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AHIP Final Exam Latest (2025/2026) Test Questions and Correct Answers Complete, Exams of Nursing

Tiffin UniversityNursing

A comprehensive set of questions and answers for the ahip final exam, covering various aspects of medicare and its related programs. It offers insights into common scenarios and challenges faced by individuals seeking medicare coverage, providing valuable information for students studying healthcare administration or those seeking to understand medicare's complexities.

Typology: Exams

2024/2025

Available from 02/26/2025

Nursebrahim01
Nursebrahim01 🇺🇸

485 documents

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AHIP Final Exam Latest (2025/2026) Test
Questions and Correct Answers Complete
GRADED A+
1. Mrs.gWestgwearsgglassesgandgdenturesgandghasgenjoyedgconsiderablegpain
reliefgfromgarthritisgthroughgacupuncture.gShegisgconcernedgaboutgwhethergorg
notgMedicaregwillgcovergthesegitemsgandgservices.gWhatgshouldgyougtellgher?:gM
edicaregdoesgnotgcovergacupuncture,gor,ginggeneral,gglassesgorgdentures.
2. Mr.gBickfordgdidgnotgquitegqualifygforgthegextraghelpglow-
incomegsubsidygundergthegMedicaregPartgDgPrescriptiongDruggprogramgandgheg
isgwonderinggifgtheregisganygothergoptiongheghasgforgobtainingghelpgwithghisgcon
siderablegdruggcosts.gWhatgshouldgyougtellghim?:gHegcouldgcheckgwithgthegmanufa
cturersgofghisgmedicationsgtogseegifgtheygoffergangassistancegprogramgtoghelpgpeoplegwi
th
limitedgmeansgobtaingthegmedicationsgtheygneed.gAlternatively,ghegcouldgcheckgtogseegwh
etherghisgstateghasgagpharmacygassistancegprogramgtoghelpghimgwithghisgexpenses.
3. Mr.gLombardigisginterestedgingagMedicaregAdvantageg(MA)gPPOgplangthatgyo
ugrepresent.gItgisgonegofgthreegplansgoperatedgbygthegsamegorganizationgingMr.g
Lombardi'sgarea.gThegMAgPPOgplangdoesgnotgincludegdruggcoverage,gbutgtheg
othergtwogplansgdo.gMr.gLombardiglikesgthegPPOgplangthatgdoesgnotgincludegdr
uggcoveragegandgintendsgtogobtainghisgdruggcoveragegthroughga
stand-
alonegMedicaregprescriptiongdruggplan.gWhatgshouldgyougtellghimgaboutgthisgsitu
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Download AHIP Final Exam Latest (2025/2026) Test Questions and Correct Answers Complete and more Exams Nursing in PDF only on Docsity!

AHIP Final Exam Latest (2025/2026) Test

Questions and Correct Answers Complete

GRADED A+

  1. Mrs.gWestgwearsgglassesgandgdenturesgandghasgenjoyedgconsiderablegpain reliefgfromgarthritisgthroughgacupuncture.gShegisgconcernedgaboutgwhetherg org notgMedicaregwillgcovergthesegitemsgandgservices.gWhatgshouldgyougtellg her?:gM edicaregdoesgnotgcovergacupuncture,gor,ginggeneral,gglassesgorgdentures.
  2. Mr.gBickfordgdidgnotgquitegqualifygforgthegextraghelpglow- incomegsubsidyg undergthegMedicaregPartgDgPrescriptiongDruggprogramgandgheg isgwonderingg ifgtheregisganygothergoptiongheghasgforgobtainingghelpgwithghisgcon siderableg druggcosts.gWhatgshouldgyougtellghim?:gHegcouldgcheckgwithgthegmanufa cturersg ofghisgmedicationsgtogseegifgtheygoffergangassistancegprogramgtoghelpgpeoplegwi th limitedgmeansgobtaingthegmedicationsgtheygneed.gAlternatively,ghegcouldgcheckgtogseegwh etherghisgstateghasgagpharmacygassistancegprogramgtoghelpghimgwithghisgexpenses.
  3. Mr.gLombardigisginterestedgingagMedicaregAdvantageg(MA)gPPOgplangthatg yo ugrepresent.gItgisgonegofgthreegplansgoperatedgbygthegsamegorganizationg ingMr.g Lombardi'sgarea.gThegMAgPPOgplangdoesgnotgincludegdruggcoverage,g butgtheg othergtwogplansgdo.gMr.gLombardiglikesgthegPPOgplangthatgdoesgnotg includegdr uggcoveragegandgintendsgtogobtainghisgdruggcoveragegthroughga stand- alonegMedicaregprescriptiongdruggplan.gWhatgshouldgyougtellghimgaboutg thisgsitu

