AHIP Final Exam 2027 | Practice Questions &
Verified Answers | Complete Exam Prep
Welcome to this 2027 AHIP Final Exam practice resource. This comprehensive study guide contains
questions covering Medicare Parts A, B, C, and D, Medigap, enrollment periods, marketing
guidelines, and beneficiary counseling scenarios. Each question includes the correct answer and a
concise rationale for exam preparation.
Key Topics Covered
• Medicare Part A – Hospital insurance, skilled nursing facility coverage, inpatient psychiatric care
• Medicare Part B – Physician services, preventive services, premiums, deductibles, copayments
• Medicare Part C (Medicare Advantage) – HMOs, PPOs, PFFS, MSA, SNPs, eligibility, enrollment periods
• Medicare Part D – Prescription drug coverage, formularies, tiers, TrOOP, Medicare Prescription
Payment Plan
• Medigap – Supplemental insurance, Plan F availability, coordination with Original Medicare
• Enrollment Periods – IEP, AEP, MA OEP, SEP, ICEP
• Marketing Guidelines – Educational events, scope of appointment, gifts, TMO requirements
• Special Populations – ESRD, dual eligible, LEP individuals, low-income subsidies
1. Mrs. Shields is covered by Original Medicare. She sustained a hip fracture and is being
successfully treated for that condition. However, she and her physicians feel that after her lengthy
hospital stay, she will need a month or two of nursing and rehabilitative care. What should you tell
them about Original Medicare's coverage of care in a skilled nursing facility?
A) Medicare covers skilled nursing care for 100 days with no copay
B) Medicare will cover Mrs. Shield's skilled nursing services provided during the first 20 days of her stay,
after which she would have a copay until she has been in the facility for 100 days
C) Medicare does not cover skilled nursing facility care
D) Medicare covers skilled nursing care for 200 days
,Answer B: Medicare will cover Mrs. Shield's skilled nursing services provided during the first 20
days of her stay, after which she would have a copay until she has been in the facility for 100 days
Rationale: Medicare covers 100 days of SNF care per benefit period; days 1-20 have no copay, days 21-
100 require coinsurance. ---
2. Mrs. West wears glasses and dentures and has enjoyed considerable pain relief from arthritis
through massage therapy. She is concerned about whether or not Medicare will cover these items
and services. What should you tell her?
A) Medicare covers glasses and dentures
B) Medicare does not cover massage therapy, or, in general, glasses or dentures
C) Medicare covers massage therapy with a prescription
D) Medicare covers all three services
Answer B: Medicare does not cover massage therapy, or, in general, glasses or dentures
Rationale: Original Medicare generally does not cover routine vision, dental, or massage therapy. ---
3. Mrs. Park is an elderly retiree with a low fixed income. What could you tell Mrs. Park that might
be of assistance?
A) She should apply for Medicare Advantage
B) She should contact her state Medicaid agency to see if she qualifies for one of several programs that
can help with Medicare costs for which she is responsible
C) She should enroll in a Part D plan
D) She should purchase a Medigap policy
Answer B: She should contact her state Medicaid agency to see if she qualifies for one of several
programs that can help with Medicare costs for which she is responsible
Rationale: State Medicaid agencies offer programs (e.g., QMB, SLMB) that help low-income beneficiaries
with Medicare costs. ---
, 4. Mr. Alonso receives some help paying for his two generic prescription drugs from his
employer's retiree coverage, but he wants to compare it to a Part D prescription drug plan. He
asks you what costs he would generally expect to encounter when enrolling into a standard
Medicare Part D prescription drug plan. What should you tell him?
A) He would pay only a monthly premium
B) He generally would pay a monthly premium, annual deductible, and per-prescription cost-sharing
C) He would pay no costs
D) He would pay only per-prescription costs
Answer B: He generally would pay a monthly premium, annual deductible, and per-prescription
cost-sharing
Rationale: Part D plans typically involve a monthly premium, annual deductible, and cost-sharing
(copays/coinsurance). ---
5. Mrs. Gonzalez is enrolled in Original Medicare and has a Medigap policy as well, but it provides
no drug coverage. She would like to keep the coverage she has but replace her existing Medigap
plan with one that provides drug coverage. What should you tell her?
A) She can purchase a Medigap plan with drug coverage
B) Mrs. Gonzalez cannot purchase a Medigap plan that covers drugs, but she could keep her Medigap
policy and enroll in a Part D prescription drug plan
C) She must drop her Medigap policy
D) Medigap plans always include drug coverage
Answer B: Mrs. Gonzalez cannot purchase a Medigap plan that covers drugs, but she could keep
her Medigap policy and enroll in a Part D prescription drug plan
Rationale: Medigap plans no longer cover prescription drugs; beneficiaries must enroll in a standalone
Part D plan. ---
6. Mr. Davis is 52 years old and has recently been diagnosed with end-stage renal disease (ESRD)
and will soon begin dialysis. He is wondering if he can obtain coverage under Medicare. What
should you tell him?
