Page 1 of 112
2027 AHIP Final Exam – Medicare Certification EXAM
QUESTIONS AND CORRECT VERIFIED SOLUTIONS LATEST
UPDATE THIS YEAR – JUST RELEASED
2027 AHIP Final Exam – Medicare Certification
10-Line Exam Coverage in Points Form
1. Exam Logistics & Requirements - 50 questions, 2-hour time limit, 90% passing score, 3
attempts allowed, open-book format, $125–$175 cost, opens June 22, 2026
2. Medicare Program Basics - Part A (hospital, SNF, hospice, home health), Part B
(outpatient, physician, DME), Original Medicare structure, and coordination with
employer coverage
3. Medicare Advantage (Part C) - MA plans (HMO, PPO, PFFS, SNP, MSA), enrollment
eligibility (Part A + Part B required), network rules, referrals, and out-of-pocket maximum
($8,700 in-network for 2027)
4. Medicare Part D Prescription Drug Plans - Formularies, coverage gap ("Donut Hole"),
Initial Enrollment Period (7 months), Late Enrollment Penalty (LEP), and Low-Income
Subsidy (LIS) eligibility
5. Medigap (Medicare Supplements) - Supplement Original Medicare only; illegal to sell to
MA enrollees; covers deductibles, copayments, and coinsurance; Open Enrollment
Period protections
6. Enrollment Periods - Initial Enrollment Period (IEP), Annual Election Period (AEP: Oct
15–Dec 7), Medicare Advantage Open Enrollment Period (OEP: Jan 1–Mar 31), and
Special Enrollment Periods (SEPs) triggered by qualifying life events
7. Fraud, Waste, and Abuse (FWA) - Prevention, detection, and reporting; mandatory
separate module; high-priority exam topic
8. CMS Marketing & Compliance Rules - Prohibited high-pressure sales tactics; educational
vs. marketing events; Scope of Appointment (SOA) rules; pre-enrollment checklist
requirements
9. Eligibility & Enrollment Rules - Age 65+ or qualifying disability; lawful presence
requirements (non-citizens with 40 quarters of contributions may qualify); SNP eligibility
restrictions (I-SNP, D-SNP, C-SNP)
10. Appeals, Grievances & Beneficiary Rights - Standard appeal timeframe (30 days);
expedited appeals (72 hours); coverage determinations; MOOP limit application
, Page 2 of 112
250 MCQ Questions with Rationales
1. A beneficiary enrolled in a Medicare Advantage plan and a Medigap plan is likely in
violation of federal law. Why?
A) Medigap plans are only available during the Initial Enrollment Period
B) It is illegal to sell a Medigap policy to someone enrolled in a Medicare Advantage plan
C) Medicare Advantage plans automatically include supplemental coverage
D) Medigap policies duplicate Medicaid benefits, not Medicare benefits
Correct Answer: B
Rationale: Medigap plans are supplemental policies that work exclusively with Original
Medicare (Parts A and B). Federal law prohibits the sale of a Medigap policy to someone
enrolled in a Medicare Advantage plan, as Medigap cannot pay for MA plan deductibles,
copayments, or coinsurance .
2. A Medicare beneficiary with Original Medicare wants help paying deductibles and
coinsurance. Which option may help?
A) Medicare Advantage PPO
B) Medigap policy
C) Medicaid Expansion
D) Employer disability insurance
, Page 3 of 112
Correct Answer: B
Rationale: Medigap policies are designed to cover certain out-of-pocket costs associated with
Original Medicare, such as deductibles, copayments, and coinsurance .
3. Which Medicare plan type combines hospital, medical, and often prescription drug
coverage into one plan?
A) Medigap
B) Medicare Advantage
C) Medicaid
D) COBRA
Correct Answer: B
Rationale: Medicare Advantage plans (Part C) combine Medicare Part A and Part B benefits into
a single plan, and many also include Part D prescription drug coverage (MAPD plans) .
4. Medicare Advantage plans are also known as:
A) Medigap Plans
B) Medicare Supplement Plans
C) Medicare Part C Plans
D) Medicaid Expansion Plans
Correct Answer: C
Rationale: Medicare Advantage (Part C) is an alternative way to receive Original Medicare
benefits through private insurers approved by Medicare .
, Page 4 of 112
5. Medicare Part A helps pay for which of the following?
A) Outpatient physician visits
B) Prescription drugs
C) Inpatient hospital care
D) Dental services
Correct Answer: C
Rationale: Part A helps pay for inpatient hospital care, skilled nursing facility care (under
qualifying conditions), hospice services, and some home health services .
6. Which beneficiary would generally NOT be eligible to enroll in Medicare based solely on
age?
A) 65 years old
B) 67 years old
C) 62 years old
D) 70 years old
Correct Answer: C
Rationale: Medicare eligibility based on age generally begins at age 65. Individuals under 65
may qualify through disability or other qualifying conditions, but not solely based on age .
7. Which Medicare Advantage plan usually requires members to obtain referrals before seeing
specialists?
