AHIP Final Exam Latest (2025/2026) | 200 Verified Questions and Correct Answers | A+ Graded

AHIP Final Exam Latest (2025/2026) | 200
Verified Questions and Correct Answers |
A+ Graded



1. Which part of Medicare covers inpatient hospital services?
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Answer: Part A ts ts




Rationale: Medicare Part A pays for inpatient stays, skilled nursing facility care, hospice, and some h
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ome health.
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2. A beneficiary turning 65 and already receiving Social Security benefits is aut
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omatically enrolled in: ts ts




Answer: Part A and Part B
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Rationale: Automatic enrollment occurs when receiving SSA benefits prior to 65.
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3. The penalty for delaying Medicare Part B enrollment without creditable co
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verage is: ts




Answer: 10% for every 12 months delayed
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Rationale: CMS applies a 10% surcharge for each full uncovered year.
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4. Medicare Advantage plans must cover: ts ts ts ts




Answer: All services covered by Original Medicare
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Rationale: MA plans are required to provide equal or greater coverage than Parts A and B.
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,5. What is the main requirement to join a Medicare Advantage plan?
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Answer: Must have both Part A and Part B
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Rationale: Enrollment in both parts is mandatory for MA.
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6. The six protected drug classes under Part D ensure:
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Answer: Broad access to critical medications
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Rationale: Plans must cover all or nearly all drugs in these categories.
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7. An agent must obtain a Scope of Appointment (SOA):
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Answer: Before discussing specific plan benefits
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Rationale: CMS requires SOA to document beneficiary permission.
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8. LIS (Low-Income Subsidy) helps beneficiaries with:
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Answer: Part D premium, deductible, and cost-sharing
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Rationale: LIS reduces or eliminates drug plan costs for low-income enrollees.
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9. What is considered marketing?
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Answer: Materials intended to steer beneficiaries toward enrollment
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Rationale: CMS defines marketing by intent and content.
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10. Medicare Part B covers: ts ts ts




Answer: Outpatient services and preventive care
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Rationale: Part B includes doctor visits, screenings, DME, and outpatient services.
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11. A Special Enrollment Period (SEP) for Part B exists when:
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,Answer: A beneficiary has creditable employer coverage and delays enrollment
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Rationale: SEP avoids penalties when credible employer insurance exists.
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12. Medicare Advantage plans receive payment from CMS through:
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Answer: Monthly capitated payments
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Rationale: Plans get a fixed per-member amount regardless of service use.
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13. Upcoding by a provider is an example of:
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Answer: Fraud
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Rationale: Intentionally coding higher levels of service is deceptive and illegal.
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14. Waste refers to: ts ts




Answer: Over-utilization of services
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Rationale: Waste does not require intent to break rules.
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15. Which program helps pay Medicare costs for individuals with limited inc
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ome?

Answer: Medicare Savings Programs (MSPs)
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Rationale: MSPs cover Part A/B premiums and sometimes cost-sharing.
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16. A marketing event allows an agent to:
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Answer: Present plan-specific information
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Rationale: Unlike educational events, marketing events permit discussing benefits.
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17. A PPO Medicare Advantage plan allows members to:
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Answer: See out-of-network providers at higher cost
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Rationale: PPOs offer flexibility, but at increased OOP costs.
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, 18. Which plan type restricts members to their network for all no
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n-emergency care? ts




Answer: HMO ts




Rationale: HMOs generally require in-network providers.
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19. Which of the following is required for enrollment in a Special Needs Pla
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n (SNP)?
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Answer: Must meet the SNP’s eligibility criteria
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Rationale: SNPs require chronic conditions, institutional status, or dual eligibility.
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20. The Medicare Part D coverage gap (“donut hole”) occurs after:
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Answer: The initial coverage limit is reached
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Rationale: After the limit, members pay a percentage of drug costs until catastrophic coverage.
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21. A permissible activity at an educational event is:
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Answer: Giving out general Medicare information
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Rationale: No plan-specific info or enrollment forms allowed.
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22. Which statement is true about MA plans and emergency care?
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Answer: Emergency care must be covered everywhere in the U.S.
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Rationale: CMS requires universal emergency coverage.
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23. A drug formulary is:
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Answer: The list of drugs a Part D plan covers
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Rationale: Formularies categorize drugs by tiers and coverage rules.
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