general terms, what
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could you tell him about his costs for inpatient hospital services under Original Medicare? -
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Under Original Medicare, there is a single deductible amount due for the first 60 days of
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any inpatient hospital stay, after which it converts into a per-day coinsurance amount
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, through day 90. After day 90, he would pay a daily amount up to 60 days over his lifetime,
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after which he would be responsible for all costs.
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What impact, if any, have recent regulatory changes had on Medigap plans? - The Part B
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deductible is no longer covered for individuals newly eligible for Medicare starting January
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1, 2020.
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Mrs. Paterson is concerned about the deductibles and co-payments associated with
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Original Medicare. What can you tell her about Medigap as an option to address this
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concern? - Medigap plans do not cover Original Medicare benefits, but they coordinate
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with Original Medicare coverage.
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Mrs. Turner is comparing her employer's retiree insurance to Original Medicare and would
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like to know which of the following services Original Medicare will cover if the appropriate
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criteria are met. What could you tell her? - Original Medicare covers ambulance services.
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Ms. Brooks has aggressive cancer and would like to know if Medicare will cover hospice
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services in case she needs them. What should you tell her? - Medicare covers hospice
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services, and they will be available for her.
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Mr. Diaz continued working with his company and was insured under his employer's group
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plan until he reached age 68. He has heard that there is a premium penalty for those who
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did not sign up for Part B when first eligible and wants to know how much he will have to
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pay. What should you tell him? - Mr. Diaz will not pay any penalty because he had
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continuous coverage under his employer's plan.
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Anita Magri will turn age 65 in August 2023. Anita intends to enroll in Original Medicare
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Part A and Part B. She would also like to enroll in a Medicare Supplement (Medigap) plan.
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Anita's older neighbor Mel has told her about the Medigap Plan F in which he is enrolled. It
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not only provides foreign travel emergency benefits but also covers his Medicare Part B
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deductible. Anita comes to you for advice. What should you tell her? - You are sorry to
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disappoint Anita, but a Medigap F plan is no longer available to those who turn age 65 after
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January 1, 2020. Anita might instead consider other Medigap plans that offer foreign travel
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benefits but do not cover the Part B deductible.
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Hank's Fish Store, Inc. is a small company with just 15 employees located in Florida. Hank,
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the store owner, has provided excellent health benefits to the store's workforce. William,
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one of the store's long-time employees, will soon be reaching age 65 and eligible for
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Medicare. William is in good health. He intends to remain an active full-time employee,
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working several years after becoming eligible for Medicare. What type(s) of retiree health
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benefit will Hank's Fish Store be able to offer William? - Hank's can continue to offer
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William the same employee health benefit plan, or, if William enrolls in Medicare Part B, it
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can enroll him in a Medicare Advantage plan that is offered to the public.
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