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AHIP Medicare Certification – Study Guide & Original Practice Q&A Bank Original Practice
Questions with Answers & Detailed Rationales
Key Content Areas in this EXAM FOCUS!!!!!
1. Medicare Basics and Eligibility
• Medicare Parts A, B, C, D
• Eligibility requirements (age 65+, disability, ESRD, ALS)
• Enrollment periods (IEP, GEP, SEP, AEP, OEP)
• Medicare cards and identifiers
2. Medicare Part A (Hospital Insurance)
• Covered services (inpatient hospital, SNF, home health, hospice)
• Benefit periods and deductibles
• Coinsurance and lifetime reserve days
3. Medicare Part B (Medical Insurance)
• Covered services (physician, outpatient, preventive)
• Deductible and coinsurance (80/20)
• Premiums and IRMAA
• Preventive services covered
4. Medicare Part C (Medicare Advantage)
• Types of MA plans (HMO, PPO, PFFS, SNP)
• Eligibility and enrollment
• Plan networks and prior authorization
• Maximum out-of-pocket limits
• Marketing and enrollment guidelines
5. Medicare Part D (Prescription Drug Coverage)
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• Eligibility and enrollment
• Formularies and tiers
• Coverage gap (donut hole) and catastrophic coverage
• Late enrollment penalty
• TrOOP (True Out-of-Pocket) costs
6. Medicare Supplement (Medigap)
• Standardized plans (A-N)
• Guaranteed issue rights
• Open enrollment period
• What Medigap does NOT cover
7. Compliance and Fraud, Waste, and Abuse (FWA)
• Marketing guidelines and prohibited activities
• Scope of appointment
• Permission to contact
• Fraud, waste, and abuse definitions
• Reporting requirements
8. Enrollment and Eligibility
• Initial Enrollment Period (IEP)
• Annual Election Period (AEP): Oct 15 – Dec 7
• Medicare Advantage Open Enrollment Period: Jan 1 – Mar 31
• Special Election Periods (SEPs)
• Late enrollment penalties
Original Questions
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1. A beneficiary is turning 65. When does their Initial
Enrollment Period (IEP) begin?
A. 3 months before the month of their 65th birthday
B. The month of their 65th birthday
C. 3 months after their 65th birthday
D. 6 months before their 65th birthday
Answer: A
Rationale: The IEP is a 7-month period that begins 3 months
before the month of the 65th birthday, includes the birthday
month, and ends 3 months after.
2. Which of the following is covered under Medicare Part A?
A. Inpatient hospital stays
B. Outpatient physician visits
C. Prescription drugs (outpatient)
D. Routine dental care
Answer: A
Rationale: Part A covers inpatient hospital, skilled nursing
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facility, home health, and hospice. Part B covers outpatient
services.
3. A Medicare beneficiary is admitted to the hospital for the
first time in a benefit period. What is the Part A deductible
for 2026?
A. $1,632 (subject to annual adjustment)
B. $1,000
C. $2,000
D. There is no deductible
**Answer: A**
Rationale: The Part A deductible changes annually; for 2025
it is $1,632, and for 2026 it may increase. The question uses
2026, so the correct answer reflects the current year's
deductible, which is subject to change.
4. What is the Medicare Part B coinsurance for most covered
services after the deductible is met?
A. 20%
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AHIP Medicare Certification – Study Guide & Original Practice Q&A Bank Original Practice
Questions with Answers & Detailed Rationales
Key Content Areas in this EXAM FOCUS!!!!!
1. Medicare Basics and Eligibility
• Medicare Parts A, B, C, D
• Eligibility requirements (age 65+, disability, ESRD, ALS)
• Enrollment periods (IEP, GEP, SEP, AEP, OEP)
• Medicare cards and identifiers
2. Medicare Part A (Hospital Insurance)
• Covered services (inpatient hospital, SNF, home health, hospice)
• Benefit periods and deductibles
• Coinsurance and lifetime reserve days
3. Medicare Part B (Medical Insurance)
• Covered services (physician, outpatient, preventive)
• Deductible and coinsurance (80/20)
• Premiums and IRMAA
• Preventive services covered
4. Medicare Part C (Medicare Advantage)
• Types of MA plans (HMO, PPO, PFFS, SNP)
• Eligibility and enrollment
• Plan networks and prior authorization
• Maximum out-of-pocket limits
• Marketing and enrollment guidelines
5. Medicare Part D (Prescription Drug Coverage)
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• Eligibility and enrollment
• Formularies and tiers
• Coverage gap (donut hole) and catastrophic coverage
• Late enrollment penalty
• TrOOP (True Out-of-Pocket) costs
6. Medicare Supplement (Medigap)
• Standardized plans (A-N)
• Guaranteed issue rights
• Open enrollment period
• What Medigap does NOT cover
7. Compliance and Fraud, Waste, and Abuse (FWA)
• Marketing guidelines and prohibited activities
• Scope of appointment
• Permission to contact
• Fraud, waste, and abuse definitions
• Reporting requirements
8. Enrollment and Eligibility
• Initial Enrollment Period (IEP)
• Annual Election Period (AEP): Oct 15 – Dec 7
• Medicare Advantage Open Enrollment Period: Jan 1 – Mar 31
• Special Election Periods (SEPs)
• Late enrollment penalties
Original Questions
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1. A beneficiary is turning 65. When does their Initial
Enrollment Period (IEP) begin?
A. 3 months before the month of their 65th birthday
B. The month of their 65th birthday
C. 3 months after their 65th birthday
D. 6 months before their 65th birthday
Answer: A
Rationale: The IEP is a 7-month period that begins 3 months
before the month of the 65th birthday, includes the birthday
month, and ends 3 months after.
2. Which of the following is covered under Medicare Part A?
A. Inpatient hospital stays
B. Outpatient physician visits
C. Prescription drugs (outpatient)
D. Routine dental care
Answer: A
Rationale: Part A covers inpatient hospital, skilled nursing
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facility, home health, and hospice. Part B covers outpatient
services.
3. A Medicare beneficiary is admitted to the hospital for the
first time in a benefit period. What is the Part A deductible
for 2026?
A. $1,632 (subject to annual adjustment)
B. $1,000
C. $2,000
D. There is no deductible
**Answer: A**
Rationale: The Part A deductible changes annually; for 2025
it is $1,632, and for 2026 it may increase. The question uses
2026, so the correct answer reflects the current year's
deductible, which is subject to change.
4. What is the Medicare Part B coinsurance for most covered
services after the deductible is met?
A. 20%
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