2027 AHIP Final Exam – Medicare
Certification – Actual Questions &
Answers (AHIP) Guarantee Pass
(Updated Pdf)
SECTION I: MEDICARE BASICS & ELIGIBILITY
1. A client is turning 65 on June 15, 2027. When does their Initial Enrollment
Period (IEP) for Medicare begin and end?
A) June 1 to June 30, 2027
B) March 1 to September 30, 2027
C) April 1 to July 31, 2027
D) January 1 to December 31, 2027
Correct Answer: B
Rationale: The Initial Enrollment Period is a 7-month window: 3 months before, the
month of, and 3 months after the month of the 65th birthday. For a June birthday, the
IEP runs from March 1 through September 30 .
2. A client is 67 and currently has coverage through their employer's group health
plan with 100+ employees. They are considering Medicare. What should you
advise?
A) They must enroll in Part B immediately to avoid penalties
B) They can delay Part B without penalty while covered by the large employer plan
C) They must enroll in Part A but can delay Part B
D) They should drop employer coverage and enroll in Medicare now
, Correct Answer: B
Rationale: Individuals covered by an employer group health plan with 20+ employees
can delay Part B enrollment without penalty. When the employer coverage ends, they
are eligible for a Special Enrollment Period .
3. What is the standard monthly premium amount for Medicare Part A for most
beneficiaries who paid Medicare taxes while working?
A) $174.70 per month
B) $0 per month
C) $278.00 per month
D) $506.00 per month
Correct Answer: B
Rationale: Most beneficiaries who paid Medicare taxes for at least 40 quarters (10
years) while working receive Part A with a $0 monthly premium .
4. If a beneficiary delays enrollment in Medicare Part B when first eligible and does
not qualify for a Special Enrollment Period, what permanent financial penalty
applies?
A) A flat 50% penalty on all medical bills
B) A 10% premium penalty for each full 12-month period they delayed enrollment
C) A temporary 5% surcharge lasting for exactly two years
D) A lifetime suspension of prescription drug coverage
Correct Answer: B
Rationale: The Part B late enrollment penalty is a lifetime 10% premium increase for
each full 12-month period an individual went without Part B despite being eligible .
5. Mr. Lee was eligible for Medicare but delayed enrolling in Part D because he had
creditable coverage. He dropped that coverage in October 2027. When can he
enroll in a Part D plan without a penalty?
A) During the next AEP
B) During a 2-month Special Enrollment Period (SEP) after losing creditable coverage
C) During the Medicare Advantage Open Enrollment Period (MA-OEP)
D) He must wait 5 years
Correct Answer: B
Rationale: Beneficiaries who lose creditable coverage are granted a 63-day SEP to enroll
, in Part D without incurring the late enrollment penalty. They must enroll within 63 days
(approximately 2 months) of losing coverage .
6. A beneficiary did not enroll in Part B when first eligible. She now wants to enroll
during the General Enrollment Period (GEP). When will her coverage start?
A) The month she enrolls
B) The first day of the following month
C) July 1st of that year
D) January 1st of the following year
Correct Answer: C
Rationale: The GEP runs from January 1 to March 31. Coverage for those enrolling
during the GEP always begins on July 1 of that year .
7. If a beneficiary misses their Initial Enrollment Period (IEP) when they turn 65,
they can enroll during the General Enrollment Period (GEP). When does the GEP
take place each year?
A) January 1 – March 31
B) October 15 – December 7
C) April 1 – June 30
D) July 1 – September 30
Correct Answer: A
Rationale: The General Enrollment Period (GEP) for Medicare Parts A and B occurs
annually from January 1 through March 31 for individuals who missed enrolling when
they were first eligible .
8. A beneficiary turns 65 on August 10, 2026. She is still actively working at a
company with 150 employees and has had employer group health coverage since
age 62. She wants to delay Part B without penalty. She retires on March 15, 2027,
and employer coverage ends March 31, 2027. What is the last day of her Special
Enrollment Period (SEP) to enroll in Part B without a late enrollment penalty?
