1|Page
AHIP FINAL EXAM AND PRACTICE EXAM NEWEST
2026/ 2027 TEST BANK| AHIP FINAL EXAM REVIEW -
MEDICARE CERTIFICATION WITH 300 REAL EXAM
QUESTIONS AND CORRECT VERIFIED ANSWERS/
ALREADY GRADED A+ (MOST RECENT!!)
Mr. Lopez enrolled in a Medicare Advantage plan during the Annual
Election Period. When does his coverage generally become effective?
A. December 1
B. January 1
C. The day he enrolls
D. February 1 - Correct Answer - B
Coverage elected during the Annual Election Period generally begins
January 1.
Mrs. Chang has Medicare Parts A and B and wants help paying
prescription drug costs but does not want managed care. Which option is
most appropriate?
A. Medicare Advantage PPO
B. Stand-alone Part D Plan
C. Medigap only
D. Medicaid only - Correct Answer - B
A stand-alone Part D plan adds prescription drug coverage to Original
Medicare.
pg. 1
,2|Page
An agent learns that another producer intentionally altered an enrollment
application to increase commissions. This behavior is best classified as:
A. Abuse
B. Waste
C. Fraud
D. Marketing - Correct Answer - C
Intentional deception for financial gain constitutes fraud.
Mrs. Evans qualifies for both Medicare and full Medicaid benefits. She
is considered:
A. LIS only
B. Medigap Eligible
C. Employer Eligible
D. Dual Eligible - Correct Answer - D
Individuals enrolled in both Medicare and Medicaid are dual eligible.
Which enrollment period allows a beneficiary already enrolled in a
Medicare Advantage plan to switch to another Medicare Advantage plan
or return to Original Medicare?
A. Initial Enrollment Period
B. Medicare Advantage Open Enrollment Period
C. Annual Wellness Period
D. Guaranteed Issue Period - Correct Answer - B
The Medicare Advantage Open Enrollment Period allows eligible
beneficiaries to make one qualifying change.
pg. 2
,3|Page
A beneficiary permanently relocates outside the service area of her
current Medicare Advantage HMO. She contacts the plan after moving
and wants to enroll in another Medicare Advantage plan. Which
enrollment opportunity applies?
A. Initial Enrollment Period (IEP)
B. Annual Election Period (AEP)
C. Special Enrollment Period (SEP)
D. General Enrollment Period (GEP) - Correct Answer - C
Moving outside a plan's service area qualifies for a Special Enrollment
Period.
Mr. Johnson delayed enrolling in Medicare Part D because he did not
think he needed prescription coverage. He has now gone 18 months
without creditable prescription drug coverage after becoming eligible.
What is the likely consequence?
A. No consequence
B. Permanent Part D late enrollment penalty
C. Loss of Part A
D. Six-month waiting period - Correct Answer - B
Going without creditable drug coverage for 63 or more continuous days
may result in a permanent Part D late enrollment penalty.
Mr. Owens is enrolled in a Medicare Advantage HMO while traveling in
another state. He develops severe chest pain and goes to the nearest
emergency department. Which statement is correct?
A. The plan must cover emergency care.
B. Coverage applies only in the plan's service area.
pg. 3
, 4|Page
C. The claim is denied because the hospital is out of network.
D. He must first contact his primary care provider. - Correct Answer - A
Medicare Advantage plans must cover emergency services regardless of
network location.
A beneficiary receives a written denial for a Part D medication because
it is not on the plan's formulary. Before paying entirely out of pocket,
what should the beneficiary first request?
A. A grievance
B. A formulary exception
C. A Medigap policy
D. Immediate disenrollment - Correct Answer - B
Beneficiaries may request a formulary exception before pursuing further
appeals.
Mrs. Bennett is reviewing two Medicare Advantage plans. One has an
overall 5-Star Rating. What does this rating primarily represent?
A. The plan's quality and performance.
B. The size of its provider network.
C. Its monthly premium.
D. CMS funding level. - Correct Answer: A
Star Ratings measure quality and performance.
