AHIP MEDICARE CERTIFICATION EXAM
120 Questions | Answer Key & Rationales Included
1. Medicare Part A primarily covers which type of care?
A. Outpatient physician visits
B. Inpatient hospital, skilled nursing facility, hospice, and some home health care
C. Prescription drugs only
D. Routine dental and vision care
Correct Answer: B
Rationale: Part A is often called 'hospital insurance' and covers inpatient hospital stays,
skilled nursing facility care, hospice, and certain home health services, not routine
outpatient physician visits or drugs.
2. Medicare Part B primarily covers:
A. Inpatient hospital stays only
B. Physician services, outpatient care, durable medical equipment, and preventive
services
C. Long-term custodial nursing home care
D. Prescription drugs dispensed at retail pharmacies
Correct Answer: B
Rationale: Part B is 'medical insurance,' covering physician services, outpatient care,
durable medical equipment, and many preventive services; it does not cover custodial
long-term care or retail prescription drugs, which fall under Part D.
3. Most people become eligible for Medicare based on age at what birthday?
A. 62nd birthday
B. 65th birthday
C. 70th birthday
D. 59th birthday
Correct Answer: B
Rationale: Age-based Medicare eligibility generally begins at age 65, though people
may also qualify earlier due to certain disabilities or conditions such as ESRD or ALS.
,4. A person may qualify for Medicare before age 65 if they:
A. Have received Social Security Disability Insurance (SSDI) benefits for a qualifying
period, or have specific conditions such as ESRD or ALS
B. Simply request it from their employer
C. Have private insurance already
D. Live in a state that opted out of Medicaid
Correct Answer: A
Rationale: Individuals under 65 can qualify for Medicare after receiving SSDI for a
qualifying period (typically 24 months) or immediately upon diagnosis of certain
conditions such as End-Stage Renal Disease (ESRD) or ALS.
5. Most beneficiaries do not pay a monthly premium for Part A because:
A. Part A is entirely funded by state governments
B. They or a spouse paid Medicare taxes for a sufficient number of quarters while
working
C. Part A premiums are waived for everyone regardless of work history
D. Congress eliminated Part A premiums in all cases
Correct Answer: B
Rationale: Individuals (or their spouse) who paid Medicare payroll taxes for at least 40
quarters (10 years) of qualifying work generally receive premium-free Part A.
6. Part B generally requires beneficiaries to pay:
A. No premium under any circumstance
B. A monthly premium, which may be higher for beneficiaries with higher income
(IRMAA)
C. A one-time enrollment fee only
D. Only a copay at the time of service, with no premium
Correct Answer: B
Rationale: Part B requires an ongoing monthly premium, and higher-income
beneficiaries pay an Income-Related Monthly Adjustment Amount (IRMAA) in addition to
the standard premium.
,7. What is the Initial Enrollment Period (IEP) for Medicare?
A. A 3-month window only before turning 65
B. A 7-month period spanning 3 months before, the month of, and 3 months after a
person's 65th birthday
C. A single day each year
D. A 30-day period after retirement only
Correct Answer: B
Rationale: The IEP is a 7-month window: it begins 3 months before the month a person
turns 65, includes their birthday month, and extends 3 months after, giving a total of 7
months to enroll.
8. The General Enrollment Period (GEP) for Medicare Part A and/or B allows
enrollment:
A. Only for people who missed their IEP and have no Special Enrollment Period
available, generally January 1 through March 31 each year
B. Only during the month of a person's birthday
C. At any time throughout the year with no restriction
D. Only for people already enrolled in a Medicare Advantage plan
Correct Answer: A
Rationale: The GEP, generally running January 1 through March 31 annually, allows
people who missed their Initial Enrollment Period (and do not qualify for a Special
Enrollment Period) to enroll in Part A and/or Part B, though late enrollment penalties
may apply.
9. A Special Enrollment Period (SEP) for Part B may be available to someone who:
A. Simply changes their mind about enrolling
B. Delayed Part B enrollment because they had creditable group health coverage
based on current employment
C. Wants to switch dentists
D. Moved to a new home within the same city
Correct Answer: B
Rationale: People who delayed Part B because they (or their spouse) had creditable
coverage through current employment generally qualify for an SEP to enroll without
penalty once that employment or coverage ends.
, 10. Failing to enroll in Part B when first eligible, without qualifying for an SEP, can
generally result in:
A. No consequence at all
B. A late enrollment penalty added to the Part B premium for as long as the person
has Part B
C. Automatic disenrollment from Part A as well
D. Immediate loss of Social Security benefits
Correct Answer: B
Rationale: Late enrollment in Part B (absent a qualifying SEP) typically results in a
lifetime premium penalty, calculated based on the number of full 12-month periods the
person was eligible but not enrolled.
11. Which of the following is generally NOT covered by Original Medicare (Parts A
& B)?
A. Inpatient hospital care
B. Physician office visits
C. Routine long-term custodial care in a nursing home
D. Durable medical equipment
Correct Answer: C
Rationale: Original Medicare does not cover most long-term custodial care (help with
daily living activities); it may cover short-term skilled nursing facility stays under specific
conditions, but not extended custodial care.
12. What is a Medicare Summary Notice (MSN)?
A. A bill demanding immediate payment
B. A statement sent to Original Medicare beneficiaries summarizing claims and what
Medicare paid
C. A marketing brochure for Medicare Advantage plans
D. A prescription drug formulary
Correct Answer: B
Rationale: The MSN is a notice (not a bill) sent periodically to people with Original
Medicare, summarizing the services billed, what Medicare approved and paid, and what
the beneficiary may owe.
