AHIP Medicare Certification Final Exam Prep — 2026/2027 Edition
AHIP Medicare Certification Exam 2026
Medicare Parts A-D, Advantage, CMS Compliance Study Guide
Page 1 of 35 | Independent Study Guide
, AHIP Medicare Certification Final Exam Prep — 2026/2027 Edition
Question 1
Which of the following best describes who is generally eligible for Medicare based on age?
A. U.S. citizens or legal residents who have lived in the country for at least five continuous years and are
age 62 or older
B. U.S. citizens or qualified legal residents who are age 65 or older and eligible for Social Security or
Railroad Retirement benefits
C. Any U.S. resident age 60 or older regardless of work history
D. Individuals age 55 or older who have paid into Medicare for at least 5 years
Correct Answer: B
Detailed Rationale: Age-based Medicare eligibility generally requires that an individual be age 65 or older
and be a U.S. citizen or lawfully present resident who has met the residency requirement, and be eligible for
Social Security or Railroad Retirement Board benefits. Eligibility can also arise through disability or
certain diagnoses such as End-Stage Renal Disease, but age-based eligibility is defined by this
65-and-older standard.
Question 2
Original Medicare consists of which two parts?
A. Part C and Part D
B. Part A and Part D
C. Part A and Part B
D. Part B and Part C
Correct Answer: C
Detailed Rationale: Original Medicare is composed of Part A (Hospital Insurance) and Part B (Medical
Insurance). Part C refers to Medicare Advantage, an alternative way to receive Original Medicare benefits
through private plans, and Part D refers to prescription drug coverage, which is a separate, optional
benefit.
Question 3
Which statement most accurately reflects a beneficiary's rights under Medicare?
A. Beneficiaries may only appeal a coverage decision if they enrolled through a licensed agent
B. Beneficiaries have the right to receive information in a manner they can understand and to appeal
decisions about their care or coverage
C. Beneficiaries waive their appeal rights once they select a Medicare Advantage plan
D. Beneficiaries must obtain a court order before requesting an appeal of a coverage denial
Correct Answer: B
Detailed Rationale: CMS beneficiary protections guarantee the right to receive accessible, understandable
information about coverage and the right to appeal denied claims or services. These protections apply
across Original Medicare, Medicare Advantage, and Part D, and do not require legal action to initiate the
process.
Question 4
Page 2 of 35 | Independent Study Guide
, AHIP Medicare Certification Final Exam Prep — 2026/2027 Edition
Which of the following is NOT typically a covered service under Original Medicare?
A. Inpatient hospital care
B. Physician office visits
C. Routine long-term custodial care in a nursing home
D. Preventive screenings such as mammograms
Correct Answer: C
Detailed Rationale: Original Medicare does not cover long-term custodial care, which involves assistance
with daily living activities rather than skilled medical treatment. Medicare does cover medically necessary
inpatient hospital stays, physician visits, and many preventive services, but ongoing custodial care
generally falls to Medicaid, long-term care insurance, or private payment.
Question 5
A beneficiary asks an agent to explain what 'Medicare beneficiary rights' means in the context of
nondiscrimination. Which response is most accurate?
A. Plans may set different premiums for beneficiaries with pre-existing conditions
B. Medicare-certified plans cannot discriminate against beneficiaries on the basis of health status, race,
national origin, disability, sex, or age in providing benefits
C. Plans can deny enrollment to beneficiaries with a history of chronic illness
D. Nondiscrimination protections apply only during the Initial Enrollment Period
Correct Answer: B
Detailed Rationale: Federal law and CMS regulations prohibit Medicare plans from discriminating against
beneficiaries based on health status, race, national origin, disability, sex, or age. This protection is
continuous and not limited to a specific enrollment window, and it prevents plans from using health status to
deny enrollment or vary benefits improperly.
Question 6
Which term describes the amount a beneficiary must pay for Part A inpatient hospital services before
Medicare begins to pay for a benefit period?
A. Coinsurance
B. Deductible
C. Premium
D. Copayment
Correct Answer: B
Detailed Rationale: The Part A deductible is the set amount a beneficiary must pay out of pocket for
inpatient hospital services at the start of each benefit period before Medicare coverage contributes. This
differs from coinsurance, which is a percentage of costs paid after the deductible, and from copayments,
which are typically flat fees.
Question 7
A Medicare benefit period for Part A hospital coverage begins and ends according to which rule?
