AHIP Medicare Parts A, B, C, and D Exam
Questions and Verified Answers with
Rationale Latest Edition 2026/2027
Question 1
Which of the following services is typically covered under Original
Medicare Parts A and B?
A. Routine dental care, dentures, and exams
B. Inpatient hospital stays, skilled nursing facility care, and
hospice care
C. Routine acupuncture and cosmetic surgery
D. Long-term custodial nursing home care
Correct Answer: B
Rationale: Original Medicare Part A provides coverage for inpatient
hospital stays, skilled nursing facility care, hospice, and certain home
health services. Routine dental, cosmetic procedures, acupuncture, and
long-term custodial care are generally excluded under Original
Medicare.
Question 2
Mr. Capadona is currently enrolled in Original Medicare Parts A and B
and wants to purchase a Medigap (Medicare Supplement Insurance)
policy to help cover out-of-pocket costs. What must you tell him
regarding combining Medigap with other coverage?
A. He can simultaneously hold a Medigap policy and a Medicare
Advantage (Part C) plan.
, B. It is illegal to sell a Medigap policy to someone enrolled in a
Medicare Advantage plan, as Medigap only works alongside
Original Medicare.
C. Medigap automatically includes prescription drug coverage
equivalent to Part D.
D. Medigap plans replace Original Medicare entirely.
Correct Answer: B
Rationale: Medigap policies are strictly designed to supplement Original
Medicare. It is illegal for an agent or insurer to sell a Medigap policy to
an individual who is enrolled in a Medicare Advantage plan.
Furthermore, standard Medigap policies sold today do not include
prescription drug coverage.
Question 3
What is a formulary in the context of Medicare Part D prescription drug
plans?
A. The monthly premium calculation formula based on income
B. The network of preferred and non-preferred doctors and
hospitals
C. A list of prescription drugs covered by a health or plan
D. The official government documentation required for late
enrollment penalties
Correct Answer: C
Rationale: A formulary is the specific list of prescription medications
covered by a Medicare Part D plan or a Medicare Advantage
Prescription Drug (MA-PD) plan. Plans use tiered formularies to
determine cost-sharing levels for different drugs.
Question 4
,Which specialized type of Medicare Advantage Special Needs Plan
(SNP) is specifically designed for individuals who are eligible for both
Medicare and Medicaid?
A. Chronic Condition SNP (C-SNP)
B. Institutional SNP (I-SNP)
C. Dual-Eligible SNP (D-SNP)
D. Standard Medicare Advantage Prescription Drug Plan (MA-PD)
Correct Answer: C
Rationale: Dual-Eligible SNPs (D-SNPs) cater specifically to
beneficiaries who qualify for both Medicare and Medicaid, helping to
coordinate their benefits seamlessly and minimize out-of-pocket
expenses.
Question 5
When does the Annual Enrollment Period (AEP) for Medicare
Advantage and Medicare Part D take place each year?
A. January 1 through March 31
B. April 1 through June 30
C. October 15 through December 7
D. November 1 through January 31
Correct Answer: C
Rationale: The Annual Enrollment Period (AEP) runs from October 15
through December 7 each year. Changes made during this window
become effective on January 1 of the following year.
Question 6
Which of the following describes the Late Enrollment Penalty (LEP) for
Medicare Part D?
, A. A one-time fee added to the first month's premium upon
enrollment
B. An amount added to the monthly premium for as long as the
beneficiary has Part D, if they went 63 continuous days or more
without creditable prescription drug coverage
C. A penalty assessed only against individuals who qualify for
Extra Help
D. A fine paid directly to the social security administration that
completely eliminates future drug deductibles
Correct Answer: B
Rationale: If a beneficiary goes without creditable prescription drug
coverage for 63 continuous days or more after their initial enrollment
period ends, they may owe a lifetime Late Enrollment Penalty. The
penalty is calculated as 1 percent of the national base beneficiary
premium for every full month they were eligible but lacked coverage.
Question 7
What is the primary function of Medicare Part C (Medicare Advantage)?
A. To provide government-funded long-term care in state-operated
nursing homes
B. To allow private, CMS-approved insurance companies to
provide Medicare hospital and medical benefits, often along with
extra services
C. To replace both Medicare and Medicaid with a single private
health account
D. To offer supplementary coverage exclusively for foreign travel
medical emergencies
Correct Answer: B
Rationale: Medicare Part C, or Medicare Advantage, packages hospital
(Part A) and medical (Part B) coverage—and usually prescription drug
Questions and Verified Answers with
Rationale Latest Edition 2026/2027
Question 1
Which of the following services is typically covered under Original
Medicare Parts A and B?
