AHIP Final Exam Actual Exam 2026/2027 | Complete Medicare
Certification Question Bank with Frequently Tested Questions &
Correct Answers Plus Rationales | Updated for Current CMS
Guidelines | A+ Graded
Q1: Mr. Capadona would like to purchase a Medicare Advantage (MA) plan and a Medigap plan to pick up costs not
covered by that plan. What should you tell him?
A. You can sell him a Medigap plan to help with costs not covered under Medicare Advantage
B. It is illegal to sell a Medigap plan if he is enrolled in an MA plan, and Medigap only works with Original
Medicare
C. Medigap plans are designed to work alongside Medicare Advantage plans
D. He must disenroll from his MA plan before buying a Medigap plan
Correct Answer: B
Rationale: Federal law prohibits issuing a Medigap policy to anyone enrolled in a Medicare Advantage plan, as
Medigap cannot pay MA costs; this prevents duplicate coverage and ensures proper coordination of benefits.
Q2: Mr. Davis is 52 years old and has been diagnosed with end-stage renal disease (ESRD) and will soon begin
dialysis. He is wondering if he can obtain coverage under Medicare. What should you tell him?
A. He is not eligible for Medicare until age 65 regardless of his condition
B. He may sign up for Medicare at any time, but coverage usually begins on the fourth month after dialysis
treatments start
C. He must wait until he turns 65 to enroll in Medicare
D. ESRD patients are only eligible for Medicaid, not Medicare
1
, Correct Answer: B
Rationale: Individuals with ESRD qualify for Medicare at any age; coverage typically begins the fourth month after
dialysis treatments commence, with certain exceptions for home dialysis training.
Q3: What is the minimum age for most individuals to qualify for Medicare Part A without paying a premium?
A. 55 years old
B. 60 years old
C. 65 years old
D. 67 years old
Correct Answer: C
Rationale: Most individuals become eligible for premium-free Part A at age 65 if they or their spouse paid Medicare
taxes for at least 10 years (40 quarters).
Q4: During which enrollment period can beneficiaries enrolled in Original Medicare join a Medicare Advantage
plan or switch plans?
A. Initial Enrollment Period (IEP)
B. Annual Enrollment Period (AEP)
C. Special Enrollment Period (SEP)
D. Medicare Advantage Open Enrollment Period (MA OEP)
Correct Answer: B
2
, Rationale: The Annual Enrollment Period runs from October 15 to December 7 each year, allowing beneficiaries
enrolled in Original Medicare to join or switch Medicare Advantage plans.
Q5: Mrs. Duarte is enrolled in Original Medicare Parts A and B. She has reviewed her Medicare Summary Notice
(MSN) and disagrees with a determination that partially denied one of her claims. What advice would you give her?
A. She should file an appeal within 120 days of receiving the MSN
B. She should file a grievance with her plan
C. She should contact her state insurance department
D. She should wait for her plan to automatically correct the error
Correct Answer: A
Rationale: Beneficiaries have the right to appeal initial claim determinations within 120 days of receiving the
Medicare Summary Notice in the mail.
Q6: Juan Perez, turning 65 next month, works for Smallcap Incorporated with 15 employees and employer-
sponsored coverage. He is a naturalized citizen who has contributed to Medicare for over 20 years. What should you
tell him about his Medicare eligibility and employer coverage?
A. He is not eligible for Medicare until he retires from Smallcap
B. He is eligible for Medicare at 65, and Medicare becomes primary payor; Smallcap does not have to offer
him comparable coverage
C. His employer plan remains primary payor indefinitely
D. He must disenroll from his employer plan to receive Medicare benefits
Correct Answer: B
Rationale: Juan is eligible for Medicare at 65; Medicare becomes primary payor for employers with fewer than 20
employees, and the employer is not required to continue offering comparable coverage.
3
, Q7: Which Medicare part covers inpatient hospital stays, skilled nursing facility care, and hospice?
A. Part A
B. Part B
C. Part C
D. Part D
Correct Answer: A
Rationale: Part A is hospital insurance covering inpatient services, skilled nursing facility care (not custodial),
hospice, and some home health services.
Q8: Mr. Moy wants to understand what coverage Medicare Supplemental Insurance (Medigap) provides since his
healthcare needs differ from his wife's. What could you tell him?
A. It covers everything Original Medicare does not cover
B. It provides prescription drug coverage
C. It helps cover Part A deductible and Part B coinsurance in Original Fee-for-Service Medicare, and
possibly some services Medicare does not cover
D. It is only available for Medicare Advantage enrollees
Correct Answer: C
Rationale: Medigap policies supplement Original Medicare by covering Part A deductibles and Part B coinsurance
or copayments, and may cover some services not covered by Medicare.
