AHIP Medicare Certification Exam Questions
and Verified Answers with Rationale Latest
Edition 2026/2027
Question 1
A Medicare beneficiary enrolled in Original Medicare (Parts A and B)
asks an agent about coverage for routine physical exams, routine dental
care, and routine eye examinations. What is the most accurate response
regarding these services under Original Medicare?
A. Original Medicare covers routine physical exams, routine dental
care, and routine eyeglasses in full.
B. Original Medicare generally does not cover routine physical
checkups, routine dental care, routine dentures, or routine eye
exams and glasses.
C. Original Medicare covers routine dental and vision care only if
the beneficiary is enrolled in a Medigap plan.
D. Original Medicare covers all routine preventative maintenance
once the Part B deductible is met.
Correct Answer: B
Rationale: Original Medicare (Parts A and B) does not cover routine
physical examinations (outside of the initial "Welcome to Medicare"
preventive visit and annual wellness visits), routine dental care,
dentures, routine eye exams for glasses, or routine hearing exams and
aids. Beneficiaries typically look to Medicare Advantage (Part C) plans
to secure coverage for these supplemental benefits.
Question 2
Which of the following describes the primary purpose and structure of
Medicare Supplement Insurance (Medigap) policies?
, A. Medigap policies are standalone prescription drug plans that
replace Medicare Part D.
B. Medigap policies are sold by private insurance companies to
help pay some of the health care costs that Original Medicare does
not cover, such as copayments, coinsurance, and deductibles.
C. Medigap policies provide complete medical and hospital
coverage while eliminating the need to pay the Part B monthly
premium.
D. Medigap policies are government-funded managed care plans
that operate identically to Medicare Advantage HMOs.
Correct Answer: B
Rationale: Medigap policies are standardized health insurance policies
sold by private companies designed specifically to supplement Original
Medicare by covering out-of-pocket costs like coinsurance, copays, and
deductibles (gaps). They cannot be paired with a Medicare Advantage
plan.
Question 3
An eligible individual is turning 65 and wants to know the standard
duration of the Initial Enrollment Period (IEP) for Medicare Parts A and
B. What is the correct timeframe?
A. A 3-month window starting the month the individual turns 65
B. A 7-month period that begins 3 months before the month of an
individual's 65th birthday, includes the birth month, and ends 3
months after that month
C. A continuous 12-month open enrollment period every calendar
year
D. Exactly 30 days following the date of retirement
Correct Answer: B
,Rationale: The Initial Enrollment Period (IEP) spans 7 months: the 3
months before the individual's 65th birthday month, the birth month
itself, and the 3 months following it.
Question 4
A beneficiary currently enrolled in a Medicare Advantage Prescription
Drug (MAPD) plan wants to switch to a different Medicare Advantage
plan during the calendar year. Which designated enrollment period
occurs annually from January 1 through March 31, allowing individuals
enrolled in a Medicare Advantage plan to switch to another MA plan or
disenroll to Original Medicare with a Part D plan?
A. Annual Election Period (AEP)
B. Medicare Advantage Open Enrollment Period (MA OEP)
C. Special Enrollment Period (SEP)
D. General Enrollment Period (GEP)
Correct Answer: B
Rationale: The Medicare Advantage Open Enrollment Period runs from
January 1 to March 31 each year. It allows anyone enrolled in a
Medicare Advantage plan to make a one-time change to another MA
plan or return to Original Medicare.
Question 5
When can a Medicare beneficiary make changes to their Medicare
Advantage or Part D coverage during the Annual Election Period
(AEP)?
A. October 15 through December 7, with coverage effective
January 1 of the following year
B. January 1 through March 31
C. April 1 through June 30
D. October 1 through October 14
, Correct Answer: A
Rationale: The Annual Election Period (AEP) takes place every year
from October 15 to December 7. Changes made during this window
become effective on January 1 of the upcoming year.
Question 6
An agent is discussing Medicare Part D prescription drug coverage with
a client. Which statement correctly characterizes the structure of
standard Part D benefit phases?
A. Part D coverage consists exclusively of a single flat copay for
all medications regardless of cost.
B. The standard Part D benefit typically includes stages such as the
deductible phase, initial coverage phase, coverage gap (donut
hole), and catastrophic coverage phase.
C. Beneficiaries must pay 100% of all drug costs after reaching the
initial coverage limit without exception.
D. Part D plans cover all over-the-counter medications and
cosmetics.
Correct Answer: B
Rationale: The standard Medicare Part D benefit structure progresses
through distinct phases: the annual deductible, the initial coverage phase,
the coverage gap, and catastrophic coverage (where beneficiary out-of-
pocket costs are reduced significantly).
Question 7
Which of the following individuals is automatically enrolled in Medicare
Part A and Part B without having to submit an application?