120 Questions | Answer Key & Rationales Included
1. Medicare Part A primarily covers which type of care?
A. Outpatient physician visits
B. Inpatient hospital, skilled nursing facility, hospice, and some home health care
C. Prescription drugs only
D. Routine dental and vision care
Correct Answer: B
Rationale: Part A is often called 'hospital insurance' and covers inpatient hospital stays,
skilled nursing facility care, hospice, and certain home health services, not routine
outpatient physician visits or drugs.
2. Medicare Part B primarily covers:
A. Inpatient hospital stays only
B. Physician services, outpatient care, durable medical equipment, and preventive
services
C. Long-term custodial nursing home care
D. Prescription drugs dispensed at retail pharmacies
Correct Answer: B
Rationale: Part B is 'medical insurance,' covering physician services, outpatient care,
durable medical equipment, and many preventive services; it does not cover custodial
long-term care or retail prescription drugs, which fall under Part D.
3. Most people become eligible for Medicare based on age at what birthday?
A. 62nd birthday
B. 65th birthday
C. 70th birthday
D. 59th birthday
Correct Answer: B
Rationale: Age-based Medicare eligibility generally begins at age 65, though people
may also qualify earlier due to certain disabilities or conditions such as ESRD or ALS.
,4. A person may qualify for Medicare before age 65 if they:
A. Have received Social Security Disability Insurance (SSDI) benefits for a qualifying
period, or have specific conditions such as ESRD or ALS
B. Simply request it from their employer
C. Have private insurance already
D. Live in a state that opted out of Medicaid
Correct Answer: A
Rationale: Individuals under 65 can qualify for Medicare after receiving SSDI for a
qualifying period (typically 24 months) or immediately upon diagnosis of certain
conditions such as End-Stage Renal Disease (ESRD) or ALS.
5. Most beneficiaries do not pay a monthly premium for Part A because:
A. Part A is entirely funded by state governments
B. They or a spouse paid Medicare taxes for a sufficient number of quarters while
working
C. Part A premiums are waived for everyone regardless of work history
D. Congress eliminated Part A premiums in all cases
Correct Answer: B
Rationale: Individuals (or their spouse) who paid Medicare payroll taxes for at least 40
quarters (10 years) of qualifying work generally receive premium-free Part A.
6. Part B generally requires beneficiaries to pay:
A. No premium under any circumstance
B. A monthly premium, which may be higher for beneficiaries with higher income
(IRMAA)
C. A one-time enrollment fee only
D. Only a copay at the time of service, with no premium
Correct Answer: B
Rationale: Part B requires an ongoing monthly premium, and higher-income
beneficiaries pay an Income-Related Monthly Adjustment Amount (IRMAA) in addition to
the standard premium.
,7. What is the Initial Enrollment Period (IEP) for Medicare?
A. A 3-month window only before turning 65
B. A 7-month period spanning 3 months before, the month of, and 3 months after a
person's 65th birthday
C. A single day each year
D. A 30-day period after retirement only
Correct Answer: B
Rationale: The IEP is a 7-month window: it begins 3 months before the month a person
turns 65, includes their birthday month, and extends 3 months after, giving a total of 7
months to enroll.
8. The General Enrollment Period (GEP) for Medicare Part A and/or B allows
enrollment:
A. Only for people who missed their IEP and have no Special Enrollment Period
available, generally January 1 through March 31 each year
B. Only during the month of a person's birthday
C. At any time throughout the year with no restriction
D. Only for people already enrolled in a Medicare Advantage plan
Correct Answer: A
Rationale: The GEP, generally running January 1 through March 31 annually, allows
people who missed their Initial Enrollment Period (and do not qualify for a Special
Enrollment Period) to enroll in Part A and/or Part B, though late enrollment penalties
may apply.
9. A Special Enrollment Period (SEP) for Part B may be available to someone who:
A. Simply changes their mind about enrolling
B. Delayed Part B enrollment because they had creditable group health coverage
based on current employment
C. Wants to switch dentists
D. Moved to a new home within the same city
Correct Answer: B
Rationale: People who delayed Part B because they (or their spouse) had creditable
coverage through current employment generally qualify for an SEP to enroll without
penalty once that employment or coverage ends.
, 10. Failing to enroll in Part B when first eligible, without qualifying for an SEP, can
generally result in:
A. No consequence at all
B. A late enrollment penalty added to the Part B premium for as long as the person
has Part B
C. Automatic disenrollment from Part A as well
D. Immediate loss of Social Security benefits
Correct Answer: B
Rationale: Late enrollment in Part B (absent a qualifying SEP) typically results in a
lifetime premium penalty, calculated based on the number of full 12-month periods the
person was eligible but not enrolled.
11. Which of the following is generally NOT covered by Original Medicare (Parts A
& B)?
A. Inpatient hospital care
B. Physician office visits
C. Routine long-term custodial care in a nursing home
D. Durable medical equipment
Correct Answer: C
Rationale: Original Medicare does not cover most long-term custodial care (help with
daily living activities); it may cover short-term skilled nursing facility stays under specific
conditions, but not extended custodial care.
12. What is a Medicare Summary Notice (MSN)?
A. A bill demanding immediate payment
B. A statement sent to Original Medicare beneficiaries summarizing claims and what
Medicare paid
C. A marketing brochure for Medicare Advantage plans
D. A prescription drug formulary
Correct Answer: B
Rationale: The MSN is a notice (not a bill) sent periodically to people with Original
Medicare, summarizing the services billed, what Medicare approved and paid, and what
the beneficiary may owe.
