AHIP 2027 Final Exam – Medicare Certification –
Actual Questions & Answers (AHIP) Guarantee Pass
1. Larry Miller is an Original Medicare beneficiary with Parts A and B coverage.
Larry is admitted to Good Care Hospital in January with pneumonia and stays for
three days before being discharged. Six months later in July, Larry takes a bad
fall and is admitted to Good Care Hospital with a broken leg. After emergency
surgery to repair his broken leg, Larry is hospitalized for a week before being
discharged home. In December, Larry is admitted to Mount Wellness Hospital once
again with a serious case of the flu. For how many Part A deductibles will Larry be
responsible for?
A. One Part A deductible
B. Two Part A deductibles
C. Larry will be responsible for three Part A deductibles.
D. Larry will not have to pay any Part A deductibles.
Correct Answer: C
Expert Rationale:
The Medicare Part A hospital deductible applies to each benefit period, not
annually. A benefit period begins the day a beneficiary is admitted as an inpatient
and ends when they have not received inpatient care for 60 consecutive days.
Larry's three hospitalizations (January, July, December) each represent separate
benefit periods because they are separated by more than 60 days. Therefore, he
owes three separate Part A deductibles.
,2. Kevin Birch enrolled in Original Medicare (Parts A and B). Mr. Birch has been
receiving rehabilitation services in a skilled nursing facility. He calls you to say
that he has just received a notice that Medicare will no longer cover his stay and
he still cannot walk properly. He thinks they are ending his services too soon.
What do you tell him?
A. He should accept the decision and prepare for discharge immediately.
B. He should follow the directions on the notice to file a fast appeal. Mr. Birch
should file it by noon of the calendar day following receipt of the provider's notice
of termination of services.
C. He must wait until he is discharged to file a standard grievance with Medicare.
D. He must contact his local state Medicaid office to secure coverage for the
remaining days.
Correct Answer: B
Expert Rationale:
When a beneficiary receives a Notice of Medicare Non-Coverage (NOMNC) from a
skilled nursing facility, home health agency, or comprehensive outpatient
rehabilitation facility, they have the right to an expedited (fast) appeal through the
Quality Improvement Organization (QIO). To exercise this right, the beneficiary
must submit the appeal request no later than noon of the calendar day following
receipt of the written notice.
3. A beneficiary wants to enroll in a Medicare Part D prescription drug plan. Which
of the following is a strict eligibility requirement for enrolling in a stand-alone
Prescription Drug Plan (PDP)?
,A. The individual must be enrolled in both Medicare Part A and Part B.
B. The individual must be entitled to Medicare Part A and/or enrolled in Part B,
and live in the plan's service area.
C. The individual must not have any pre-existing chronic medical conditions.
D. The individual must have an income below 150% of the Federal Poverty Level.
Correct Answer: B
Expert Rationale:
To be eligible to enroll in a stand-alone Medicare Part D Prescription Drug Plan
(PDP), an individual must be entitled to Part A and/or enrolled in Part B.
Additionally, they must reside within the geographic service area served by the
specific Part D plan. They do not need to be enrolled in both Part A and Part B
simultaneously, which differentiates PDP eligibility from Medicare Advantage
enrollment.
4. An agent is conducting a formal sales presentation for a Medicare Advantage
plan. Under CMS guidelines, which of the following activities is the agent permitted
to perform?
A. Comparing the plan to a competitor's product using unapproved, self-made
marketing material.
B. Requiring attendees to fill out a contact information sheet as a prerequisite for
entering the room.
C. Distributing official, CMS-approved plan ratings and summary of benefits
documents to attendees.
D. Directing attendees toward specific individual health insurance plans outside of
Medicare.
Correct Answer: C
, Expert Rationale:
During a formal Medicare marketing or sales event, agents are required to use
CMS-approved materials to explain plan details accurately. Distributing the
Summary of Benefits, Star Ratings, and official enrollment forms is completely
permissible. Requiring contact info for entry or utilizing unapproved materials
violates CMS guidelines.
5. Mrs. Davis is a Medicare beneficiary who forgot to enroll in Medicare Part B
when she first became eligible at age 65. She does not qualify for a Special
Enrollment Period (SEP). During which annual window can she enroll in Part B, and
when will her coverage begin?
A. The Annual Election Period (AEP) from October 15 to December 7; coverage
begins January 1.
B. The General Enrollment Period (GEP) from January 1 to March 31; coverage
begins the first of the month following enrollment.
C. The Open Enrollment Period (OEP) from January 1 to March 31; coverage begins
July 1.
D. The Special Election Period from June 1 to August 31; coverage begins
immediately.
Correct Answer: B
Expert Rationale:
Individuals who miss their Initial Enrollment Period and do not qualify for an SEP
must use the General Enrollment Period (GEP), which runs annually from January 1
through March 31. Under current CMS rules, coverage becomes effective on the
first day of the month following the month in which they enroll during the GEP.
