STUDY GUIDE & PRACTICE EXAM
Medicare Course Home
2026–2027 Updated Exam Test Bank
Subject: Medicare Knowledge Check: AHIP Training Final Review
Target Audience: Licensed Health Agents, Brokers, and Compliance Specialists
Format: Comprehensive 50-Question Bank with Correct Answers & Rationale
Current Edition: 2026–2027 Updated Edition (No Publisher Attributions)
This textbook-grade study bank has been professionally prepared as a student-friendly testing resource
for candidates preparing for the annual AHIP Medicare Certification. Every section is directly mapped to
the official Medicare Course Modules. It provides realistic scenarios, application questions, and detailed
compliance rationales. Questions are designed to highlight critical-thinking, commonly confused
concepts, and specific procedures to ensure complete conceptual mastery. All answers are strictly
grounded in regulatory guidelines and represent the highest standard of academic rigor.
,MEDICARE COURSE HOME — 2026–2027 UPDATED EXAM TEST BANK STUDY MATERIAL
TABLE OF CONTENTS
Chapter 1: Medicare Advantage (Part C) & Cost Plans (Q1 - Q10) Page 3
Chapter 2: Original Medicare & Medigap Coverage Basics (Q11 - Q20) Page 5
Chapter 3: Medicare Part D Prescription Drug Plans (Q21 - Q30) Page 7
Chapter 4: Centers for Medicare & Medicaid Services (CMS) Marketing Guidelines
Page 9
(Q31 - Q40)
Chapter 5: Medicare Enrollment, Eligibility & Special Election Periods (Q41 - Q50) Page 11
METHODOLOGY & STUDY GUIDE USAGE
Candidates should approach this practice exam in a simulated test environment, allocating
approximately 2 minutes per question. It is critical to analyze not just why the correct answer is right,
but also why the other options are incorrect. The detailed explanations provided under each question
are drafted to reinforce the core compliance guidelines established by the Centers for Medicare &
Medicaid Services (CMS). Pay special attention to Special Election Periods (SEPs), late enrollment
penalties, and non-preempted state agent licensing rules, which are historically the most frequently
tested concepts on the exam.
Key Learning Objectives Covered:
• Identify the core benefits, limitations, and operational rules of Private Fee-for-Service (PFFS) and
Medicare Cost plans.
• Recognize Medigap enrollment constraints, specifically illegal dual-enrollment with Medicare
Advantage plans.
• Calculate Medicare Part A work quarters and standard Part D cost-sharing phases based on standard
benefit designs.
• Outline CMS compliance regulations regarding nominal-value gifts, hospital marketing restrictions,
and educational events.
• Determine valid Special Election Periods (SEPs) for geographic relocation, retirement transitions, and
disability entitlements.
Medicare Knowledge Check: AHIP Training Final Review Page 2
,MEDICARE COURSE HOME — 2026–2027 UPDATED EXAM TEST BANK STUDY MATERIAL
CHAPTER 1: Medicare Advantage (Part C) & Cost Plans
Covers PFFS plans, MSA accounts, Special Needs Plans (SNPs), Cost Plans, eligibility, and core
differences between private plans and Original Medicare.
Question 1
Dr. Elizabeth Brennan does not contract with the PFFS plan but accepts the plan’s terms
and conditions for payment. Mary Rodgers sees Dr. Brennan for treatment. How much may
Dr. Brennan charge?
A. Dr. Brennan can charge Mary no more than the cost sharing specified in the PFFS plan’s terms and
conditions of payment which may include balance billing up to 25 percent of the Medicare rate.
B. Dr. Brennan can charge the beneficiary the same costsharing as Original Medicare as long as she
sends the claim to Medicare and not the plan.
C. Dr. Brennan can charge Mary Rodgers more than the cost sharing specified in the PFFS plan’s terms
and conditions as long as she treats all beneficiaries the same.
D. Dr. Brennan can charge Mary Rogers no more than the cost sharing specified in the PFFS plan’s
terms and condition of payment which may include balance billing up to 15 percent of the Medicare rate.
ANSWER : D
Explanation: Under a Private Fee-for-Service (PFFS) plan, a non-contracting provider who accepts the plan's
terms of payment may not charge more than the plan's cost sharing, which may include balance billing of up
to 15 percent of the Medicare rate. Balance billing is limited to a maximum of 15% of the Medicare fee
schedule rate for non-participating providers.