ation?:gHegcouldgenrollgingonegofgthegMAgplansgthatgincludegprescriptiong druggcoverageg orgagMedigapgplangandgagstand- alonegprescriptiongdruggplan,gbutgheg cannotgenrollgingthegMA- onlygPPOgplangandgagstand-alonegprescriptiongdruggplan.

  1. Mr.gTorresghasgagsmallgsavingsgaccount.gHegwouldglikegtogpaygforghisgmonthlygPar tgDgpremiumsgwithgangautomaticgmonthlygwithdrawalgfromghisgsavingsg accountgu ntilgitgisgexhausted,gandgthenghaveghisgpremiumsgwithheldgfromghisg SocialgSecuri tygcheck.gWhatgshouldgyougtellghim?:gInggeneral,ghegmustgselectgag singlegPartgDgpremi umgpaymentgmechanismgthatgwillgbegusedgthroughoutgthegyear.
  2. AgentgJenningsgmakesgagpresentationgongMedicaregadvertisedgasgangeduca- g tionalgevent.gAgentgJenningsgdistributesgmaterialsgthatgaregsolelygeducationalg i ngnature.gHowever,gsheggivesgagbriefgpresentationgthatgmentionsgplan- specificg premiums.gIsgthisgagprohibitedgactivitygatgangeventgthatghasgbeengadverti sedg asgeducational?:gYes.gWhengangeventghasgbeengadvertisedgasg"educational,"gdis- gcussinggplan-specificgpremiumsgisgimpermissible.
  3. Mrs.gMulcahygisgconcernedgthatgshegmaygnotgqualifygforgenrollmentgingag Medic aregprescriptiongdruggplangbecause,galthoughgshegisgentitledgtogPartgA,g shegisgnotg enrolledgundergMedicaregPartgB.gWhatgshouldgyougtellgher?:gEveryoneg whogisgentitle dgtogPartgAgorgenrolledgundergPartgBgisgeligiblegtogenrollgingagMedicareg prescriptiongdruggp lan.gAsglonggasgMrs.gMulcahygisgentitledgtogPartgA,gshegdoesgnotg needgtogenrollgundergPart gBgbeforegenrollinggingagprescriptiongdruggplan.
  4. Mr.gJacobgunderstandsgthatgtheregisgagstandardgMedicaregPartgDgprescriptiong dr uggbenefit,gbutgwhengheglooksgatginformationgongvariousgplansgavailablegin
  1. YougaregseekinggtogrepresentgangindividualgMedicaregAdvantagegplangandgangin dividualgPartgDgplangingyourgstate.gYoughavegcompletedgthegrequiredgtraininggforge achgplan,gbutgyougdidgnotgachievegagpassinggscoregongthegtestsgthatgcameg aftergth egtraining.gWhatgcangyougdogingthisgsituation?:gYougwillgnotgbegablegtogrepresentganyg MedicaregAdvantagegorgPartgDgplanguntilgyougcompletegthegtrainingg andgachievegangade quategscore,galthoughgyougwillgnotghavegtogtakegagtestgifgyoug exclusivelygmarketgemploye r/unionggroupgplansgandgthegcompaniesgdognotgrequireg testing.
  2. Mr.gChengisgenrolledginghisgemployer'sggroupghealthgplangandgwillgbegretiringg so on.gHegwouldglikegtogknowghisgoptionsgsincegheghasgdecidedgtogdropghisg retireegco veragegandgisgeligiblegforgMedicare.gWhatgshouldgyougtellghim?:gMr.g Chengcangdise nrollgfromghisgemployer- sponsoredgcoveragegtogelectgagMedicareg AdvantagegorgPartgDgplangwithing 2 gmonthsgofgh isgdisenrollment,gbutghegshouldg revaluategifghegreallygwantsgtogdropghisgemployergcovera ge.
  1. Mr.gDavisgisg 52 gyearsgoldgandghasgrecentlygbeengdiagnosedgwithgend-stage renalgdiseaseg(ESRD)gandgwillgsoongbegingdialysis.gHegisgwonderinggifghegcang obt aingcoveragegundergMedicare.gWhatgshouldgyougtellghim?:gHegmaygsign- upg forgMedicaregatganygtimeghowevergcoveragegusuallygbeginsgongthegfourthgmonthgafterg dialysisgtreatmentsgstart.
  2. Mr.gJohannsengisgentitledgtogMedicaregPartgAgandgPartgB.gHeggainsgthegPartgDg low