An insurance company discovers that it accidentally paid the same
provider claim twice because of a computer processing error. This is best
classified as:
pg. 4
AHIP FINAL EXAM AND PRACTICE EXAM NEWEST
2026/ 2027 TEST BANK| AHIP FINAL EXAM REVIEW -
MEDICARE CERTIFICATION WITH 300 REAL EXAM
QUESTIONS AND CORRECT VERIFIED ANSWERS/
ALREADY GRADED A+ (MOST RECENT!!)
Mr. Lopez enrolled in a Medicare Advantage plan during the Annual
Election Period. When does his coverage generally become effective?
A. December 1
B. January 1
C. The day he enrolls
D. February 1 - Correct Answer - B
Coverage elected during the Annual Election Period generally begins
January 1.
Mrs. Chang has Medicare Parts A and B and wants help paying
prescription drug costs but does not want managed care. Which option is
most appropriate?
A. Medicare Advantage PPO
B. Stand-alone Part D Plan
C. Medigap only
D. Medicaid only - Correct Answer - B
A stand-alone Part D plan adds prescription drug coverage to Original
Medicare.
pg. 1
,2|Page
An agent learns that another producer intentionally altered an enrollment
application to increase commissions. This behavior is best classified as:
A. Abuse
B. Waste
C. Fraud
D. Marketing - Correct Answer - C
Intentional deception for financial gain constitutes fraud.
Mrs. Evans qualifies for both Medicare and full Medicaid benefits. She
is considered:
A. LIS only
B. Medigap Eligible
C. Employer Eligible
D. Dual Eligible - Correct Answer - D
Individuals enrolled in both Medicare and Medicaid are dual eligible.
Which enrollment period allows a beneficiary already enrolled in a
Medicare Advantage plan to switch to another Medicare Advantage plan
or return to Original Medicare?
A. Initial Enrollment Period
B. Medicare Advantage Open Enrollment Period
C. Annual Wellness Period
D. Guaranteed Issue Period - Correct Answer - B
The Medicare Advantage Open Enrollment Period allows eligible
beneficiaries to make one qualifying change.
pg. 2
,3|Page
A beneficiary permanently relocates outside the service area of her
current Medicare Advantage HMO. She contacts the plan after moving
and wants to enroll in another Medicare Advantage plan. Which
enrollment opportunity applies?
A. Initial Enrollment Period (IEP)
B. Annual Election Period (AEP)
C. Special Enrollment Period (SEP)
D. General Enrollment Period (GEP) - Correct Answer - C
Moving outside a plan's service area qualifies for a Special Enrollment
Period.
Mr. Johnson delayed enrolling in Medicare Part D because he did not
think he needed prescription coverage. He has now gone 18 months
without creditable prescription drug coverage after becoming eligible.
What is the likely consequence?
A. No consequence
B. Permanent Part D late enrollment penalty
C. Loss of Part A
D. Six-month waiting period - Correct Answer - B
Going without creditable drug coverage for 63 or more continuous days
may result in a permanent Part D late enrollment penalty.
Mr. Owens is enrolled in a Medicare Advantage HMO while traveling in
another state. He develops severe chest pain and goes to the nearest
emergency department. Which statement is correct?
A. The plan must cover emergency care.
B. Coverage applies only in the plan's service area.
pg. 3
, 4|Page
C. The claim is denied because the hospital is out of network.
D. He must first contact his primary care provider. - Correct Answer - A
Medicare Advantage plans must cover emergency services regardless of
network location.
A beneficiary receives a written denial for a Part D medication because
it is not on the plan's formulary. Before paying entirely out of pocket,
what should the beneficiary first request?
A. A grievance
B. A formulary exception
C. A Medigap policy
D. Immediate disenrollment - Correct Answer - B
Beneficiaries may request a formulary exception before pursuing further
appeals.
Mrs. Bennett is reviewing two Medicare Advantage plans. One has an
overall 5-Star Rating. What does this rating primarily represent?
A. The plan's quality and performance.
B. The size of its provider network.
C. Its monthly premium.
D. CMS funding level. - Correct Answer: A
Star Ratings measure quality and performance.
An insurance company discovers that it accidentally paid the same
provider claim twice because of a computer processing error. This is best
classified as:
pg. 4
