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2025 AHIP Final Exam questions and answers
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2025 AHIP Final Exam questions and answers
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2025 AHIPFinal Exam
questions
and
answers
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.
,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.
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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.
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.
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.
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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.
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?
Mrs. Duarte should file an appeal of this initial determination within
120 days of the date she received the MSN in the mail.
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.
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?
Medicare will cover a total of 190 days of inpatient psychiatric care
during Mr. Rainey's entire lifetime.
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