incomegsubsidy.gHowgdoesgthatgaffectghisgabilitygtogenrollgorgdisenrollgingagPartgDg plan?:gHegqualifiesgforgagspecialgelectiongperiodgandgcangenrollgingorgdisenrollg fromgagPart gDgplangoncegduringgthatgperiod.

  1. Mr.gLopez,gwhogisgfairlygwell- offgfinancially,gwouldglikegtogenrollgingagMedicaregprescriptiongdruggplangyougrepre sentgandgsimplyggivegyougagcheckgtogcoverg hisgpremiumsgforgthegentiregyear.gWhat gshouldgyougtellghim?:gEnrolleesgshouldg paygusinggautomaticgwithdrawalgfromgagbankg accountgorgcreditgorgdebitgcard,gdirectg monthlygbillinggfromgthegplan,gorgdeductionsgfromgt heirgSocialgSecuritygcheck.
  2. Youghavegapproachedgaghospitalgadministratorgaboutgmarketingginghergfacilit y.gThegadministratorgisguncomfortablegwithgthegsuggestion.gHowgcouldgyougaddre ssghergconcerns?:gTellghergthatgMedicaregguidelinesgallowgyougtogconductgmarketinggacti vitiesgingcommongareasgofgagprovider'sgfacility.
  3. YoughavegcomegtogMrs.gMidler'sghomegforgagsalesgpresentation.gAtgthegbeginni nggofgthegpresentation,gMrs.gMidlergtellsgyougthatgsheghasgagcopygofgherg medicalgre cordgavailablegbecausegshegthinksgthisgwillghelpgyougunderstandgherg needs.gShegs uggestsgthatgyougwillgknowgwhichgquestionsgtogaskghergaboutgherg healthgstatusging ordergtogbestgassistghergingselectinggagplan.gWhatgshouldgyoug do?:gYougcangonlygas

Whatgwouldgyougsaygtoghergingregardgtogagspecialgenrollmentgperiodg(SEP)?:gShe isglikelygtogqualifygforgagSEP.gShegcangchoosegangeffectivegdategofgupgtogthreegmonthsgafterg thegmonthgingwhichgthegenrollmentgformgisgreceivedgbygthegnewgplan,gbutgtheg effectivegda tegmaygnotgbegearliergthangthegdategofghergpermanentgmove.