Verified Answers | Complete Exam Prep
Welcome to this 2027 AHIP Final Exam practice resource. This comprehensive study guide contains
questions covering Medicare Parts A, B, C, and D, Medigap, enrollment periods, marketing
guidelines, and beneficiary counseling scenarios. Each question includes the correct answer and a
concise rationale for exam preparation.
Key Topics Covered
• Medicare Part A – Hospital insurance, skilled nursing facility coverage, inpatient psychiatric care
• Medicare Part B – Physician services, preventive services, premiums, deductibles, copayments
• Medicare Part C (Medicare Advantage) – HMOs, PPOs, PFFS, MSA, SNPs, eligibility, enrollment periods
• Medicare Part D – Prescription drug coverage, formularies, tiers, TrOOP, Medicare Prescription
Payment Plan
• Medigap – Supplemental insurance, Plan F availability, coordination with Original Medicare
• Enrollment Periods – IEP, AEP, MA OEP, SEP, ICEP
• Marketing Guidelines – Educational events, scope of appointment, gifts, TMO requirements
• Special Populations – ESRD, dual eligible, LEP individuals, low-income subsidies
1. Mrs. Shields is covered by Original Medicare. She sustained a hip fracture and is being
successfully treated for that condition. However, she and her physicians feel that after her lengthy
hospital stay, she will need a month or two of nursing and rehabilitative care. What should you tell
them about Original Medicare's coverage of care in a skilled nursing facility?
A) Medicare covers skilled nursing care for 100 days with no copay
B) Medicare will cover Mrs. Shield's skilled nursing services provided during the first 20 days of her stay,
after which she would have a copay until she has been in the facility for 100 days
C) Medicare does not cover skilled nursing facility care
D) Medicare covers skilled nursing care for 200 days
,Answer B: Medicare will cover Mrs. Shield's skilled nursing services provided during the first 20
days of her stay, after which she would have a copay until she has been in the facility for 100 days
Rationale: Medicare covers 100 days of SNF care per benefit period; days 1-20 have no copay, days 21-
100 require coinsurance. ---
2. Mrs. West wears glasses and dentures and has enjoyed considerable pain relief from arthritis
through massage therapy. She is concerned about whether or not Medicare will cover these items
and services. What should you tell her?
A) Medicare covers glasses and dentures
B) Medicare does not cover massage therapy, or, in general, glasses or dentures
C) Medicare covers massage therapy with a prescription
D) Medicare covers all three services
Answer B: Medicare does not cover massage therapy, or, in general, glasses or dentures
Rationale: Original Medicare generally does not cover routine vision, dental, or massage therapy. ---
3. Mrs. Park is an elderly retiree with a low fixed income. What could you tell Mrs. Park that might
be of assistance?
A) She should apply for Medicare Advantage
B) She should contact her state Medicaid agency to see if she qualifies for one of several programs that
can help with Medicare costs for which she is responsible
C) She should enroll in a Part D plan
D) She should purchase a Medigap policy
Answer B: She should contact her state Medicaid agency to see if she qualifies for one of several
programs that can help with Medicare costs for which she is responsible
Rationale: State Medicaid agencies offer programs (e.g., QMB, SLMB) that help low-income beneficiaries
with Medicare costs. ---
, 4. Mr. Alonso receives some help paying for his two generic prescription drugs from his
employer's retiree coverage, but he wants to compare it to a Part D prescription drug plan. He
asks you what costs he would generally expect to encounter when enrolling into a standard
Medicare Part D prescription drug plan. What should you tell him?
A) He would pay only a monthly premium
B) He generally would pay a monthly premium, annual deductible, and per-prescription cost-sharing
C) He would pay no costs
D) He would pay only per-prescription costs
Answer B: He generally would pay a monthly premium, annual deductible, and per-prescription
cost-sharing
Rationale: Part D plans typically involve a monthly premium, annual deductible, and cost-sharing
(copays/coinsurance). ---
5. Mrs. Gonzalez is enrolled in Original Medicare and has a Medigap policy as well, but it provides
no drug coverage. She would like to keep the coverage she has but replace her existing Medigap
plan with one that provides drug coverage. What should you tell her?
A) She can purchase a Medigap plan with drug coverage
B) Mrs. Gonzalez cannot purchase a Medigap plan that covers drugs, but she could keep her Medigap
policy and enroll in a Part D prescription drug plan
C) She must drop her Medigap policy
D) Medigap plans always include drug coverage
Answer B: Mrs. Gonzalez cannot purchase a Medigap plan that covers drugs, but she could keep
her Medigap policy and enroll in a Part D prescription drug plan
Rationale: Medigap plans no longer cover prescription drugs; beneficiaries must enroll in a standalone
Part D plan. ---
6. Mr. Davis is 52 years old and has recently been diagnosed with end-stage renal disease (ESRD)
and will soon begin dialysis. He is wondering if he can obtain coverage under Medicare. What
should you tell him?
