AHIP FINAL EXAM 2026/2027 ACTUAL
EXAM QUESTIONS AND CORRECT
ANSWERS WITH RATIONALES GRADED
A+ LATEST
AHIP Final Exam 2025/2026
The exam covers Medicare Advantage, Part D, plan
benefits, compliance, fraud prevention, care
coordination, member communications, and ethical
considerations. Each question includes the correct answer
and detailed rationale.
1.
Which of the following individuals is eligible to enroll in a
Medicare Advantage (MA) plan?
A. A 65-year-old with Medicare Part A only
B. A 72-year-old with Medicare Parts A and B who lives within the
plan’s service area
C. A 60-year-old with employer group coverage only
D. A 68-year-old who permanently resides outside the United
States
✅Answer: B. A 72-year-old with Medicare Parts A and B
who lives within the plan’s service area
Rationale:
To enroll in an MA plan, a beneficiary must be entitled to Part
A, enrolled in Part B, and reside in the plan’s service
area.
,2.
What is the primary goal of Medicare Advantage plans?
A. Replace Original Medicare with private coverage that adds
more out-of-pocket costs
B. Provide Medicare-covered benefits through private insurers
that meet CMS standards
C. Eliminate Part D coverage
D. Offer coverage only for hospital services
✅Answer: B. Provide Medicare-covered benefits through
private insurers that meet CMS standards
Rationale:
MA plans deliver Medicare benefits via CMS-approved
private insurers, often with additional benefits like vision or
dental.
3.
Which of the following services are not covered under
Medicare Part A?
A. Skilled nursing facility
care
B. Hospice care
C. Home health services
D. Outpatient physical
therapy
✅Answer: D. Outpatient physical therapy
Rationale:
Outpatient therapy is covered under Part B, not Part A, which
primarily covers inpatient and facility-based care.
4.
During the Annual Election Period (AEP), beneficiaries can:
,A. Only drop their current plan
B. Only enroll in a new plan if they have a special
circumstance
, C. Enroll, switch, or disenroll from Medicare Advantage or
Part D plans D. Only switch from MA to Original Medicare
✅Answer: C. Enroll, switch, or disenroll from Medicare
Advantage or Part
D plans
Rationale:
AEP (October 15 – December 7) allows plan changes,
enrollment, or disenrollment for the upcoming year.
5.
Which of the following best defines a Special Enrollment
Period (SEP)?
A. A set period when everyone can join Medicare
B. Time allowed for changes due to specific
qualifying events C. The first time a person
becomes eligible for Medicare D. Period between
AEPs
✅Answer: B. Time allowed for changes due to specific
qualifying events
Rationale:
SEPs occur after specific life events, such as moving out of a
service area or losing employer coverage.
6.
Which entity regulates and oversees Medicare Advantage and
Part D plans?
A. The Department of Health and Human Services
(HHS)
B. The Centers for Medicare & Medicaid Services
(CMS)
C. The National Association of Insurance
EXAM QUESTIONS AND CORRECT
ANSWERS WITH RATIONALES GRADED
A+ LATEST
AHIP Final Exam 2025/2026
The exam covers Medicare Advantage, Part D, plan
benefits, compliance, fraud prevention, care
coordination, member communications, and ethical
considerations. Each question includes the correct answer
and detailed rationale.
1.
Which of the following individuals is eligible to enroll in a
Medicare Advantage (MA) plan?
A. A 65-year-old with Medicare Part A only
B. A 72-year-old with Medicare Parts A and B who lives within the
plan’s service area
C. A 60-year-old with employer group coverage only
D. A 68-year-old who permanently resides outside the United
States
✅Answer: B. A 72-year-old with Medicare Parts A and B
who lives within the plan’s service area
Rationale:
To enroll in an MA plan, a beneficiary must be entitled to Part
A, enrolled in Part B, and reside in the plan’s service
area.
,2.
What is the primary goal of Medicare Advantage plans?
A. Replace Original Medicare with private coverage that adds
more out-of-pocket costs
B. Provide Medicare-covered benefits through private insurers
that meet CMS standards
C. Eliminate Part D coverage
D. Offer coverage only for hospital services
✅Answer: B. Provide Medicare-covered benefits through
private insurers that meet CMS standards
Rationale:
MA plans deliver Medicare benefits via CMS-approved
private insurers, often with additional benefits like vision or
dental.
3.
Which of the following services are not covered under
Medicare Part A?
A. Skilled nursing facility
care
B. Hospice care
C. Home health services
D. Outpatient physical
therapy
✅Answer: D. Outpatient physical therapy
Rationale:
Outpatient therapy is covered under Part B, not Part A, which
primarily covers inpatient and facility-based care.
4.
During the Annual Election Period (AEP), beneficiaries can:
,A. Only drop their current plan
B. Only enroll in a new plan if they have a special
circumstance
, C. Enroll, switch, or disenroll from Medicare Advantage or
Part D plans D. Only switch from MA to Original Medicare
✅Answer: C. Enroll, switch, or disenroll from Medicare
Advantage or Part
D plans
Rationale:
AEP (October 15 – December 7) allows plan changes,
enrollment, or disenrollment for the upcoming year.
5.
Which of the following best defines a Special Enrollment
Period (SEP)?
A. A set period when everyone can join Medicare
B. Time allowed for changes due to specific
qualifying events C. The first time a person
becomes eligible for Medicare D. Period between
AEPs
✅Answer: B. Time allowed for changes due to specific
qualifying events
Rationale:
SEPs occur after specific life events, such as moving out of a
service area or losing employer coverage.
6.
Which entity regulates and oversees Medicare Advantage and
Part D plans?
A. The Department of Health and Human Services
(HHS)
B. The Centers for Medicare & Medicaid Services
(CMS)
C. The National Association of Insurance
