AHIP Practice Questions – 2026 Edition
1. Mr. Thompson is covered under Medicare Part B and needs a preventive screening for
colorectal cancer. Which statement is correct regarding coverage?
A. Medicare Part B does not cover preventive screenings.
B. Medicare Part B covers colorectal cancer screening with no cost-sharing if medically
appropriate.
C. Medicare Part B only covers screenings after symptoms appear.
D. Medicare Part B requires a copay for all preventive screenings.
Answer: B
Explanation: Medicare Part B covers preventive screenings like colorectal cancer screening
without cost-sharing when recommended and medically appropriate.
2. Which of the following is a key principle of HIPAA?
A. Patient records must be stored indefinitely.
B. Patients have the right to access and request corrections to their medical records.
C. Providers can share patient information freely with all family members.
D. HIPAA only applies to insurance companies, not healthcare providers.
Answer: B
Explanation: HIPAA ensures patients have rights to access their medical records and request
amendments; it also protects the privacy and security of health information.
3. A patient enrolled in a Medicare Advantage plan wants to switch back to Original Medicare.
When is the standard window to make this change?
A. Anytime during the year
B. During the Medicare Open Enrollment Period (October 15–December 7)
C. Only during the initial enrollment period
D. Every 6 months
Answer: B
Explanation: Medicare beneficiaries can switch from a Medicare Advantage plan to Original
Medicare during the annual Open Enrollment Period.
4. Which of the following is covered under Medicare Part D?
A. Preventive screenings
B. Prescription drugs
C. Inpatient hospital stays
D. Hospice care
Answer: B
Explanation: Medicare Part D provides prescription drug coverage, while Part A covers inpatient
care, Part B covers outpatient services, and hospice is covered under Part A.
,5. A healthcare provider accidentally sends a patient’s lab results to the wrong patient. Which
HIPAA violation occurred?
A. Breach of confidentiality
B. Failure to obtain consent
C. Unauthorized access
D. Data theft
Answer: A
Explanation: Sending protected health information to the wrong patient is a breach of
confidentiality, which HIPAA prohibits.
6. Which statement about Medigap (Medicare Supplement Insurance) policies is true?
A. Medigap plans are offered by the federal government.
B. Medigap policies cover all prescription drugs.
C. Medigap helps pay for costs not covered by Original Medicare, like copayments and
coinsurance.
D. Medigap plans replace Medicare Advantage plans.
Answer: C
Explanation: Medigap policies supplement Original Medicare by covering gaps like copays,
coinsurance, and deductibles.
7. A patient has a chronic condition requiring frequent hospitalizations. The physician
recommends inpatient psychiatric care. Under the national health scheme, what is the lifetime
coverage limit?
A. 90 days
B. 120 days
C. 190 days
D. 365 days
Answer: C
Explanation: Beneficiaries are generally allowed up to 190 days of inpatient psychiatric care
during their lifetime under national coverage.
8. Which of the following is an example of an effective patient communication strategy?
A. Using medical jargon to explain conditions
B. Speaking slowly and checking for understanding
C. Ignoring patient questions to save time
D. Providing written instructions only
, Answer: B
Explanation: Clear communication involves speaking slowly, checking understanding, and
confirming the patient comprehends their care plan.
9. Under Medicare rules, a preventive wellness visit is covered:
A. Only if the patient has a chronic illness
B. Once every 12 months with no copay
C. Only after a patient reaches age 70
D. Only if requested by a specialist
Answer: B
Explanation: Medicare covers an annual wellness visit once per year at no cost to the patient.
10. Which of the following describes a high-deductible health plan (HDHP)?
A. Low monthly premium with high out-of-pocket costs
B. High monthly premium with no deductible
C. Coverage that only applies to preventive care
D. A plan that covers everything with zero cost-sharing
Answer: A
Explanation: HDHPs have lower monthly premiums but higher deductibles, which may result in
higher out-of-pocket costs before coverage begins.
11. A patient requests their medical record. According to HIPAA, the provider must:
A. Deny the request for 90 days
B. Provide access within 30 days (may extend by 30 days with written notice)
C. Charge any amount they deem appropriate
D. Only allow access to records older than 5 years
Answer: B
Explanation: HIPAA requires providers to respond to access requests within 30 days; a one-time
30-day extension is allowed with notice.
12. Which type of preventive service is fully covered by Medicare Part B without cost-sharing?
A. Annual blood pressure checks
B. Cosmetic surgery
C. Immunizations like influenza and pneumococcal vaccines
D. Elective weight loss surgery
1. Mr. Thompson is covered under Medicare Part B and needs a preventive screening for
colorectal cancer. Which statement is correct regarding coverage?
