AHIP 2027 Medicare Advantage & Part D
Certification – Practice Exam
(Original Study Questions – Not Actual AHIP Items)
Instructions:
One best answer per question.
Correct answer: bold.
Rationale: italics.
Medicare Basics & Eligibility (1–20)
1. Which statement best describes who is eligible for Medicare Part A at age
65?
A. Only U.S. citizens
B. U.S. citizens and permanent residents who have worked and paid
Medicare taxes for at least 10 years (or qualify through a spouse)
C. Only people with disabilities
D. Only people with end-stage renal disease (ESRD)
Answer: B
Rationale: Part A at 65 is generally available to citizens and certain permanent
residents with sufficient work history (or via a spouse), not only citizens or only
those with disabilities/ESRD.
2. A 67-year-old permanent resident has lived in the U.S. for 6 years and has
never worked or paid Medicare taxes. How can they potentially qualify for
Part A?
A. They cannot qualify under any circumstances
B. They may buy Part A if they meet specific residency and enrollment
requirements
C. They automatically get Part A for free
D. They qualify only if they have ESRD
,Answer: B
Rationale: Some individuals who don’t have enough work credits can purchase
Part A if they meet age, residency, and other criteria.
3. Which part of Medicare primarily covers inpatient hospital care?
A. Part A
B. Part B
C. Part C
D. Part D
Answer: A
Rationale: Part A is hospital insurance covering inpatient stays, skilled nursing
facility care (under conditions), hospice, and some home health.
4. Medicare Part B primarily covers:
A. Inpatient hospital stays
B. Outpatient medical services, physician services, and preventive care
C. Prescription drugs only
D. Long-term custodial care in nursing homes
Answer: B
Rationale: Part B covers medically necessary outpatient services, doctor visits,
preventive services, and some home health.
5. Which of the following is generally NOT covered by Original Medicare (Parts
A & B)?
A. Medically necessary hospital care
B. Routine dental care (cleanings, fillings, dentures)
C. Physician office visits
D. Home health services under certain conditions
Answer: B
Rationale: Original Medicare generally excludes routine dental, vision, and hearing
services, with limited exceptions.
6. Who is automatically enrolled in Medicare Parts A and B at age 65?
A. Everyone turning 65
B. Individuals already receiving Social Security or Railroad Retirement Board
benefits
, C. Only people with Medicaid
D. Only veterans
Answer: B
Rationale: People already receiving SS or RRB benefits before 65 are typically
auto-enrolled in Parts A and B.
7. A person under 65 may qualify for Medicare primarily due to:
A. Having a high income
B. Being unemployed
C. Having certain disabilities or ESRD/ALS
D. Being a full-time student
Answer: C
Rationale: Under-65 eligibility is generally based on qualifying disabilities, ESRD, or
ALS.
8. The Initial Enrollment Period (IEP) for Medicare is:
A. 3 months before to 3 months after the 65th birthday month
B. 6 months before to 6 months after the 65th birthday month
C. 7 months: 3 months before, the birthday month, and 3 months after
D. Only the birthday month
Answer: C
Rationale: The IEP spans 7 months centered on the 65th birthday month.
9. If someone delays Part B enrollment beyond their IEP and does not have
qualifying coverage, they may face:
A. A one-time fine only
B. A lifetime late enrollment penalty added to the Part B premium
C. Loss of eligibility for Part B forever
D. No consequences
Answer: B
Rationale: Late enrollment without qualifying coverage can result in a permanent
Part B premium penalty.
10.Which program helps people with limited income and resources pay
Medicare costs?
, A. Medigap
B. Medicare Savings Programs (MSP) and Extra Help
C. COBRA
D. Workers’ Compensation
Answer: B
Rationale: MSPs and Extra Help (Low-Income Subsidy) assist with premiums,
deductibles, and drug costs for eligible individuals.
11.Medicare Advantage (Part C) plans are offered by:
A. Only the federal government
B. Private insurance companies approved by Medicare
C. Employers only
D. State governments
Answer: B
Rationale: MA plans are offered by private insurers under contract with Medicare.
12.To join a Medicare Advantage plan, a person must:
A. Have only Part A
B. Have both Part A and Part B and live in the plan’s service area
C. Have Part D only
D. Have Medicaid only
Answer: B
Rationale: MA enrollment requires Parts A and B and residence in the plan’s
service area (with some exceptions).
13.Which of the following is true about Medicare Part D?
A. It is included automatically in Original Medicare
B. It provides outpatient prescription drug coverage through private plans
C. It covers all medications with no cost sharing
D. It is only for people in Medicare Advantage
Answer: B
Rationale: Part D is optional drug coverage offered through private plans; it is not
automatic with Original Medicare.