Medicare Knowledge Check: AHIP Training Final Review Page 3
, MEDICARE COURSE HOME — 2026–2027 UPDATED EXAM TEST BANK STUDY MATERIAL
Question 2
Mrs. Davenport enrolled in the ABC Medicare Advantage (MA) plan several years ago. Her
doctor recently confirmed a diagnosis of end-stage renal disease (ESRD). What options
does Mrs. Davenport have in regard to her MA plan during the next open enrollment
season?
A. She must immediately drop her ABC MA plan and enroll in a Special Needs Plan (SNP) for
individuals suffering from ESRD if one is available in her area.
B. She may remain in her ABC MA plan or enroll in a Special Needs Plan (SNP) for individuals suffering
from ESRD if one is available in her area.
C. She must remain enrolled in her ABC MA plan unless the plan terminates.
D. She must immediately drop her ABC MA plan and enroll in Original Medicare.
ANSWER : B
Explanation: Beneficiaries who develop End-Stage Renal Disease (ESRD) while enrolled in a Medicare
Advantage plan are permitted to remain in their current plan. During open enrollment, they also have the
option to switch to an ESRD Special Needs Plan (SNP) if there is one operating in their service area, or they
can choose to return to Original Medicare.
Question 3
Mrs. Lyons is in good health, uses a single prescription, and lives independently in her own
home. She is attracted by the idea of maintaining control over a Medical Savings Account
(MSA) but is not sure if the plan associated with the account will fit her needs. What
specific piece of information about a Medicare MSA plan would it be important for her to
know, prior to enrolling in such a plan?
A. All MSAs cover Part A and Part B benefits, but not Part D prescription drug benefits, which could be
obtained by also enrolling in a separate prescription drug plan.
B. For enrollees in an MSA, after the annual deductible is met, the MSA plan generally pays 75% of
covered services.
C. MSA enrollees may only receive covered health care services from a limited panel of network
providers because otherwise some providers may charge more than Original Medicare rates.
D. All beneficiaries enrolled in an MSA pay a plan premium in addition to their Part B premium.
ANSWER : A
Explanation: Medicare Medical Savings Account (MSA) plans do not provide Part D prescription drug
coverage. To obtain drug coverage, beneficiaries enrolled in an MSA must join a separate, stand-alone
Prescription Drug Plan (PDP). MSAs do not charge premiums in addition to the standard Part B premium, and
they must cover all Part A and Part B benefits after the deductible is met.
Medicare Knowledge Check: AHIP Training Final Review Page 4
Medicare Course Home
2026–2027 Updated Exam Test Bank
Subject: Medicare Knowledge Check: AHIP Training Final Review
Target Audience: Licensed Health Agents, Brokers, and Compliance Specialists
Format: Comprehensive 50-Question Bank with Correct Answers & Rationale
Current Edition: 2026–2027 Updated Edition (No Publisher Attributions)
This textbook-grade study bank has been professionally prepared as a student-friendly testing resource
for candidates preparing for the annual AHIP Medicare Certification. Every section is directly mapped to
the official Medicare Course Modules. It provides realistic scenarios, application questions, and detailed
compliance rationales. Questions are designed to highlight critical-thinking, commonly confused
concepts, and specific procedures to ensure complete conceptual mastery. All answers are strictly
grounded in regulatory guidelines and represent the highest standard of academic rigor.
,MEDICARE COURSE HOME — 2026–2027 UPDATED EXAM TEST BANK STUDY MATERIAL
TABLE OF CONTENTS
Chapter 1: Medicare Advantage (Part C) & Cost Plans (Q1 - Q10) Page 3
Chapter 2: Original Medicare & Medigap Coverage Basics (Q11 - Q20) Page 5
Chapter 3: Medicare Part D Prescription Drug Plans (Q21 - Q30) Page 7
Chapter 4: Centers for Medicare & Medicaid Services (CMS) Marketing Guidelines
Page 9
(Q31 - Q40)
Chapter 5: Medicare Enrollment, Eligibility & Special Election Periods (Q41 - Q50) Page 11
METHODOLOGY & STUDY GUIDE USAGE
Candidates should approach this practice exam in a simulated test environment, allocating
approximately 2 minutes per question. It is critical to analyze not just why the correct answer is right,
but also why the other options are incorrect. The detailed explanations provided under each question
are drafted to reinforce the core compliance guidelines established by the Centers for Medicare &
Medicaid Services (CMS). Pay special attention to Special Election Periods (SEPs), late enrollment
penalties, and non-preempted state agent licensing rules, which are historically the most frequently
tested concepts on the exam.
Key Learning Objectives Covered:
• Identify the core benefits, limitations, and operational rules of Private Fee-for-Service (PFFS) and
Medicare Cost plans.
