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2025 AHIP Final Exam New Full Questions and Answers ( Included ) 100% Correct
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AHIP Final ExamBy ExamNavigator
, 2025 AHIP Final Exam
1. Mrs. Shields is covered by Original Medicare. She sustained a hip fractureand 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 ofher 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 whetheror 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.
3. Mrs. Park is an elderly retiree. Mrs. Park has a low fixed income. What couldyou 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.
4. Mr. Alonso receives some help paying for his two generic prescription drugsfrom 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 toencounter 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.
5. Mrs. Gonzalez is enrolled in Original Medicare and has a Medigap policy aswell, 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 Medigapplan 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 canobtain 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 afterdialysis 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 determination that partially denied
one of her claims for services. What advice wouldyou give her?
Answer: Mrs. Duarte should file an appeal of this initial determination within120 days of the
, date she received the MSN in the mail.
8. Mrs. Geisler's neighbor told her she should look at her Part D options duringthe 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,
andcost-sharing among other factors to see if they have changed.
9. Mr. Rainey is experiencing paranoid delusions and his physician feels thathe 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.
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?-
Answer: 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?
Answer: Mr. Singh can enroll in astand-alone prescription drug plan and continue to be
covered for Part A and PartB 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 concernedthat she will not qualify for
coverage under part A because she was not born inthe 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.
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 enrolledin 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 payinga monthly premium and,
except for many preventive and screening tests, generallywill 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 hisretirement 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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