2025 AHIP Final Exam|| 105 QUESTIONS|| CORRECT SOLUTIONS|| RATED A+
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Course
AHIP
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AHIP
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 abou...
2025 AHIP Final Exam|| 105 QUESTIONS||
CORRECT SOLUTIONS|| RATED A+
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. 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. 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.
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? - ANSWER 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? - 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.
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.
, 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? - ANSWER Mrs. Duarte should file an appeal of this initial
determination within 120 days of the date she received the MSN in the mail.
inpatient hospital services under Original Medicare? - 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.
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. Paterson is concerned about the deductibles and co-payments associated with Original Medicare.
What can you tell her about Medigap as an option to address this concern? - ANSWER Medigap plans do
not cover Original Medicare benefits, but they coordinate with Original Medicare coverage.
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.
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? - ANSWER Medicare covers hospice services, and they will be
available for her.
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.
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? - ANSWER 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.
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 Hank's Fish Store be able to offer William? -
ANSWER Hank's can continue to offer William the same employee health benefit plan, or, if William
enrolls in Medicare Part B, it can enroll him in a Medicare Advantage plan that is offered to the public.
Mr. Sanchez has just turned 65 and is entitled to Part A but has not enrolled in Part B because he has
coverage through an employer plan. If he wants to enroll in a Medicare Advantage plan, what will he
have to do? - ANSWER He will have to enroll in Part B.
Mrs. Velasquez cares for her frail elderly mother, Maria, who lives in North Carolina. She is worried that
without additional support, her mother will need to go into a nursing home. Mrs. Velasquez asks you if
there is any Medicare plan that might allow her mother to remain in the community rather than going
into a nursing home. How should you advise Mrs. Velasquez? - ANSWER There are Programs of All-
Inclusive Care for the Elderly (PACE) for frail elderly beneficiaries certified as needing a nursing home
level of care but are able to live safely in the community at the time of enrolment.
Which of the following statement(s) is/are correct about a Medicare Savings Account (MSA) Plans?
I. MSAs may have either a partial network, full network, or no network of providers.
II. MSA plans cover Part A and Part B benefits but not Part D prescription drug benefits.
III. An individual who is enrolled in an MSA plan is responsible for a minimal deductible of $500 indexed
for inflation.
IV. Non-network providers must accept the same amount that Original Medicare would pay them as
payment in full. - ANSWER I, II, and IV only
Mrs. Chi is age 75 and enjoys a comfortable but not extremely high-income level. She wishes to enroll in
a MA MSA plan that she heard about from her neighbor. She also wants to have prescription drug
coverage since her doctor recently prescribed several expensive medications. Currently, she is enrolled in
Original Medicare and a standalone Part D plan. How would you advise Mrs. Chi? - ANSWER Mrs. Chi
may enroll in a MA MSA plan and remain in her current standalone Part D prescription drug plan.
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