A. Routine dental care, dentures, and exams
B. Inpatient hospital stays, skilled nursing facility care, and
hospice care
C. Routine acupuncture and cosmetic surgery
D. Long-term custodial nursing home care
Correct Answer: B
Rationale: Original Medicare Part A provides coverage for inpatient
hospital stays, skilled nursing facility care, hospice, and certain home
health services. Routine dental, cosmetic procedures, acupuncture, and
long-term custodial care are generally excluded under Original
Medicare.
Question 2
Mr. Capadona is currently enrolled in Original Medicare Parts A and B
and wants to purchase a Medigap (Medicare Supplement Insurance)
policy to help cover out-of-pocket costs. What must you tell him
regarding combining Medigap with other coverage?
A. He can simultaneously hold a Medigap policy and a Medicare
Advantage (Part C) plan.
, B. It is illegal to sell a Medigap policy to someone enrolled in a
Medicare Advantage plan, as Medigap only works alongside
Original Medicare.
C. Medigap automatically includes prescription drug coverage
equivalent to Part D.
D. Medigap plans replace Original Medicare entirely.
Correct Answer: B
Rationale: Medigap policies are strictly designed to supplement Original
Medicare. It is illegal for an agent or insurer to sell a Medigap policy to
an individual who is enrolled in a Medicare Advantage plan.
Furthermore, standard Medigap policies sold today do not include
prescription drug coverage.
Question 3
What is a formulary in the context of Medicare Part D prescription drug
plans?
A. The monthly premium calculation formula based on income
B. The network of preferred and non-preferred doctors and
hospitals
C. A list of prescription drugs covered by a health or plan
D. The official government documentation required for late
enrollment penalties
Correct Answer: C
Rationale: A formulary is the specific list of prescription medications
covered by a Medicare Part D plan or a Medicare Advantage
Prescription Drug (MA-PD) plan. Plans use tiered formularies to
determine cost-sharing levels for different drugs.
Question 4
,Which specialized type of Medicare Advantage Special Needs Plan
(SNP) is specifically designed for individuals who are eligible for both
Medicare and Medicaid?
A. Chronic Condition SNP (C-SNP)
B. Institutional SNP (I-SNP)
C. Dual-Eligible SNP (D-SNP)
D. Standard Medicare Advantage Prescription Drug Plan (MA-PD)
Correct Answer: C
Rationale: Dual-Eligible SNPs (D-SNPs) cater specifically to
beneficiaries who qualify for both Medicare and Medicaid, helping to
coordinate their benefits seamlessly and minimize out-of-pocket
expenses.
Question 5
When does the Annual Enrollment Period (AEP) for Medicare
Advantage and Medicare Part D take place each year?
A. January 1 through March 31
B. April 1 through June 30
C. October 15 through December 7
D. November 1 through January 31
Correct Answer: C
Rationale: The Annual Enrollment Period (AEP) runs from October 15
through December 7 each year. Changes made during this window
become effective on January 1 of the following year.
Question 6
Which of the following describes the Late Enrollment Penalty (LEP) for
Medicare Part D?
, A. A one-time fee added to the first month's premium upon
enrollment
B. An amount added to the monthly premium for as long as the
beneficiary has Part D, if they went 63 continuous days or more
without creditable prescription drug coverage
C. A penalty assessed only against individuals who qualify for
Extra Help
D. A fine paid directly to the social security administration that
completely eliminates future drug deductibles
Correct Answer: B
Rationale: If a beneficiary goes without creditable prescription drug
coverage for 63 continuous days or more after their initial enrollment
period ends, they may owe a lifetime Late Enrollment Penalty. The
penalty is calculated as 1 percent of the national base beneficiary
premium for every full month they were eligible but lacked coverage.
Question 7
What is the primary function of Medicare Part C (Medicare Advantage)?
A. To provide government-funded long-term care in state-operated
nursing homes
B. To allow private, CMS-approved insurance companies to
provide Medicare hospital and medical benefits, often along with
extra services
C. To replace both Medicare and Medicaid with a single private
health account
D. To offer supplementary coverage exclusively for foreign travel
medical emergencies
Correct Answer: B
Rationale: Medicare Part C, or Medicare Advantage, packages hospital
(Part A) and medical (Part B) coverage—and usually prescription drug