Page 3 of 35 | Independent Study Guide
, AHIP Medicare Certification Final Exam Prep — 2026/2027 Edition
A. It begins on January 1 and ends December 31 each year
B. It begins the day a beneficiary is admitted as an inpatient and ends after 60 consecutive days without
inpatient or skilled care
C. It begins when the beneficiary turns 65 and never ends
D. It begins the day Part B coverage starts
Correct Answer: B
Detailed Rationale: A Part A benefit period starts on the day of hospital or skilled nursing facility
admission and ends after the beneficiary has gone 60 consecutive days without receiving inpatient hospital
or skilled nursing care. A beneficiary can have multiple benefit periods in a year, each with its own
deductible.
Question 8
Which of the following statements about Medicare Part B premiums is accurate?
A. All beneficiaries pay the same flat premium regardless of income
B. Higher-income beneficiaries may pay an Income-Related Monthly Adjustment Amount (IRMAA) in
addition to the standard premium
C. Part B premiums are waived for anyone enrolled in a Medicare Advantage plan
D. Part B has no monthly premium; only Part A carries a premium
Correct Answer: B
Detailed Rationale: Beneficiaries with higher modified adjusted gross income may be required to pay an
Income-Related Monthly Adjustment Amount on top of the standard Part B premium. This IRMAA
surcharge is determined by CMS and the Social Security Administration based on income reported on tax
returns from two years prior.
Question 9
Which of the following best defines Durable Medical Equipment (DME) coverage under Part B?
A. Coverage for cosmetic devices not related to a medical condition
B. Coverage for equipment such as wheelchairs, walkers, and oxygen equipment that is medically
necessary and prescribed by a physician for home use
C. Coverage only available to beneficiaries residing in skilled nursing facilities
D. Coverage limited exclusively to hospital-owned equipment
Correct Answer: B
Detailed Rationale: Part B covers durable medical equipment that a physician prescribes as medically
necessary for use in the beneficiary's home, such as wheelchairs, hospital beds, walkers, and oxygen
equipment. The equipment must be reusable, primarily serve a medical purpose, and be appropriate for
home use.
Question 10
Which preventive service is generally covered by Medicare Part B at no cost to the beneficiary when
criteria are met?
A. Cosmetic dermatology visits
Page 4 of 35 | Independent Study Guide
AHIP Medicare Certification Exam 2026
Medicare Parts A-D, Advantage, CMS Compliance Study Guide
Page 1 of 35 | Independent Study Guide
, AHIP Medicare Certification Final Exam Prep — 2026/2027 Edition
Question 1
Which of the following best describes who is generally eligible for Medicare based on age?
A. U.S. citizens or legal residents who have lived in the country for at least five continuous years and are
age 62 or older
B. U.S. citizens or qualified legal residents who are age 65 or older and eligible for Social Security or
Railroad Retirement benefits
C. Any U.S. resident age 60 or older regardless of work history
D. Individuals age 55 or older who have paid into Medicare for at least 5 years
Correct Answer: B
Detailed Rationale: Age-based Medicare eligibility generally requires that an individual be age 65 or older
and be a U.S. citizen or lawfully present resident who has met the residency requirement, and be eligible for
Social Security or Railroad Retirement Board benefits. Eligibility can also arise through disability or
certain diagnoses such as End-Stage Renal Disease, but age-based eligibility is defined by this
65-and-older standard.
Question 2
Original Medicare consists of which two parts?
A. Part C and Part D
B. Part A and Part D
C. Part A and Part B
D. Part B and Part C
Correct Answer: C
Detailed Rationale: Original Medicare is composed of Part A (Hospital Insurance) and Part B (Medical
Insurance). Part C refers to Medicare Advantage, an alternative way to receive Original Medicare benefits
through private plans, and Part D refers to prescription drug coverage, which is a separate, optional
benefit.
Question 3
Which statement most accurately reflects a beneficiary's rights under Medicare?
A. Beneficiaries may only appeal a coverage decision if they enrolled through a licensed agent
B. Beneficiaries have the right to receive information in a manner they can understand and to appeal
decisions about their care or coverage
C. Beneficiaries waive their appeal rights once they select a Medicare Advantage plan
D. Beneficiaries must obtain a court order before requesting an appeal of a coverage denial
Correct Answer: B
Detailed Rationale: CMS beneficiary protections guarantee the right to receive accessible, understandable
information about coverage and the right to appeal denied claims or services. These protections apply
across Original Medicare, Medicare Advantage, and Part D, and do not require legal action to initiate the
process.