A) August 10, 2027 (12 months after turning 65)
B) September 30, 2027 (6 months after employer coverage ends)
C) November 30, 2027 (8 months after employer coverage ends)
D) December 31, 2027 (end of calendar year after coverage ends)
Correct Answer: C
Rationale: Part B SEP for active employment-based coverage lasts 8 months after
, employment ends OR group health coverage ends, whichever comes first. Coverage
ended March 31, 2027 → plus 8 months = November 30, 2027 .
9. Under Medicare Part B, what percentage of the Medicare-approved amount
does the beneficiary typically pay as coinsurance after meeting their annual
deductible?
A) 10%
B) 20%
C) 30%
D) 50%
Correct Answer: B
Rationale: For most outpatient medical services, doctor visits, preventive care, and
durable medical equipment covered under Medicare Part B, the standard beneficiary
coinsurance obligation is exactly 20% of the Medicare-approved amount .
10. Which of the following individuals is eligible to enroll in a Medicare Advantage
(MA) plan?
A) A 65-year-old with Medicare Part A only
B) A 72-year-old with Medicare Parts A and B who lives within the plan's service area
C) A 60-year-old with employer group coverage only
D) A 68-year-old who permanently resides outside the United States
Correct Answer: B
Rationale: To enroll in an MA plan, a beneficiary must be entitled to Part A, enrolled in
Part B, and reside in the plan's service area. Both Part A and Part B enrollment is
required .
11. Which of the following services is NOT covered under Medicare Part A?
A) Semi-private room in a Skilled Nursing Facility (SNF)
B) Home Health Aide services (part-time)
C) Custodial care in a nursing home (assistance with ADLs only)
D) Inpatient hospital care
Correct Answer: C
Rationale: Medicare Part A covers skilled care (medical necessity), not custodial care
(help with bathing, dressing, eating) if that is the only type of care needed. Medicare
pays for medical/skilled needs, not "room and board" or long-term custodial care .
Certification – Actual Questions &
Answers (AHIP) Guarantee Pass
(Updated Pdf)
SECTION I: MEDICARE BASICS & ELIGIBILITY
1. A client is turning 65 on June 15, 2027. When does their Initial Enrollment
Period (IEP) for Medicare begin and end?
A) June 1 to June 30, 2027
B) March 1 to September 30, 2027
C) April 1 to July 31, 2027
D) January 1 to December 31, 2027
Correct Answer: B
Rationale: The Initial Enrollment Period is a 7-month window: 3 months before, the
month of, and 3 months after the month of the 65th birthday. For a June birthday, the
IEP runs from March 1 through September 30 .
2. A client is 67 and currently has coverage through their employer's group health
plan with 100+ employees. They are considering Medicare. What should you
advise?
A) They must enroll in Part B immediately to avoid penalties
B) They can delay Part B without penalty while covered by the large employer plan
C) They must enroll in Part A but can delay Part B
D) They should drop employer coverage and enroll in Medicare now
, Correct Answer: B
Rationale: Individuals covered by an employer group health plan with 20+ employees
can delay Part B enrollment without penalty. When the employer coverage ends, they
are eligible for a Special Enrollment Period .
3. What is the standard monthly premium amount for Medicare Part A for most
beneficiaries who paid Medicare taxes while working?
A) $174.70 per month
B) $0 per month
C) $278.00 per month
D) $506.00 per month
Correct Answer: B
Rationale: Most beneficiaries who paid Medicare taxes for at least 40 quarters (10
years) while working receive Part A with a $0 monthly premium .
4. If a beneficiary delays enrollment in Medicare Part B when first eligible and does
not qualify for a Special Enrollment Period, what permanent financial penalty
applies?
A) A flat 50% penalty on all medical bills
B) A 10% premium penalty for each full 12-month period they delayed enrollment
C) A temporary 5% surcharge lasting for exactly two years
D) A lifetime suspension of prescription drug coverage
Correct Answer: B
Rationale: The Part B late enrollment penalty is a lifetime 10% premium increase for
each full 12-month period an individual went without Part B despite being eligible .