4
Certification Question Bank with Frequently Tested Questions &
Correct Answers Plus Rationales | Updated for Current CMS
Guidelines | A+ Graded
Q1: Mr. Capadona would like to purchase a Medicare Advantage (MA) plan and a Medigap plan to pick up costs not
covered by that plan. What should you tell him?
A. You can sell him a Medigap plan to help with costs not covered under Medicare Advantage
B. It is illegal to sell a Medigap plan if he is enrolled in an MA plan, and Medigap only works with Original
Medicare
C. Medigap plans are designed to work alongside Medicare Advantage plans
D. He must disenroll from his MA plan before buying a Medigap plan
Correct Answer: B
Rationale: Federal law prohibits issuing a Medigap policy to anyone enrolled in a Medicare Advantage plan, as
Medigap cannot pay MA costs; this prevents duplicate coverage and ensures proper coordination of benefits.
Q2: Mr. Davis is 52 years old and has been diagnosed with end-stage renal disease (ESRD) and will soon begin
dialysis. He is wondering if he can obtain coverage under Medicare. What should you tell him?
A. He is not eligible for Medicare until age 65 regardless of his condition
B. He may sign up for Medicare at any time, but coverage usually begins on the fourth month after dialysis
treatments start
C. He must wait until he turns 65 to enroll in Medicare
D. ESRD patients are only eligible for Medicaid, not Medicare
1
, Correct Answer: B
Rationale: Individuals with ESRD qualify for Medicare at any age; coverage typically begins the fourth month after
dialysis treatments commence, with certain exceptions for home dialysis training.
Q3: What is the minimum age for most individuals to qualify for Medicare Part A without paying a premium?
A. 55 years old
B. 60 years old
C. 65 years old
D. 67 years old
Correct Answer: C
Rationale: Most individuals become eligible for premium-free Part A at age 65 if they or their spouse paid Medicare
taxes for at least 10 years (40 quarters).
Q4: During which enrollment period can beneficiaries enrolled in Original Medicare join a Medicare Advantage
plan or switch plans?
A. Initial Enrollment Period (IEP)
B. Annual Enrollment Period (AEP)
C. Special Enrollment Period (SEP)
D. Medicare Advantage Open Enrollment Period (MA OEP)
Correct Answer: B
2
, Rationale: The Annual Enrollment Period runs from October 15 to December 7 each year, allowing beneficiaries
enrolled in Original Medicare to join or switch Medicare Advantage plans.
Q5: Mrs. Duarte is enrolled in Original Medicare Parts A and B. She has reviewed her Medicare Summary Notice
(MSN) and disagrees with a determination that partially denied one of her claims. What advice would you give her?
A. She should file an appeal within 120 days of receiving the MSN
B. She should file a grievance with her plan
C. She should contact her state insurance department
D. She should wait for her plan to automatically correct the error
Correct Answer: A
Rationale: Beneficiaries have the right to appeal initial claim determinations within 120 days of receiving the
Medicare Summary Notice in the mail.
Q6: Juan Perez, turning 65 next month, works for Smallcap Incorporated with 15 employees and employer-
sponsored coverage. He is a naturalized citizen who has contributed to Medicare for over 20 years. What should you
tell him about his Medicare eligibility and employer coverage?
A. He is not eligible for Medicare until he retires from Smallcap
B. He is eligible for Medicare at 65, and Medicare becomes primary payor; Smallcap does not have to offer
him comparable coverage
C. His employer plan remains primary payor indefinitely
D. He must disenroll from his employer plan to receive Medicare benefits
Correct Answer: B
Rationale: Juan is eligible for Medicare at 65; Medicare becomes primary payor for employers with fewer than 20
employees, and the employer is not required to continue offering comparable coverage.
3
, Q7: Which Medicare part covers inpatient hospital stays, skilled nursing facility care, and hospice?
A. Part A
B. Part B
C. Part C
D. Part D
Correct Answer: A
Rationale: Part A is hospital insurance covering inpatient services, skilled nursing facility care (not custodial),
hospice, and some home health services.
Q8: Mr. Moy wants to understand what coverage Medicare Supplemental Insurance (Medigap) provides since his
healthcare needs differ from his wife's. What could you tell him?
A. It covers everything Original Medicare does not cover
B. It provides prescription drug coverage
C. It helps cover Part A deductible and Part B coinsurance in Original Fee-for-Service Medicare, and
possibly some services Medicare does not cover
D. It is only available for Medicare Advantage enrollees
Correct Answer: C
Rationale: Medigap policies supplement Original Medicare by covering Part A deductibles and Part B coinsurance
or copayments, and may cover some services not covered by Medicare.
4