Question 4
Page 2 of 35 | Independent Study Guide
, AHIP Medicare Certification Final Exam Prep — 2026/2027 Edition
Which of the following is NOT typically a covered service under Original Medicare?
A. Inpatient hospital care
B. Physician office visits
C. Routine long-term custodial care in a nursing home
D. Preventive screenings such as mammograms
Correct Answer: C
Detailed Rationale: Original Medicare does not cover long-term custodial care, which involves assistance
with daily living activities rather than skilled medical treatment. Medicare does cover medically necessary
inpatient hospital stays, physician visits, and many preventive services, but ongoing custodial care
generally falls to Medicaid, long-term care insurance, or private payment.
Question 5
A beneficiary asks an agent to explain what 'Medicare beneficiary rights' means in the context of
nondiscrimination. Which response is most accurate?
A. Plans may set different premiums for beneficiaries with pre-existing conditions
B. Medicare-certified plans cannot discriminate against beneficiaries on the basis of health status, race,
national origin, disability, sex, or age in providing benefits
C. Plans can deny enrollment to beneficiaries with a history of chronic illness
D. Nondiscrimination protections apply only during the Initial Enrollment Period
Correct Answer: B
Detailed Rationale: Federal law and CMS regulations prohibit Medicare plans from discriminating against
beneficiaries based on health status, race, national origin, disability, sex, or age. This protection is
continuous and not limited to a specific enrollment window, and it prevents plans from using health status to
deny enrollment or vary benefits improperly.
Question 6
Which term describes the amount a beneficiary must pay for Part A inpatient hospital services before
Medicare begins to pay for a benefit period?
A. Coinsurance
B. Deductible
C. Premium
D. Copayment
Correct Answer: B
Detailed Rationale: The Part A deductible is the set amount a beneficiary must pay out of pocket for
inpatient hospital services at the start of each benefit period before Medicare coverage contributes. This
differs from coinsurance, which is a percentage of costs paid after the deductible, and from copayments,
which are typically flat fees.
Question 7
A Medicare benefit period for Part A hospital coverage begins and ends according to which rule?
Page 3 of 35 | Independent Study Guide
, AHIP Medicare Certification Final Exam Prep — 2026/2027 Edition
A. It begins on January 1 and ends December 31 each year
B. It begins the day a beneficiary is admitted as an inpatient and ends after 60 consecutive days without
inpatient or skilled care
C. It begins when the beneficiary turns 65 and never ends
D. It begins the day Part B coverage starts
Correct Answer: B
Detailed Rationale: A Part A benefit period starts on the day of hospital or skilled nursing facility
admission and ends after the beneficiary has gone 60 consecutive days without receiving inpatient hospital
or skilled nursing care. A beneficiary can have multiple benefit periods in a year, each with its own
deductible.
Question 8
Which of the following statements about Medicare Part B premiums is accurate?
A. All beneficiaries pay the same flat premium regardless of income
B. Higher-income beneficiaries may pay an Income-Related Monthly Adjustment Amount (IRMAA) in
addition to the standard premium
C. Part B premiums are waived for anyone enrolled in a Medicare Advantage plan
D. Part B has no monthly premium; only Part A carries a premium
Correct Answer: B
Detailed Rationale: Beneficiaries with higher modified adjusted gross income may be required to pay an
Income-Related Monthly Adjustment Amount on top of the standard Part B premium. This IRMAA
surcharge is determined by CMS and the Social Security Administration based on income reported on tax
returns from two years prior.
Question 9
Which of the following best defines Durable Medical Equipment (DME) coverage under Part B?
A. Coverage for cosmetic devices not related to a medical condition
B. Coverage for equipment such as wheelchairs, walkers, and oxygen equipment that is medically
necessary and prescribed by a physician for home use
C. Coverage only available to beneficiaries residing in skilled nursing facilities
D. Coverage limited exclusively to hospital-owned equipment
Correct Answer: B
Detailed Rationale: Part B covers durable medical equipment that a physician prescribes as medically
necessary for use in the beneficiary's home, such as wheelchairs, hospital beds, walkers, and oxygen
equipment. The equipment must be reusable, primarily serve a medical purpose, and be appropriate for
home use.
Question 10
Which preventive service is generally covered by Medicare Part B at no cost to the beneficiary when
criteria are met?
A. Cosmetic dermatology visits
Page 4 of 35 | Independent Study Guide