A. An individual turning 65 who is still actively working and
covered by an employer group health plan
and Verified Answers with Rationale Latest
Edition 2026/2027
Question 1
A Medicare beneficiary enrolled in Original Medicare (Parts A and B)
asks an agent about coverage for routine physical exams, routine dental
care, and routine eye examinations. What is the most accurate response
regarding these services under Original Medicare?
A. Original Medicare covers routine physical exams, routine dental
care, and routine eyeglasses in full.
B. Original Medicare generally does not cover routine physical
checkups, routine dental care, routine dentures, or routine eye
exams and glasses.
C. Original Medicare covers routine dental and vision care only if
the beneficiary is enrolled in a Medigap plan.
D. Original Medicare covers all routine preventative maintenance
once the Part B deductible is met.
Correct Answer: B
Rationale: Original Medicare (Parts A and B) does not cover routine
physical examinations (outside of the initial "Welcome to Medicare"
preventive visit and annual wellness visits), routine dental care,
dentures, routine eye exams for glasses, or routine hearing exams and
aids. Beneficiaries typically look to Medicare Advantage (Part C) plans
to secure coverage for these supplemental benefits.
Question 2
Which of the following describes the primary purpose and structure of
Medicare Supplement Insurance (Medigap) policies?
, A. Medigap policies are standalone prescription drug plans that
replace Medicare Part D.
B. Medigap policies are sold by private insurance companies to
help pay some of the health care costs that Original Medicare does
not cover, such as copayments, coinsurance, and deductibles.
C. Medigap policies provide complete medical and hospital
coverage while eliminating the need to pay the Part B monthly
premium.
D. Medigap policies are government-funded managed care plans
that operate identically to Medicare Advantage HMOs.
Correct Answer: B
Rationale: Medigap policies are standardized health insurance policies
sold by private companies designed specifically to supplement Original
Medicare by covering out-of-pocket costs like coinsurance, copays, and
deductibles (gaps). They cannot be paired with a Medicare Advantage
plan.
Question 3
An eligible individual is turning 65 and wants to know the standard
duration of the Initial Enrollment Period (IEP) for Medicare Parts A and
B. What is the correct timeframe?
A. A 3-month window starting the month the individual turns 65
B. A 7-month period that begins 3 months before the month of an
individual's 65th birthday, includes the birth month, and ends 3
months after that month
C. A continuous 12-month open enrollment period every calendar
year
D. Exactly 30 days following the date of retirement
Correct Answer: B
,Rationale: The Initial Enrollment Period (IEP) spans 7 months: the 3
months before the individual's 65th birthday month, the birth month
itself, and the 3 months following it.
Question 4
A beneficiary currently enrolled in a Medicare Advantage Prescription
Drug (MAPD) plan wants to switch to a different Medicare Advantage
plan during the calendar year. Which designated enrollment period
occurs annually from January 1 through March 31, allowing individuals
enrolled in a Medicare Advantage plan to switch to another MA plan or
disenroll to Original Medicare with a Part D plan?
A. Annual Election Period (AEP)
B. Medicare Advantage Open Enrollment Period (MA OEP)
C. Special Enrollment Period (SEP)
D. General Enrollment Period (GEP)
Correct Answer: B
Rationale: The Medicare Advantage Open Enrollment Period runs from
January 1 to March 31 each year. It allows anyone enrolled in a
Medicare Advantage plan to make a one-time change to another MA
plan or return to Original Medicare.
Question 5
When can a Medicare beneficiary make changes to their Medicare
Advantage or Part D coverage during the Annual Election Period
(AEP)?
A. October 15 through December 7, with coverage effective
January 1 of the following year
B. January 1 through March 31
C. April 1 through June 30
D. October 1 through October 14
, Correct Answer: A
Rationale: The Annual Election Period (AEP) takes place every year
from October 15 to December 7. Changes made during this window
become effective on January 1 of the upcoming year.
Question 6
An agent is discussing Medicare Part D prescription drug coverage with
a client. Which statement correctly characterizes the structure of
standard Part D benefit phases?
A. Part D coverage consists exclusively of a single flat copay for
all medications regardless of cost.
B. The standard Part D benefit typically includes stages such as the
deductible phase, initial coverage phase, coverage gap (donut
hole), and catastrophic coverage phase.
C. Beneficiaries must pay 100% of all drug costs after reaching the
initial coverage limit without exception.
D. Part D plans cover all over-the-counter medications and
cosmetics.
Correct Answer: B
Rationale: The standard Medicare Part D benefit structure progresses
through distinct phases: the annual deductible, the initial coverage phase,
the coverage gap, and catastrophic coverage (where beneficiary out-of-
pocket costs are reduced significantly).
Question 7
Which of the following individuals is automatically enrolled in Medicare
Part A and Part B without having to submit an application?
A. An individual turning 65 who is still actively working and
covered by an employer group health plan