2027 AHIP Final Exam – Medicare Certification EXAM
QUESTIONS AND CORRECT VERIFIED SOLUTIONS LATEST
UPDATE THIS YEAR – JUST RELEASED
2027 AHIP Final Exam – Medicare Certification
10-Line Exam Coverage in Points Form
1. Exam Logistics & Requirements - 50 questions, 2-hour time limit, 90% passing score, 3
attempts allowed, open-book format, $125–$175 cost, opens June 22, 2026
2. Medicare Program Basics - Part A (hospital, SNF, hospice, home health), Part B
(outpatient, physician, DME), Original Medicare structure, and coordination with
employer coverage
3. Medicare Advantage (Part C) - MA plans (HMO, PPO, PFFS, SNP, MSA), enrollment
eligibility (Part A + Part B required), network rules, referrals, and out-of-pocket maximum
($8,700 in-network for 2027)
4. Medicare Part D Prescription Drug Plans - Formularies, coverage gap ("Donut Hole"),
Initial Enrollment Period (7 months), Late Enrollment Penalty (LEP), and Low-Income
Subsidy (LIS) eligibility
5. Medigap (Medicare Supplements) - Supplement Original Medicare only; illegal to sell to
MA enrollees; covers deductibles, copayments, and coinsurance; Open Enrollment
Period protections
6. Enrollment Periods - Initial Enrollment Period (IEP), Annual Election Period (AEP: Oct
15–Dec 7), Medicare Advantage Open Enrollment Period (OEP: Jan 1–Mar 31), and
Special Enrollment Periods (SEPs) triggered by qualifying life events
7. Fraud, Waste, and Abuse (FWA) - Prevention, detection, and reporting; mandatory
separate module; high-priority exam topic
8. CMS Marketing & Compliance Rules - Prohibited high-pressure sales tactics; educational
vs. marketing events; Scope of Appointment (SOA) rules; pre-enrollment checklist
requirements
9. Eligibility & Enrollment Rules - Age 65+ or qualifying disability; lawful presence
requirements (non-citizens with 40 quarters of contributions may qualify); SNP eligibility
restrictions (I-SNP, D-SNP, C-SNP)
10. Appeals, Grievances & Beneficiary Rights - Standard appeal timeframe (30 days);
expedited appeals (72 hours); coverage determinations; MOOP limit application
, Page 2 of 112
250 MCQ Questions with Rationales
1. A beneficiary enrolled in a Medicare Advantage plan and a Medigap plan is likely in
violation of federal law. Why?
A) Medigap plans are only available during the Initial Enrollment Period
B) It is illegal to sell a Medigap policy to someone enrolled in a Medicare Advantage plan
C) Medicare Advantage plans automatically include supplemental coverage
D) Medigap policies duplicate Medicaid benefits, not Medicare benefits
Correct Answer: B
Rationale: Medigap plans are supplemental policies that work exclusively with Original
Medicare (Parts A and B). Federal law prohibits the sale of a Medigap policy to someone
enrolled in a Medicare Advantage plan, as Medigap cannot pay for MA plan deductibles,
copayments, or coinsurance .
2. A Medicare beneficiary with Original Medicare wants help paying deductibles and
coinsurance. Which option may help?
A) Medicare Advantage PPO
B) Medigap policy
C) Medicaid Expansion
D) Employer disability insurance
, Page 3 of 112
Correct Answer: B
Rationale: Medigap policies are designed to cover certain out-of-pocket costs associated with
Original Medicare, such as deductibles, copayments, and coinsurance .
3. Which Medicare plan type combines hospital, medical, and often prescription drug
coverage into one plan?
A) Medigap
B) Medicare Advantage
C) Medicaid
D) COBRA
Correct Answer: B
Rationale: Medicare Advantage plans (Part C) combine Medicare Part A and Part B benefits into
a single plan, and many also include Part D prescription drug coverage (MAPD plans) .
4. Medicare Advantage plans are also known as:
A) Medigap Plans
B) Medicare Supplement Plans
C) Medicare Part C Plans
D) Medicaid Expansion Plans
Correct Answer: C
Rationale: Medicare Advantage (Part C) is an alternative way to receive Original Medicare
benefits through private insurers approved by Medicare .
, Page 4 of 112
5. Medicare Part A helps pay for which of the following?
A) Outpatient physician visits
B) Prescription drugs
C) Inpatient hospital care
D) Dental services
Correct Answer: C
Rationale: Part A helps pay for inpatient hospital care, skilled nursing facility care (under
qualifying conditions), hospice services, and some home health services .
6. Which beneficiary would generally NOT be eligible to enroll in Medicare based solely on
age?
A) 65 years old
B) 67 years old
C) 62 years old
D) 70 years old
Correct Answer: C
Rationale: Medicare eligibility based on age generally begins at age 65. Individuals under 65
may qualify through disability or other qualifying conditions, but not solely based on age .
7. Which Medicare Advantage plan usually requires members to obtain referrals before seeing
specialists?
