AHIP 2026 FINAL & MODULES 1–5 EXAM –
150 QUESTIONS & ANSWERS Complete
Test Bank with Verified Solutions
EXAM OVERVIEW
| Detail | Information |
|:|:|
| Exam | AHIP Certification (Modules 1–5 & Final) |
| Latest Update | |
| Key Topics | Medicare Basics, Medicare Advantage (Part C), Prescription Drug Coverage (Part
D), Marketing Guidelines, Nondiscrimination, Fraud, Waste & Abuse (FWA) |
| Sources | Verified 2025 AHIP exam materials |
SECTION 1: MEDICARE BASICS – ELIGIBILITY & COVERAGE (Questions 1–25)
QUESTION 1
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. Which of the following is true regarding her Medicare
eligibility?
A) She is eligible for premium-free Part A
B) She must pay a premium for Part A
C) She is not eligible for Medicare
D) She is only eligible for Part B
Correct Answer: A
Rationale: Individuals who are age 65 or older and have been a U.S. citizen or permanent
resident for at least five years, and who have worked and paid Medicare taxes for at least 10
years (40 quarters), are eligible for premium-free Part A.
QUESTION 2
What is the primary difference between Medicare Part A and Part B?
,A) Part A covers prescription drugs; Part B covers hospital care
B) Part A covers hospital care; Part B covers medical services
C) Part A is voluntary; Part B is mandatory
D) Part A has no deductible; Part B has a deductible
Correct Answer: B
Rationale: Medicare Part A covers hospital inpatient care, skilled nursing facility care, hospice,
and some home health care. Medicare Part B covers outpatient medical services, including
physician visits, preventive services, and durable medical equipment.
QUESTION 3
A client asks about enrolling in Medicare Part B. What is the Initial Enrollment Period (IEP) for
Medicare?
A) 3 months before turning 65, the month of turning 65, and 3 months after
B) 6 months before and 6 months after turning 65
C) Only during the month of turning 65
D) 1 year before and 1 year after turning 65
Correct Answer: A
Rationale: The Initial Enrollment Period (IEP) for Medicare is a 7-month window: 3 months
before the month you turn 65, the month you turn 65, and 3 months after.
QUESTION 4
Which of the following statements about Medicare Part D prescription drug coverage is TRUE?
A) All Medicare beneficiaries are automatically enrolled in Part D
B) Part D plans are offered by private insurance companies approved by Medicare
C) Part D coverage is free for all beneficiaries
D) Part D only covers brand-name medications
Correct Answer: B
Rationale: Medicare Part D prescription drug coverage is offered by private insurance
companies that contract with Medicare. Beneficiaries must enroll in a Part D plan to receive
coverage.
QUESTION 5
,Mr. Roberts is 67 years old and has been covered under an employer-sponsored health plan.
He is retiring and wants to know if he can delay Medicare Part B without penalty. What should
you tell him?
A) He can delay Part B without penalty if he has creditable coverage through his employer
B) He must enroll in Part B immediately or face a lifetime penalty
C) He can delay Part B only if he enrolls in Part A
D) He cannot delay Part B under any circumstances
Correct Answer: A
Rationale: Individuals with creditable employer coverage can delay Medicare Part B enrollment
without penalty. They have a Special Enrollment Period (SEP) of 8 months after employment or
coverage ends to enroll in Part B without penalty.
QUESTION 6
Mrs. Johnson is 66 and currently has Medicare Part A only. She wants to add Part B. When can
she enroll?
A) Only during the Annual Enrollment Period (AEP)
B) During the General Enrollment Period (January 1 – March 31)
C) Any time during the year
D) Only during her Initial Enrollment Period
Correct Answer: B
Rationale: The General Enrollment Period for Medicare Part B is January 1 to March 31 each
year. Coverage begins July 1. Late enrollment penalties may apply if she delayed enrollment
without creditable coverage.
QUESTION 7
Which of the following is NOT covered by Medicare Part A?
A) Inpatient hospital care
B) Skilled nursing facility care
C) Routine eye exams
D) Hospice care
Correct Answer: C
Rationale: Medicare Part A does NOT cover routine eye exams, eyeglasses, or contact lenses.
These may be covered by Medicare Part B in some cases (e.g., after cataract surgery).
, QUESTION 8
What is the Medicare Part B premium based on?
A) Age and gender
B) Income and Social Security benefits
C) Years worked
D) Geographic location
Correct Answer: B
Rationale: Medicare Part B premiums are based on income (modified adjusted gross income)
and are deducted from Social Security benefits for most beneficiaries. Higher-income
beneficiaries pay higher premiums (IRMAA).
QUESTION 9
Mr. Thompson is 64 and will turn 65 in 6 months. He is currently covered by his employer's
health plan. What should he do regarding Medicare?
A) Enroll in Medicare Part A and B immediately
B) Wait until his Initial Enrollment Period and evaluate his options
C) Delay Medicare enrollment indefinitely
D) Only enroll in Part D
Correct Answer: B
Rationale: Individuals approaching age 65 should evaluate their options during their Initial
Enrollment Period. If they have creditable employer coverage, they may delay Part B without
penalty.
QUESTION 10
Which of the following is TRUE about Medigap (Medicare Supplement Insurance) plans?