  1. Whichgofgthegfollowinggindividualsgisgmostglikelygtogbegeligiblegtogenrollgingag par tgdgplan?:gJose,gaggrandfathergwhogwasggrantedgasylumgandghasgworkedgingtheg Unitedg Statesgforgmanygyears.
  2. WhengMyragfirstgbecamegeligiblegforgMedicare,gshegenrolledgingOriginalg Medi careg(PartsgAgandgB).gShegisgnowg 67 gandgwillgturng 68 gongJulyg1.gSheg wouldgnowglik egtogenrollgingagMedicaregAdvantageg(MA)gplangandgapproachesg yougaboutghergo ptions.gWhatgadvicegwouldgyouggivegher?:gShegshouldgremaing ingOriginalgMedicareg untilgthegannualgelectiongperiodgrunninggfromgOctoberg 15 gtog Decemberg7,gduringgwhich gshegcangselectgangMAgplan.
  3. Mr.gChenghasgheardgaboutgMedicalgSavingsgAccountg(MSA),gbutgwantsgtog kn owgifgitgisgjustgaboutgsavinggmoney,gorgifghegwillggetginsurancegcoverageg forghisgh ealthgcaregexpendituresgasgwell.gWhatgshouldgyougtellghim?:gUnderg thegMedicareg Advantagegprogram.gangMSAgplanginvolvesgthegcombinationgofghigh deductibleghealthgplangandgsavingsgaccountgforghealthgexpenses.gMedicaregwillgmakeg co ntributionsgtogthisgsavingsgaccountgtoghelpghimgpayghisghealthgcaregexpensesgwhileg ingtheg deductible.
  4. Mrs.gChengwillgbeg 65 gsoon,ghasgbeengagcitizengforgtwelvegyears,ghasgbeeng empl oyedgfullgtime,gandgpaidgtaxesgduringgthatgentiregperiod.gShegisgconcernedg thatgsh egwillgnotgqualifygforgcoveragegundergpartgAgbecausegshegwasgnotgborng ingthegUnit edgStates.gWhatgshouldgyougtellgher?:gMostgindividualsgwhogaregcitizensg andgovergageg 65 garegcoveredgundergPartgAgbygvirtuegofghavinggpaidgMedicaregtaxesg whilegworking,gtho

ughgsomegmaygbegcoveredgasgagresultgofgpayinggmonthlygpremiums.

  1. Ms.gEdwardsgisgenrolledgingagMedicaregAdvantagegplangthatgincludesgpre- g scriptiongdruggplang(PDP)gcoverage.gShegisgtravelinggandgwishesgtogfillgtwogofg he rgprescriptionsgthatgsheghasglost.gHowgwouldgyougadvisegher?:gShegmaygfillg prescri ptionsgforgcoveredgdrugsgatgnon- networkgpharmacies,gbutglikelygatgaghigherg costgthangpaidgatgangin-networkgpharmacy.
  2. Mr.gRockwell,gageg67,gisgenrolledgingMedicaregPartgA,gbutgbecausegheg continue sgtogworkgandgisgcoveredgbygangemployerghealthgplan,gheghasgnotg enrolledgingPartg BgorgPartgD.gHegreceivesgagnoticegongJuneg 1 gthatghisgemployergisg cuttinggbackgongpre scriptiongdruggbenefitsgandgthatgasgofgJulyg 1 ghisgcoverageg willgnoglongergbegcredit able.gHeghasgcomegtogyougforgadvice.gWhatgadvicegwouldg youggivegMr.gRockwellgab outgspecialgenrollmentgperiodsg(SEPs)?:gMr.gRockwellg isgeligiblegforgagSEPgduegtoghis ginvoluntaryglossgofgcreditablegdruggcoverage;gthe

10 ougcangoffergtogreviewgthegplansgappealgprocessgtoghelpghimgaskgthegplangtogreviewgthegco veragegdecision.