• Recognize Medigap enrollment constraints, specifically illegal dual-enrollment with Medicare
Advantage plans.
• Calculate Medicare Part A work quarters and standard Part D cost-sharing phases based on standard
benefit designs.
• Outline CMS compliance regulations regarding nominal-value gifts, hospital marketing restrictions,
and educational events.
• Determine valid Special Election Periods (SEPs) for geographic relocation, retirement transitions, and
disability entitlements.
Medicare Knowledge Check: AHIP Training Final Review Page 2
,MEDICARE COURSE HOME — 2026–2027 UPDATED EXAM TEST BANK STUDY MATERIAL
CHAPTER 1: Medicare Advantage (Part C) & Cost Plans
Covers PFFS plans, MSA accounts, Special Needs Plans (SNPs), Cost Plans, eligibility, and core
differences between private plans and Original Medicare.
Question 1
Dr. Elizabeth Brennan does not contract with the PFFS plan but accepts the plan’s terms
and conditions for payment. Mary Rodgers sees Dr. Brennan for treatment. How much may
Dr. Brennan charge?
A. Dr. Brennan can charge Mary no more than the cost sharing specified in the PFFS plan’s terms and
conditions of payment which may include balance billing up to 25 percent of the Medicare rate.
B. Dr. Brennan can charge the beneficiary the same costsharing as Original Medicare as long as she
sends the claim to Medicare and not the plan.
C. Dr. Brennan can charge Mary Rodgers more than the cost sharing specified in the PFFS plan’s terms
and conditions as long as she treats all beneficiaries the same.
D. Dr. Brennan can charge Mary Rogers no more than the cost sharing specified in the PFFS plan’s
terms and condition of payment which may include balance billing up to 15 percent of the Medicare rate.
ANSWER : D
Explanation: Under a Private Fee-for-Service (PFFS) plan, a non-contracting provider who accepts the plan's
terms of payment may not charge more than the plan's cost sharing, which may include balance billing of up
to 15 percent of the Medicare rate. Balance billing is limited to a maximum of 15% of the Medicare fee
schedule rate for non-participating providers.
Medicare Knowledge Check: AHIP Training Final Review Page 3
, MEDICARE COURSE HOME — 2026–2027 UPDATED EXAM TEST BANK STUDY MATERIAL
Question 2
Mrs. Davenport enrolled in the ABC Medicare Advantage (MA) plan several years ago. Her
doctor recently confirmed a diagnosis of end-stage renal disease (ESRD). What options
does Mrs. Davenport have in regard to her MA plan during the next open enrollment
season?
A. She must immediately drop her ABC MA plan and enroll in a Special Needs Plan (SNP) for
individuals suffering from ESRD if one is available in her area.
B. She may remain in her ABC MA plan or enroll in a Special Needs Plan (SNP) for individuals suffering
from ESRD if one is available in her area.
C. She must remain enrolled in her ABC MA plan unless the plan terminates.
D. She must immediately drop her ABC MA plan and enroll in Original Medicare.
ANSWER : B
Explanation: Beneficiaries who develop End-Stage Renal Disease (ESRD) while enrolled in a Medicare
Advantage plan are permitted to remain in their current plan. During open enrollment, they also have the
option to switch to an ESRD Special Needs Plan (SNP) if there is one operating in their service area, or they
can choose to return to Original Medicare.
Question 3
Mrs. Lyons is in good health, uses a single prescription, and lives independently in her own
home. She is attracted by the idea of maintaining control over a Medical Savings Account
(MSA) but is not sure if the plan associated with the account will fit her needs. What
specific piece of information about a Medicare MSA plan would it be important for her to
know, prior to enrolling in such a plan?
A. All MSAs cover Part A and Part B benefits, but not Part D prescription drug benefits, which could be
obtained by also enrolling in a separate prescription drug plan.
B. For enrollees in an MSA, after the annual deductible is met, the MSA plan generally pays 75% of
covered services.
C. MSA enrollees may only receive covered health care services from a limited panel of network
providers because otherwise some providers may charge more than Original Medicare rates.
D. All beneficiaries enrolled in an MSA pay a plan premium in addition to their Part B premium.
ANSWER : A
Explanation: Medicare Medical Savings Account (MSA) plans do not provide Part D prescription drug
coverage. To obtain drug coverage, beneficiaries enrolled in an MSA must join a separate, stand-alone
Prescription Drug Plan (PDP). MSAs do not charge premiums in addition to the standard Part B premium, and
they must cover all Part A and Part B benefits after the deductible is met.
Medicare Knowledge Check: AHIP Training Final Review Page 4