5. Mr. Lee was eligible for Medicare but delayed enrolling in Part D because he had
creditable coverage. He dropped that coverage in October 2027. When can he
enroll in a Part D plan without a penalty?
A) During the next AEP
B) During a 2-month Special Enrollment Period (SEP) after losing creditable coverage
C) During the Medicare Advantage Open Enrollment Period (MA-OEP)
D) He must wait 5 years
Correct Answer: B
Rationale: Beneficiaries who lose creditable coverage are granted a 63-day SEP to enroll
, in Part D without incurring the late enrollment penalty. They must enroll within 63 days
(approximately 2 months) of losing coverage .
6. A beneficiary did not enroll in Part B when first eligible. She now wants to enroll
during the General Enrollment Period (GEP). When will her coverage start?
A) The month she enrolls
B) The first day of the following month
C) July 1st of that year
D) January 1st of the following year
Correct Answer: C
Rationale: The GEP runs from January 1 to March 31. Coverage for those enrolling
during the GEP always begins on July 1 of that year .
7. If a beneficiary misses their Initial Enrollment Period (IEP) when they turn 65,
they can enroll during the General Enrollment Period (GEP). When does the GEP
take place each year?
A) January 1 – March 31
B) October 15 – December 7
C) April 1 – June 30
D) July 1 – September 30
Correct Answer: A
Rationale: The General Enrollment Period (GEP) for Medicare Parts A and B occurs
annually from January 1 through March 31 for individuals who missed enrolling when
they were first eligible .
8. A beneficiary turns 65 on August 10, 2026. She is still actively working at a
company with 150 employees and has had employer group health coverage since
age 62. She wants to delay Part B without penalty. She retires on March 15, 2027,
and employer coverage ends March 31, 2027. What is the last day of her Special
Enrollment Period (SEP) to enroll in Part B without a late enrollment penalty?
A) August 10, 2027 (12 months after turning 65)
B) September 30, 2027 (6 months after employer coverage ends)
C) November 30, 2027 (8 months after employer coverage ends)
D) December 31, 2027 (end of calendar year after coverage ends)
Correct Answer: C
Rationale: Part B SEP for active employment-based coverage lasts 8 months after
, employment ends OR group health coverage ends, whichever comes first. Coverage
ended March 31, 2027 → plus 8 months = November 30, 2027 .
9. Under Medicare Part B, what percentage of the Medicare-approved amount
does the beneficiary typically pay as coinsurance after meeting their annual
deductible?
A) 10%
B) 20%
C) 30%
D) 50%
Correct Answer: B
Rationale: For most outpatient medical services, doctor visits, preventive care, and
durable medical equipment covered under Medicare Part B, the standard beneficiary
coinsurance obligation is exactly 20% of the Medicare-approved amount .
10. Which of the following individuals is eligible to enroll in a Medicare Advantage
(MA) plan?
A) A 65-year-old with Medicare Part A only
B) A 72-year-old with Medicare Parts A and B who lives within the plan's service area
C) A 60-year-old with employer group coverage only
D) A 68-year-old who permanently resides outside the United States
Correct Answer: B
Rationale: To enroll in an MA plan, a beneficiary must be entitled to Part A, enrolled in
Part B, and reside in the plan's service area. Both Part A and Part B enrollment is
required .
11. Which of the following services is NOT covered under Medicare Part A?
A) Semi-private room in a Skilled Nursing Facility (SNF)
B) Home Health Aide services (part-time)
C) Custodial care in a nursing home (assistance with ADLs only)
D) Inpatient hospital care
Correct Answer: C
Rationale: Medicare Part A covers skilled care (medical necessity), not custodial care
(help with bathing, dressing, eating) if that is the only type of care needed. Medicare
pays for medical/skilled needs, not "room and board" or long-term custodial care .