Certification – Practice Exam
(Original Study Questions – Not Actual AHIP Items)
Instructions:
One best answer per question.
Correct answer: bold.
Rationale: italics.
Medicare Basics & Eligibility (1–20)
1. Which statement best describes who is eligible for Medicare Part A at age
65?
A. Only U.S. citizens
B. U.S. citizens and permanent residents who have worked and paid
Medicare taxes for at least 10 years (or qualify through a spouse)
C. Only people with disabilities
D. Only people with end-stage renal disease (ESRD)
Answer: B
Rationale: Part A at 65 is generally available to citizens and certain permanent
residents with sufficient work history (or via a spouse), not only citizens or only
those with disabilities/ESRD.
2. A 67-year-old permanent resident has lived in the U.S. for 6 years and has
never worked or paid Medicare taxes. How can they potentially qualify for
Part A?
A. They cannot qualify under any circumstances
B. They may buy Part A if they meet specific residency and enrollment
requirements
C. They automatically get Part A for free
D. They qualify only if they have ESRD
,Answer: B
Rationale: Some individuals who don’t have enough work credits can purchase
Part A if they meet age, residency, and other criteria.
3. Which part of Medicare primarily covers inpatient hospital care?
A. Part A
B. Part B
C. Part C
D. Part D
Answer: A
Rationale: Part A is hospital insurance covering inpatient stays, skilled nursing
facility care (under conditions), hospice, and some home health.
4. Medicare Part B primarily covers:
A. Inpatient hospital stays
B. Outpatient medical services, physician services, and preventive care
C. Prescription drugs only
D. Long-term custodial care in nursing homes
Answer: B
Rationale: Part B covers medically necessary outpatient services, doctor visits,
preventive services, and some home health.
5. Which of the following is generally NOT covered by Original Medicare (Parts
A & B)?
A. Medically necessary hospital care
B. Routine dental care (cleanings, fillings, dentures)
C. Physician office visits
D. Home health services under certain conditions
Answer: B
Rationale: Original Medicare generally excludes routine dental, vision, and hearing
services, with limited exceptions.
6. Who is automatically enrolled in Medicare Parts A and B at age 65?
A. Everyone turning 65
B. Individuals already receiving Social Security or Railroad Retirement Board
benefits
, C. Only people with Medicaid
D. Only veterans
Answer: B
Rationale: People already receiving SS or RRB benefits before 65 are typically
auto-enrolled in Parts A and B.
7. A person under 65 may qualify for Medicare primarily due to:
A. Having a high income
B. Being unemployed
C. Having certain disabilities or ESRD/ALS
D. Being a full-time student
Answer: C
Rationale: Under-65 eligibility is generally based on qualifying disabilities, ESRD, or
ALS.
8. The Initial Enrollment Period (IEP) for Medicare is:
A. 3 months before to 3 months after the 65th birthday month
B. 6 months before to 6 months after the 65th birthday month
C. 7 months: 3 months before, the birthday month, and 3 months after
D. Only the birthday month
Answer: C
Rationale: The IEP spans 7 months centered on the 65th birthday month.
9. If someone delays Part B enrollment beyond their IEP and does not have
qualifying coverage, they may face:
A. A one-time fine only
B. A lifetime late enrollment penalty added to the Part B premium
C. Loss of eligibility for Part B forever
D. No consequences
Answer: B
Rationale: Late enrollment without qualifying coverage can result in a permanent
Part B premium penalty.
10.Which program helps people with limited income and resources pay
Medicare costs?
, A. Medigap
B. Medicare Savings Programs (MSP) and Extra Help
C. COBRA
D. Workers’ Compensation
Answer: B
Rationale: MSPs and Extra Help (Low-Income Subsidy) assist with premiums,
deductibles, and drug costs for eligible individuals.
11.Medicare Advantage (Part C) plans are offered by:
A. Only the federal government
B. Private insurance companies approved by Medicare
C. Employers only
D. State governments
Answer: B
Rationale: MA plans are offered by private insurers under contract with Medicare.
12.To join a Medicare Advantage plan, a person must:
A. Have only Part A
B. Have both Part A and Part B and live in the plan’s service area
C. Have Part D only
D. Have Medicaid only
Answer: B
Rationale: MA enrollment requires Parts A and B and residence in the plan’s
service area (with some exceptions).
13.Which of the following is true about Medicare Part D?
A. It is included automatically in Original Medicare
B. It provides outpatient prescription drug coverage through private plans
C. It covers all medications with no cost sharing
D. It is only for people in Medicare Advantage
Answer: B
Rationale: Part D is optional drug coverage offered through private plans; it is not
automatic with Original Medicare.
