2025 AHIP Final Exam Study Questions
and Answers with Complete Solutions
Graded A
possiblea
AHIP
,
,2025 AHIP Final Exam 2025 AHIP Final Exam
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.
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.
2025 AHIP Final Exam 2025 AHIP Final Exam
, 2025 AHIP Final Exam 2025 AHIP Final Exam
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.
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.
2025 AHIP Final Exam 2025 AHIP Final Exam
and Answers with Complete Solutions
Graded A
possiblea
AHIP
,
,2025 AHIP Final Exam 2025 AHIP Final Exam
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.
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.
2025 AHIP Final Exam 2025 AHIP Final Exam
, 2025 AHIP Final Exam 2025 AHIP Final Exam
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.
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.
2025 AHIP Final Exam 2025 AHIP Final Exam