  1. Mr.gZachowghasgagconditiongforgwhichgthreegdrugsgaregavailable.gHeghasg triedg two,gbutghadgangallergicgreactiongtogthem.gOnlygthegthirdgdruggworksgforg himgandgit gisgnotgonghisgPartgDgplan'sgformulary.gWhatgcouldgyougtellghimgtogdo?:gMr.gZachowgh asgagrightgtogrequestgagformularygexceptiongtogobtaingcoveragegforg hisgPartgDgdrug.gHegorg hisgphysiciangcouldgobtaingthegstandardizedgrequestgformgong thegplan'sgwebsite,gfillgitgou t,gandgsubmitgitgtoghisgplan.
  2. Mr.gPatelgisginggoodghealthgandgisgpreparinggagbudgetginganticipationgofghisg reti rementgwhenghegturnsg66.gHegwantsgtogunderstandgtheghealthgcaregcostsgheg mightg begexposedgtogundergMedicaregifghegweregtogrequireghospitalizationgasgag resultgofga ngillness.gInggeneralgterms,gwhatgcouldgyougtellghimgaboutghisgcostsgforg inpatientgho spitalgservicesgundergOriginalgMedicare?:gUndergOriginalgMedicare,g theregisgagsingl egdeductiblegamountgduegforgthegfirstg 60 gdaysgofganyginpatientg hospitalgstay,gaftergwhichgitg convertsgintogagper-daygamountgthroughgdayg90.gAftergday

11 90,ghegwouldgpaygagdaily amountgupgtog 60 gdaysgoverghisglifetime,gaftergwhichghegwouldgbegresponsiblegforgallg costs

  1. Mrs.gDuartegisgenrolledgingOriginalgMedicaregPartsgAgandgB.gSheghasgrecentlyg re viewedghergMedicaregSummarygNoticeg(MSN)gandgdisagreesgwithgagdetermi- g nationgthatgpartiallygdeniedgonegofghergclaimsgforgservices.gWhatgadvicegwouldg y ouggivegher?:gMrs.gDuartegshouldgfilegandgappealgofgthisginitialgdeterminationgwithing 120 g daysgofgthegdategshegreceivedgthegMSNgingthegmail
  2. Yourgfriend'sgmothergjustgmovedgtogangassistedglivinggfacilitygandghegaskedgifgy ougcouldgpresentgagprogramgforgthegresidentsgaboutgthegMA- PDgplansgyoug market.gWhatgcouldgyougtellghim?:gYougappreciategthegopportunitygan dgwouldgbeghappygtogschedulegangappointmentgwithganyonegatgtheirgrequest.
  3. Mrs.gAndrewsgaskedghowgagPrivategFee-for- Serviceg(PFFS)gplangmightgaffectg hergaccessgtogservicesgsincegshegreceivesgsomeg assistancegforgherghealthgcareg costsgfromgthegState.gWhatgshouldgyougtellgher?:gMe dicaidgmaygprovidegadditionalg benefits,gbutgMedicaidgwillgcoordinategbenefitsgonlygwithg Medicaidgparticipatingg providers.
  4. Mrs.gSchmidtgisgmovinggandgagfriendgtoldghergshegmightgqualifygforgag "Specialg ElectiongPeriod"gtogenrollgingagnewgMedicaregAdvantagegplan.gShegcon- g tactedgyougtogaskgwhatgagSpecialgElectiongPeriodgis.gWhatgcouldgyougtellgher?:gItg isga gtimegperiod,goutsidegofgthegAnnualgElectiongPeriod,gwhengagMedicaregbeneficiaryg cangse lectgagnewgorgdifferentgMedicaregAdvantagegand/orgPartgDgprescriptiongdrugg plan.gTypic allygthegSpecialgElectiongPeriodgisgbeneficiarygspecificgandgresultsgfromgevents,gsuchgasg whengthegbeneficiarygmovesgoutsidegofgthegservicegarea.
  5. Mrs.gQuinnghasgjustgturnedg65,gisgingexcellentghealth,gandghasgagrelativelyg high gincome.gShegusesgnogmedicationsgandgseesgnogreasongtogspendgmoneyg ongagMe

13 enrollgingagMedicaregAdvantagegplan,gwhatgwillgheghavegtogdo?:gHegwillghavegto enrollgingPartgB.