A) Medigap plans are offered by Medicare
B) Medigap plans cover prescription drugs
C) Medigap plans help pay Medicare out-of-pocket costs
D) Medigap plans replace Original Medicare
Correct Answer: C
150 QUESTIONS & ANSWERS Complete
Test Bank with Verified Solutions
EXAM OVERVIEW
| Detail | Information |
|:|:|
| Exam | AHIP Certification (Modules 1–5 & Final) |
| Latest Update | |
| Key Topics | Medicare Basics, Medicare Advantage (Part C), Prescription Drug Coverage (Part
D), Marketing Guidelines, Nondiscrimination, Fraud, Waste & Abuse (FWA) |
| Sources | Verified 2025 AHIP exam materials |
SECTION 1: MEDICARE BASICS – ELIGIBILITY & COVERAGE (Questions 1–25)
QUESTION 1
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. Which of the following is true regarding her Medicare
eligibility?
A) She is eligible for premium-free Part A
B) She must pay a premium for Part A
C) She is not eligible for Medicare
D) She is only eligible for Part B
Correct Answer: A
Rationale: Individuals who are age 65 or older and have been a U.S. citizen or permanent
resident for at least five years, and who have worked and paid Medicare taxes for at least 10
years (40 quarters), are eligible for premium-free Part A.
QUESTION 2
What is the primary difference between Medicare Part A and Part B?
,A) Part A covers prescription drugs; Part B covers hospital care
B) Part A covers hospital care; Part B covers medical services
C) Part A is voluntary; Part B is mandatory
D) Part A has no deductible; Part B has a deductible
Correct Answer: B
Rationale: Medicare Part A covers hospital inpatient care, skilled nursing facility care, hospice,
and some home health care. Medicare Part B covers outpatient medical services, including
physician visits, preventive services, and durable medical equipment.
QUESTION 3
A client asks about enrolling in Medicare Part B. What is the Initial Enrollment Period (IEP) for
Medicare?
A) 3 months before turning 65, the month of turning 65, and 3 months after
B) 6 months before and 6 months after turning 65
C) Only during the month of turning 65
D) 1 year before and 1 year after turning 65
Correct Answer: A
Rationale: The Initial Enrollment Period (IEP) for Medicare is a 7-month window: 3 months
before the month you turn 65, the month you turn 65, and 3 months after.
QUESTION 4
Which of the following statements about Medicare Part D prescription drug coverage is TRUE?
A) All Medicare beneficiaries are automatically enrolled in Part D
B) Part D plans are offered by private insurance companies approved by Medicare
C) Part D coverage is free for all beneficiaries
D) Part D only covers brand-name medications
Correct Answer: B
Rationale: Medicare Part D prescription drug coverage is offered by private insurance
companies that contract with Medicare. Beneficiaries must enroll in a Part D plan to receive
coverage.
QUESTION 5
,Mr. Roberts is 67 years old and has been covered under an employer-sponsored health plan.
He is retiring and wants to know if he can delay Medicare Part B without penalty. What should
you tell him?
A) He can delay Part B without penalty if he has creditable coverage through his employer
B) He must enroll in Part B immediately or face a lifetime penalty
C) He can delay Part B only if he enrolls in Part A
D) He cannot delay Part B under any circumstances
Correct Answer: A
Rationale: Individuals with creditable employer coverage can delay Medicare Part B enrollment
without penalty. They have a Special Enrollment Period (SEP) of 8 months after employment or
coverage ends to enroll in Part B without penalty.
QUESTION 6
Mrs. Johnson is 66 and currently has Medicare Part A only. She wants to add Part B. When can
she enroll?
A) Only during the Annual Enrollment Period (AEP)
B) During the General Enrollment Period (January 1 – March 31)
C) Any time during the year
D) Only during her Initial Enrollment Period
Correct Answer: B
Rationale: The General Enrollment Period for Medicare Part B is January 1 to March 31 each
year. Coverage begins July 1. Late enrollment penalties may apply if she delayed enrollment
without creditable coverage.
QUESTION 7
Which of the following is NOT covered by Medicare Part A?
A) Inpatient hospital care
B) Skilled nursing facility care
C) Routine eye exams
D) Hospice care
Correct Answer: C
Rationale: Medicare Part A does NOT cover routine eye exams, eyeglasses, or contact lenses.
These may be covered by Medicare Part B in some cases (e.g., after cataract surgery).
, QUESTION 8
What is the Medicare Part B premium based on?
A) Age and gender
B) Income and Social Security benefits
C) Years worked
D) Geographic location
Correct Answer: B
Rationale: Medicare Part B premiums are based on income (modified adjusted gross income)
and are deducted from Social Security benefits for most beneficiaries. Higher-income
beneficiaries pay higher premiums (IRMAA).
QUESTION 9
Mr. Thompson is 64 and will turn 65 in 6 months. He is currently covered by his employer's
health plan. What should he do regarding Medicare?
A) Enroll in Medicare Part A and B immediately
B) Wait until his Initial Enrollment Period and evaluate his options
C) Delay Medicare enrollment indefinitely
D) Only enroll in Part D
Correct Answer: B
Rationale: Individuals approaching age 65 should evaluate their options during their Initial
Enrollment Period. If they have creditable employer coverage, they may delay Part B without
penalty.
QUESTION 10
Which of the following is TRUE about Medigap (Medicare Supplement Insurance) plans?
A) Medigap plans are offered by Medicare
B) Medigap plans cover prescription drugs
C) Medigap plans help pay Medicare out-of-pocket costs
D) Medigap plans replace Original Medicare
Correct Answer: C
