2025 AHIP Final Exam with Verified Answers
1. 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 r...
2025 AHIP Final Exam with Verified Answers
1. 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?: 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.
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?: Medicare does not cover massage therapy, or, in general, glasses or dentures.
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?: 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.
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?: He generally would pay a monthly premium,
annual deductible, and per-prescription cost-sharing.
5. 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?: 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.
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?: He may sign-up
for Medicare at any time however coverage usually begins on the fourth month after
dialysis treatments start.
7. Mrs. Duarte is enrolled in Original Medicare Parts A and B. She has recently
reviewed her Medicare Summary Notice (MSN) and disagrees with a determi-
nation that partially denied one of her claims for services. What advice would
you give her?: Mrs. Duarte should file an appeal of this initial determination within
120 days of the date she received the MSN in the mail.
, 2025 AHIP Final Exam with Verified Answers
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 remember what Part D is so she called you
to ask what her neighbor was talking about. What could you tell her?: Part
D covers prescription drugs and she should look at her premiums, formulary, and
cost-sharing among other factors to see if they have changed.
9. Mr. Rainey is experiencing paranoid delusions and his physician feels that
he should be hospitalized. What should you tell Mr. Rainey (or his representa-
tive) about the length of an inpatient psychiatric hospital stay that Medicare
will cover?: Medicare will cover a total of 190 days of inpatient psychiatric care
during Mr. Rainey's entire lifetime.
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?-
: Beneficiaries under Original Medicare have no cost-sharing for most preventive
services.
11. Mr. Singh would like drug coverage but does not want to be enrolled in a
Medicare Advantage plan. What should you tell him?: Mr. Singh can enroll in a
stand-alone prescription drug plan and continue to be covered for Part A and Part
B services through Original Fee-for-Service Medicare.
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?: 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.
13. 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?: 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.
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 about his
costs for inpatient hospital services under Original Medicare?: Under Original
, 2025 AHIP Final Exam with Verified Answers
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.
15. What impact, if any, have recent regulatory changes had on Medigap
plans?: The Part B deductible is no longer covered for individuals newly eligible for
Medicare starting January 1, 2020.
16. Mrs. Paterson is concerned about the deductibles and co-payments as-
sociated with Original Medicare. What can you tell her about Medigap as an
option to address this concern?: Medigap plans do not cover Original Medicare
benefits, but they coordinate with Original Medicare coverage.
17. 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?: Original Medicare covers ambulance services.
18. Ms. Brooks has aggressive cancer and would like to know if Medicare
will cover hospice services in case she needs them. What should you tell
her?: Medicare covers hospice services, and they will be available for her.
19. 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?: Mr. Diaz will not pay any penalty because he had continuous coverage
under his employer's plan.
20. 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?: 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.
21. Hank's Fish Store, Inc. is a small company with just 15 employees located
in Florida. Hank, the store owner, has provided excellent health benefits to
the store's workforce. William, one of the store's long-time employees, will
soon be reaching age 65 and eligible for Medicare. William is in good health.
He intends to remain an active full-time employee, working several years
after becoming eligible for Medicare. What type(s) of retiree health benefit will
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