  1. Mr.gMoy'sgwifeghasgagMedicaregAdvantagegplan,gbutghegwantsgtogunder- g standgwhatgcoveragegMedicaregSupplementalgInsurancegprovidesgsinceghisg he althgcaregneedsgaregdifferentgfromghisgwife'sgneeds.gWhatgcouldgyougtellgMr.g Moy? :gMedicaregSupplementalgInsurancegwouldghelpgcoverghisgPartgAgandgPartgBg costgshari nggingOriginalgFee-for- Serviceg(FFS)gMedicaregasgwellgasgpossiblygsomeg servicesgthatgMedicaregdoesgnotgco ver.
  2. Mrs.gMcIntiregisgenrolledginghergstate'sgMedicaidgplangandghasgjustgbecomeg eli giblegforgMedicaregasgwell.gWhatgcangshegexpectgwillghappengwithgrespectgtog hergd ruggcoverage?:gUnlessgshegchoosesgagMedicaregPartgDgprescriptiongdruggplang onghergo wn,gshegwillgbegautomaticallygenrolledgingonegavailableginghergarea.
  3. Mrs.gYounggisgcurrentlygenrolledgingOriginalgMedicareg(PartsgAgandgB),gbutgshe ghasgbeengworkinggwithgAgentgNeilgAdamsgingthegselectiongofgagMedicareg Advant ageg(MA)gplan.gItgisgmid-September,gandgMrs.gYounggisggoinggongvaca- gtion.gAgentgAdamsgisgconsideringgsuggestinggthatghegandgMrs.Younggcompletegth egapplicationgtogethergbeforegshegleaves.gHegwillgthengsubmitgthegpaperg applicati ongpriorgthegstartgofgthegannualgenrollmentgperiodg(AEP).gWhatgwouldg yougsaygIfgy ougweregadvisinggAgentgAdams?:gThisgisgagbadgidea.gAgentsgareg generallygprohibited gfromgsolicitinggorgacceptinggangenrollmentgformgpriorgtogthegstartg ofgthegAEP.
  4. Anothergagentgworkinggforgyourgagencygclaimsgthatgbecausegyougaregnotg em ployedgbygthegMedicaregAdvantagegplansgthatgyougrepresent,gyougaregnotg subjec tgtogthegsamegrequirementsgasgthegplansgthemselves.gHowgshouldgyoug respondgt ogsuchgagstatement?:gYourgcoworkergisgnotgcorrect.gMarketinggongbehalfgofgagplangisgco

14 nsideredgmarketinggbygthegplangandgrequiresgthatgallgcontractedgandg employedgagentsg complygwithgallgMedicaregmarketinggrules.

  1. AgentgMartinezgwishesgtogsolicitgMedicaregAdvantagegprospectsgthroughg e- mailgandgasksgyougforgadvicegasgtogwhethergthisgisgpossible.gWhatgshouldgyoug tellgh er?:gMarketinggrepresentativesgmayginitiategelectronicgcontactgthroughge- mailg butgthegsubjectglinegmustgsayg"marketing"gandgangopt- outgprocessgmustgbegprovided.
  2. Duringgagsalesgpresentation,gyourgclientgasksgyougwhethergthegMedicareg age ncygrecommendsgthatgshegsigngupgforgyourgplangorgstaygingOriginalg Medicare.gWh atgshouldgyougtellgher?:gTellghergthatgthegMedicaregagencygdoesgnotgendorsegorgrecom mendganygplan.
  3. Ms.gLewisgunderstandsgthatgMedicaregprescriptiongdruggplansgmayguseg va riousgmethodsgtogcontrolgthegusegofgspecificgdrugs.gSheghasgheardgaboutg agtec hniquegcalledg"stepgtherapy"gandgisgwonderinggifgyougcangexplaingwhat thatgis.gWhatgshouldgyougtellgher?:gStepgtherapyginvolvesgusinggonegorgmoreglower