,AHIP Final Exam – Medicare Certification – Actual
Questions & Answers (AHIP) Guarantee Pass
Q1. Which part of Medicare is also known as Medicare Advantage?
A) Part A
B) Part B
C) Part C
D) Part D
Correct Answer: C
Rationale: Medicare Part C, known as Medicare Advantage, combines Part A, Part B, and
usually Part D coverage into one managed care plan run by private insurance companies
approved by Medicare .
Q2. Medicare Part B covers which of the following services?
A) Inpatient hospital stays
B) Hospice care
C) Outpatient physician services and preventive care
D) Skilled nursing facility room and board
Correct Answer: C
Rationale: Part B covers medically necessary outpatient services, doctor visits,
preventive care, and durable medical equipment (DME). Inpatient stays and hospice care
are Part A benefits .
Q3. Who is typically eligible for premium-free Medicare Part A?
A) Anyone who reaches the age of 65
B) Individuals aged 65 or older who have worked at least 40 quarters (10 years) in
Medicare-covered employment
C) Anyone enrolled in Medicaid
D) Only federal government retirees
,Correct Answer: B
Rationale: To qualify for premium-free Part A, an individual or their spouse must have
accumulated at least 40 quarters of work credits under the U.S. Social Security system.
Those with fewer quarters may pay a premium .
Q4. A client is enrolled in Original Medicare and wants prescription drug coverage.
What are their options?
A) They must enroll in a Medicare Advantage plan
B) They can enroll in a stand-alone Medicare Part D Prescription Drug Plan (PDP)
C) They must wait for the next General Enrollment Period
D) They can join a Medigap plan that includes drug coverage
Correct Answer: B
Rationale: Beneficiaries on Original Medicare who wish to obtain prescription coverage
can do so through a stand-alone Part D plan (PDP), without needing to join an MA plan.
Medigap plans do not include drug coverage .
Q5. Mr. Capadona would like to purchase a Medicare Advantage 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 to someone enrolled in an MA plan, and Medigap
only works with Original Medicare
C) He can use both plans simultaneously
D) He can only purchase a Medigap plan if he disenrolls from Medicare entirely
Correct Answer: B
Rationale: Federal law prohibits selling a Medigap policy to someone enrolled in a
Medicare Advantage plan because Medigap cannot pay for any Medicare Advantage
plan cost-sharing or deductibles. Medigap policies only work with Original Medicare
, Q6. What is the standard duration of the Initial Enrollment Period (IEP) for a newly
eligible Medicare beneficiary turning 65?
A) 3 months
B) 6 months
C) 7 months
D) 12 months
Correct Answer: C
Rationale: The IEP is a 7-month window that includes the 3 months before the
individual turns 65, their birth month, and the 3 months following their birth month .
Q7. A beneficiary who is losing employer coverage wants to enroll in Medicare
without waiting for the Annual Election Period. What enrollment period applies?
A) Initial Enrollment Period (IEP)
B) Special Enrollment Period (SEP)
C) General Enrollment Period (GEP)
D) Medicare Advantage Open Enrollment Period (MA OEP)
Correct Answer: B
Rationale: Losing employer coverage is a qualifying event for a Special Enrollment
Period (SEP). Beneficiaries have 8 months after employment or coverage ends to enroll
in Medicare Part B without penalty .
Q8. What is the standard Part B premium based on?
A) The beneficiary's zip code
B) The beneficiary's modified adjusted gross income (MAGI)
C) The beneficiary's health status and pre-existing conditions
D) The number of years the beneficiary has been retired
Correct Answer: B
Questions & Answers (AHIP) Guarantee Pass
Q1. Which part of Medicare is also known as Medicare Advantage?
A) Part A
B) Part B
C) Part C
D) Part D
Correct Answer: C
Rationale: Medicare Part C, known as Medicare Advantage, combines Part A, Part B, and
usually Part D coverage into one managed care plan run by private insurance companies
approved by Medicare .
Q2. Medicare Part B covers which of the following services?
A) Inpatient hospital stays
B) Hospice care
C) Outpatient physician services and preventive care
D) Skilled nursing facility room and board
Correct Answer: C
Rationale: Part B covers medically necessary outpatient services, doctor visits,
preventive care, and durable medical equipment (DME). Inpatient stays and hospice care
are Part A benefits .
Q3. Who is typically eligible for premium-free Medicare Part A?
A) Anyone who reaches the age of 65
B) Individuals aged 65 or older who have worked at least 40 quarters (10 years) in
Medicare-covered employment
C) Anyone enrolled in Medicaid
D) Only federal government retirees
,Correct Answer: B
Rationale: To qualify for premium-free Part A, an individual or their spouse must have
accumulated at least 40 quarters of work credits under the U.S. Social Security system.
Those with fewer quarters may pay a premium .
Q4. A client is enrolled in Original Medicare and wants prescription drug coverage.
What are their options?
A) They must enroll in a Medicare Advantage plan
B) They can enroll in a stand-alone Medicare Part D Prescription Drug Plan (PDP)
C) They must wait for the next General Enrollment Period
D) They can join a Medigap plan that includes drug coverage
Correct Answer: B
Rationale: Beneficiaries on Original Medicare who wish to obtain prescription coverage
can do so through a stand-alone Part D plan (PDP), without needing to join an MA plan.
Medigap plans do not include drug coverage .
Q5. Mr. Capadona would like to purchase a Medicare Advantage 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 to someone enrolled in an MA plan, and Medigap
only works with Original Medicare
C) He can use both plans simultaneously
D) He can only purchase a Medigap plan if he disenrolls from Medicare entirely
Correct Answer: B
Rationale: Federal law prohibits selling a Medigap policy to someone enrolled in a
Medicare Advantage plan because Medigap cannot pay for any Medicare Advantage
plan cost-sharing or deductibles. Medigap policies only work with Original Medicare
, Q6. What is the standard duration of the Initial Enrollment Period (IEP) for a newly
eligible Medicare beneficiary turning 65?
A) 3 months
B) 6 months
C) 7 months
D) 12 months
Correct Answer: C
Rationale: The IEP is a 7-month window that includes the 3 months before the
individual turns 65, their birth month, and the 3 months following their birth month .
Q7. A beneficiary who is losing employer coverage wants to enroll in Medicare
without waiting for the Annual Election Period. What enrollment period applies?
A) Initial Enrollment Period (IEP)
B) Special Enrollment Period (SEP)
C) General Enrollment Period (GEP)
D) Medicare Advantage Open Enrollment Period (MA OEP)
Correct Answer: B
Rationale: Losing employer coverage is a qualifying event for a Special Enrollment
Period (SEP). Beneficiaries have 8 months after employment or coverage ends to enroll
in Medicare Part B without penalty .
Q8. What is the standard Part B premium based on?
A) The beneficiary's zip code
B) The beneficiary's modified adjusted gross income (MAGI)
C) The beneficiary's health status and pre-existing conditions
D) The number of years the beneficiary has been retired
Correct Answer: B