Actual Questions & Answers (AHIP) Guarantee Pass
1. Larry Miller is an Original Medicare beneficiary with Parts A and B coverage.
Larry is admitted to Good Care Hospital in January with pneumonia and stays for
three days before being discharged. Six months later in July, Larry takes a bad
fall and is admitted to Good Care Hospital with a broken leg. After emergency
surgery to repair his broken leg, Larry is hospitalized for a week before being
discharged home. In December, Larry is admitted to Mount Wellness Hospital once
again with a serious case of the flu. For how many Part A deductibles will Larry be
responsible for?
A. One Part A deductible
B. Two Part A deductibles
C. Larry will be responsible for three Part A deductibles.
D. Larry will not have to pay any Part A deductibles.
Correct Answer: C
Expert Rationale:
The Medicare Part A hospital deductible applies to each benefit period, not
annually. A benefit period begins the day a beneficiary is admitted as an inpatient
and ends when they have not received inpatient care for 60 consecutive days.
Larry's three hospitalizations (January, July, December) each represent separate
benefit periods because they are separated by more than 60 days. Therefore, he
owes three separate Part A deductibles.
,2. Kevin Birch enrolled in Original Medicare (Parts A and B). Mr. Birch has been
receiving rehabilitation services in a skilled nursing facility. He calls you to say
that he has just received a notice that Medicare will no longer cover his stay and
he still cannot walk properly. He thinks they are ending his services too soon.
What do you tell him?
A. He should accept the decision and prepare for discharge immediately.
B. He should follow the directions on the notice to file a fast appeal. Mr. Birch
should file it by noon of the calendar day following receipt of the provider's notice
of termination of services.
C. He must wait until he is discharged to file a standard grievance with Medicare.
D. He must contact his local state Medicaid office to secure coverage for the
remaining days.
Correct Answer: B
Expert Rationale:
When a beneficiary receives a Notice of Medicare Non-Coverage (NOMNC) from a
skilled nursing facility, home health agency, or comprehensive outpatient
rehabilitation facility, they have the right to an expedited (fast) appeal through the
Quality Improvement Organization (QIO). To exercise this right, the beneficiary
must submit the appeal request no later than noon of the calendar day following
receipt of the written notice.
3. A beneficiary wants to enroll in a Medicare Part D prescription drug plan. Which
of the following is a strict eligibility requirement for enrolling in a stand-alone
Prescription Drug Plan (PDP)?
,A. The individual must be enrolled in both Medicare Part A and Part B.
B. The individual must be entitled to Medicare Part A and/or enrolled in Part B,
and live in the plan's service area.
C. The individual must not have any pre-existing chronic medical conditions.
D. The individual must have an income below 150% of the Federal Poverty Level.
Correct Answer: B
Expert Rationale:
To be eligible to enroll in a stand-alone Medicare Part D Prescription Drug Plan
(PDP), an individual must be entitled to Part A and/or enrolled in Part B.
Additionally, they must reside within the geographic service area served by the
specific Part D plan. They do not need to be enrolled in both Part A and Part B
simultaneously, which differentiates PDP eligibility from Medicare Advantage
enrollment.
4. An agent is conducting a formal sales presentation for a Medicare Advantage
plan. Under CMS guidelines, which of the following activities is the agent permitted
to perform?
A. Comparing the plan to a competitor's product using unapproved, self-made
marketing material.
B. Requiring attendees to fill out a contact information sheet as a prerequisite for
entering the room.
C. Distributing official, CMS-approved plan ratings and summary of benefits
documents to attendees.
D. Directing attendees toward specific individual health insurance plans outside of
Medicare.
Correct Answer: C
, Expert Rationale:
During a formal Medicare marketing or sales event, agents are required to use
CMS-approved materials to explain plan details accurately. Distributing the
Summary of Benefits, Star Ratings, and official enrollment forms is completely
permissible. Requiring contact info for entry or utilizing unapproved materials
violates CMS guidelines.
5. Mrs. Davis is a Medicare beneficiary who forgot to enroll in Medicare Part B
when she first became eligible at age 65. She does not qualify for a Special
Enrollment Period (SEP). During which annual window can she enroll in Part B, and
when will her coverage begin?
A. The Annual Election Period (AEP) from October 15 to December 7; coverage
begins January 1.
B. The General Enrollment Period (GEP) from January 1 to March 31; coverage
begins the first of the month following enrollment.
C. The Open Enrollment Period (OEP) from January 1 to March 31; coverage begins
July 1.
D. The Special Election Period from June 1 to August 31; coverage begins
immediately.
Correct Answer: B
Expert Rationale:
Individuals who miss their Initial Enrollment Period and do not qualify for an SEP
must use the General Enrollment Period (GEP), which runs annually from January 1
through March 31. Under current CMS rules, coverage becomes effective on the
first day of the month following the month in which they enroll during the GEP.
