NURSING 412 AHIP EXAM QUESTIONS AND
ANSWERS ASSURED SUCCESS GRADED A+.
COMPLETE 2024- 2025 UPDATE.
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?
- Correct Answer: Medicare does not cover massage therapy, or, in general, glasses or dentures.
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 as a result of an illness. In general terms, what could you tell him
about his costs for inpatient hospital services under Original Medicare? - Correct Answer: Under
Original Medicare, there is a single deductible amount due for the first 60 days of any inpatient
hospital stay, after which it converts into a per-day coinsurance amount through day 90. After day
90, he would pay a daily amount up to 60 days over his lifetime, after which he would be
responsible for all costs.
Ms. Henderson believes that she will qualify for Medicare Coverage when she turns 65, without
paying any premiums, because she has been working for 40 years and paying Medicare taxes.
What should you tell her? - Correct Answer: To obtain Part B coverage, she must pay a standard
monthly premium, though it is higher for individuals with higher incomes.
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? - Correct Answer: He may sign-up for Medicare at any time however coverage
usually begins on the fourth month after dialysis treatments start.
Juan Perez, who is turning age 65 next month, intends to work for several more years at Smallcap,
Incorporated. Smallcap has a workforce of15 employees and offers employer-sponsored
healthcare coverage. Juan is a naturalized citizen and has contributed to the Medicare system for
over 20 years. Juan asks you if he will be entitled to Medicare and if he enrolls how that will impact
his employer- sponsored healthcare coverage. How would you respond? - Correct Answer: Juan
,is likely to be eligible for Medicare once he turns age 65 and if he enrolls Medicare would become
the primary payor of his healthcare claims and Smallcap does not have to continue to offer him
coverage comparable to those under age 65 under its employer-sponsored group health plan.
Mr. Moy's wife has a Medicare Advantage plan, but he wants to understand what coverage
Medicare Supplemental Insurance provides since his health care needs are different from his wife's
needs. What could you tell Mr. Moy? - Correct Answer: Medicare Supplemental Insurance would
help cover his Part A and Part B deductibles or coinsurance in Original Fee-for-Service (FFS)
Medicare as well as possibly some services that Medicare does not cover.
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 MedicarePart D
prescription drug plan. What should you tell him? - Correct Answer: He generally would pay a
monthly premium, annual deductible, and per-prescription cost-sharing.
Ms. Moore plans to retire when she turns 65 in a few months. She is in excellent health and will
have considerable income when she retires. She is concerned that her income will make it
impossible for her to qualify for Medicare. What could you tell her to address her concern? -
Correct Answer: Medicare is a program for people age 65 or older and those under age 65 with
certain disabilities, end-stage renal disease, and Lou Gehrig's disease so she will be eligible for
Medicare.
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 which include immunizations such as annual flu shots.
Mrs. Pena is 66 years old, has coverage under an employer plan, and will retire next year. She
heard she must enroll in Part B at the beginning of the year to ensure no gap in coverage. What
can you tell her? - Correct Answer: She may enroll at any time while she is covered under her
employer plan, but she will have a special eight- month enrollment period after the last month on
her employer plan that differs from the standard general enrollment period, during which she may
enroll in Medicare Part B.
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.
Mrs. Gonzalez is enrolled in Original Medicare and has a Medigap policy as well, but it provides no
drug coverage. She would like to keep the coverage she has but replace her existing Medigap plan
with one that provides drug coverage. What should you tell her? - Correct Answer: Mrs.
Gonzalez cannot purchase a Medigap plan that covers drugs, but she could keep her Medigap
policy and enroll in a Part D prescription drug plan
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.
Mr. Capadona would like to purchase a Medicare Advantage (MA) plan and a Medigap plan to
pick up costs not covered by that plan.
What should you tell him? - Correct Answer: It is illegal for you to sell Mr. Capadona a
Medigap plan if he is enrolled in an MA plan, and besides, Medigap only works with Original
Medicare.
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.
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?
- Correct Answer: Medicare will cover a total of 190 days of inpatient psychiatric care during Mr.
Rainey's entire lifetime.
Mr. Schmidt would like to plan for retirement and has asked you what is covered under Original
Fee-for-Service (FFS) Medicare? What could you tell him?
- Correct Answer: Part A, which covers hospital, skilled nursing facility, hospice, and home
Health services and Part B, which covers professional services such as those provided by a doctor
are covered under Original Medicare.
Agent John Miller is meeting with Jerry Smith, a new prospect. Jerry is currently enrolled in
Medicare Parts A and B. Jerry has also purchased a Medicare Supplement (Medigap) plan which he
, has had for several years. However, the plan does not provide drug benefits. How would you
advise Agent John Miller to proceed? - Correct Answer: Tell prospect Jerry Smith that he should
consider adding a standalone Part D prescription drug coverage policy to his present coverage.
Mr. Bauer is 49 years old, but eighteen months ago he was declared disabled by the Social Security
Administration and has been receiving disability payments. He is wondering whether he can obtain
coverage under Medicare. What should you tell him? - Correct Answer: After receiving such
disability payments for 24 months, he will be automatically enrolled in Medicare, regardless of age.
Mr. Buck has several family members who died from different cancers. He wants to know if
Medicare covers cancer screening.
What should you tell him? - Correct Answer: Medicare covers the periodic performance of a
range of screening tests that are meant to provide early detection of disease. Mr. Buck will need to
check specific tests before obtaining them to see if they will be covered.
Which of the following statement is/are correct about a Medicare Savings Account (MSA) Plans?
MSAs may have either a partial network, full network, or no network of providers.
MSA plans cover Part A and Part B benefits but not Part D prescription drug benefits.
An individual who is enrolled in an MSA plan is responsible for a minimal deductible of $500
indexed for inflation.
Non-network providers must accept the same amount that Original Medicare would pay them as
payment in full. - Correct Answer: I, II, and IV only
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 and standalone Part D prescription drug coverage, but he cannot
enroll in the MA-only PPO plan and a stand-alone prescription drug plan.
Mrs. Ramos is considering a Medicare Advantage PPO and has questions about which providers
she can go to for her health care. What should you tell her?
- Correct Answer: Mrs. Ramos can obtain care from any provider who participates in Original
Medicare, but generally will have a higher cost-sharing amount if she sees a provider who/that is
not a part of the PPO network.
Mr. Romero is 64, retiring soon, and considering enrollment in his employer- sponsored retiree
group health plan that includes drug coverage with nominal copays. He heard about a neighbor's
