AHIP Final Exam 2025 EXAM NEW VERSION
LATEST UPDATE 2024-2025 WITH
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QUESTIONS
Mr. Diaz continued working with his company and was insured under his
employer's group plan until he reached age 68. He has heard that there is a
premium penalty for those who did not sign up for Part B when first eligible and
wants to know how much he will have to pay. What should you tell him?
- ANSWER Mr. Diaz will not pay any penalty because he had continuous coverage
under his employer's plan.
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. Quinn recently turned 66 and decided after many years of work to retire and
begin receiving Social Security benefits. Shortly thereafter Mrs. Quinn received a
letter informing her that she had been automatically enrolled in Medicare Part B.
She wants to understand what this means. What should you tell Mrs. Quinn?
,- ANSWER Part B primarily covers physician services. She will be paying a monthly
premium and, except for many preventive and screening tests, generally will have
20% co-payments for these services, in addition to an annual deductible.
Mrs. Turner is comparing her employer's retiree insurance to Original Medicare
and would like to know which of the following services Original Medicare will
cover if the appropriate criteria are met. What could you tell her?
- ANSWER Original Medicare covers ambulance services.
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.
What impact, if any, have recent regulatory changes had on Medigap plans?
- ANSWER The Part B deductible is no longer covered for individuals newly eligible
for Medicare starting January 1, 2020.
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. 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?
, - 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.
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?
- ANSWER He may sign-up for Medicare at any time however coverage usually
begins on the fourth month after dialysis treatments start.
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?
- 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.
Mr. Lopez has heard that he can sign up for a product called "Medicare
Advantage" but is not sure about what type of plan designs are available through
this program. What should you tell him about the types of health plans that are
available through the Medicare Advantage program?
- ANSWER There are Medicare health plans such as HMOs, PPOs, PFFS, and MSAs.
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 MA-PD plan that you represent and because
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