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2025 AHIP Final Exam Questions with
Detailed Verified Answers
Question: 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.
Question: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.
Question: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.
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Question: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.
Question: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.
Question: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.
Question: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?
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Answer: Mrs. Duarte should file an appeal of this initial determination within
120 days of the date she received the MSN in the mail.
Question: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?
Answer: 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.
Question: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?
Answer: Medicare will cover a total of 190 days of inpatient psychiatric care
during Mr. Rainey’s entire lifetime.
Question: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?
Answer: Beneficiaries under Original Medicare have no cost-sharing for most
preventive services.
Question:Mr. Singh would like drug coverage but does not want to be
enrolled in a Medicare Advantage plan. What should you tell him?
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Answer: 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.
Question: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.
Question: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.
Question: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?
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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.
Question: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.
Question: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.
Question: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.
Question: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.