A. Medicare Part B does not cover preventive screenings.
B. Medicare Part B covers colorectal cancer screening with no cost-sharing if medically
appropriate.
C. Medicare Part B only covers screenings after symptoms appear.
D. Medicare Part B requires a copay for all preventive screenings.
Answer: B
Explanation: Medicare Part B covers preventive screenings like colorectal cancer screening
without cost-sharing when recommended and medically appropriate.
2. Which of the following is a key principle of HIPAA?
A. Patient records must be stored indefinitely.
B. Patients have the right to access and request corrections to their medical records.
C. Providers can share patient information freely with all family members.
D. HIPAA only applies to insurance companies, not healthcare providers.
Answer: B
Explanation: HIPAA ensures patients have rights to access their medical records and request
amendments; it also protects the privacy and security of health information.
3. A patient enrolled in a Medicare Advantage plan wants to switch back to Original Medicare.
When is the standard window to make this change?
A. Anytime during the year
B. During the Medicare Open Enrollment Period (October 15–December 7)
C. Only during the initial enrollment period
D. Every 6 months
Answer: B
Explanation: Medicare beneficiaries can switch from a Medicare Advantage plan to Original
Medicare during the annual Open Enrollment Period.
4. Which of the following is covered under Medicare Part D?
A. Preventive screenings
B. Prescription drugs
C. Inpatient hospital stays
D. Hospice care
Answer: B
Explanation: Medicare Part D provides prescription drug coverage, while Part A covers inpatient
care, Part B covers outpatient services, and hospice is covered under Part A.
,5. A healthcare provider accidentally sends a patient’s lab results to the wrong patient. Which
HIPAA violation occurred?
A. Breach of confidentiality
B. Failure to obtain consent
C. Unauthorized access
D. Data theft
Answer: A
Explanation: Sending protected health information to the wrong patient is a breach of
confidentiality, which HIPAA prohibits.
6. Which statement about Medigap (Medicare Supplement Insurance) policies is true?
A. Medigap plans are offered by the federal government.
B. Medigap policies cover all prescription drugs.
C. Medigap helps pay for costs not covered by Original Medicare, like copayments and
coinsurance.
D. Medigap plans replace Medicare Advantage plans.
Answer: C
Explanation: Medigap policies supplement Original Medicare by covering gaps like copays,
coinsurance, and deductibles.
7. A patient has a chronic condition requiring frequent hospitalizations. The physician
recommends inpatient psychiatric care. Under the national health scheme, what is the lifetime
coverage limit?
A. 90 days
B. 120 days
C. 190 days
D. 365 days
Answer: C
Explanation: Beneficiaries are generally allowed up to 190 days of inpatient psychiatric care
during their lifetime under national coverage.
8. Which of the following is an example of an effective patient communication strategy?
A. Using medical jargon to explain conditions
B. Speaking slowly and checking for understanding
C. Ignoring patient questions to save time
D. Providing written instructions only
, Answer: B
Explanation: Clear communication involves speaking slowly, checking understanding, and
confirming the patient comprehends their care plan.
9. Under Medicare rules, a preventive wellness visit is covered:
A. Only if the patient has a chronic illness
B. Once every 12 months with no copay
C. Only after a patient reaches age 70
D. Only if requested by a specialist
Answer: B
Explanation: Medicare covers an annual wellness visit once per year at no cost to the patient.
10. Which of the following describes a high-deductible health plan (HDHP)?
A. Low monthly premium with high out-of-pocket costs
B. High monthly premium with no deductible
C. Coverage that only applies to preventive care
D. A plan that covers everything with zero cost-sharing
Answer: A
Explanation: HDHPs have lower monthly premiums but higher deductibles, which may result in
higher out-of-pocket costs before coverage begins.
11. A patient requests their medical record. According to HIPAA, the provider must:
A. Deny the request for 90 days
B. Provide access within 30 days (may extend by 30 days with written notice)
C. Charge any amount they deem appropriate
D. Only allow access to records older than 5 years
Answer: B
Explanation: HIPAA requires providers to respond to access requests within 30 days; a one-time
30-day extension is allowed with notice.
12. Which type of preventive service is fully covered by Medicare Part B without cost-sharing?
A. Annual blood pressure checks
B. Cosmetic surgery
C. Immunizations like influenza and pneumococcal vaccines
D. Elective weight loss surgery
