AHIP MEDICARE CERTIFICATION —
PRACTICE EXAM
120 Multiple-Choice Questions with Answers and Rationales
1. What is Medicare?
A. A means-tested welfare program for low-income families
B. A federal health insurance program primarily for people age 65 or older and
certain younger people with disabilities or ESRD
C. A state-run program that varies completely by state with no federal involvement
D. A private insurance product sold only by employers
Correct Answer: B
Rationale: Medicare is a federal health insurance program administered by CMS that
primarily covers people 65 and older, along with certain younger individuals with
qualifying disabilities or End-Stage Renal Disease (ESRD).
2. Which federal agency administers the Medicare program?
A. Department of Labor
B. Centers for Medicare & Medicaid Services (CMS)
C. Social Security Administration only, with no CMS involvement
D. Department of Veterans Affairs
Correct Answer: B
Rationale: CMS, an agency within the U.S. Department of Health and Human Services,
is responsible for administering Medicare, Medicaid, and the Health Insurance
Marketplace.
,3. What does Medicare Part A primarily cover?
A. Outpatient physician visits
B. Inpatient hospital care, skilled nursing facility care, hospice, and some home
health care
C. Prescription drugs only
D. Dental and vision care
Correct Answer: B
Rationale: Part A is often called 'hospital insurance' and covers inpatient hospital stays,
skilled nursing facility care (under certain conditions), hospice care, and some home
health services.
4. What does Medicare Part B primarily cover?
A. Inpatient hospital stays only
B. Medically necessary outpatient services, physician visits, preventive services,
and durable medical equipment
C. Long-term custodial nursing home care
D. Prescription drugs dispensed at retail pharmacies
Correct Answer: B
Rationale: Part B is 'medical insurance,' covering outpatient care, doctor visits,
preventive services, and durable medical equipment, generally requiring a monthly
premium and subject to deductibles and coinsurance.
5. What is Medicare Part C also known as?
A. Original Medicare
B. Medicare Advantage
C. Medigap
D. Medicaid
Correct Answer: B
Rationale: Medicare Part C, known as Medicare Advantage, allows beneficiaries to
receive their Part A and Part B benefits (and often Part D) through private plans
approved by Medicare.
,6. What does Medicare Part D provide?
A. Inpatient hospital coverage
B. Outpatient prescription drug coverage
C. Dental coverage only
D. Long-term care insurance
Correct Answer: B
Rationale: Part D provides outpatient prescription drug coverage, offered through
private plans approved by Medicare, either as stand-alone Prescription Drug Plans
(PDPs) or bundled into Medicare Advantage plans (MA-PD).
7. Which of the following individuals is generally eligible for Medicare based on
age?
A. Anyone age 55 or older, regardless of work history
B. U.S. citizens or qualifying legal residents who are age 65 or older and meet
eligibility requirements
C. Only veterans age 65 or older
D. Only individuals with private insurance
Correct Answer: B
Rationale: Age-based Medicare eligibility generally applies to U.S. citizens and
qualifying legal permanent residents who turn 65 and meet work history or other
qualifying requirements.
8. Besides age 65, which of the following can also make someone eligible for
Medicare?
A. Having a household income above a certain threshold
B. Receiving Social Security Disability Insurance (SSDI) for a required period, or
having ESRD or ALS
C. Being unemployed for more than six months
D. Owning a small business
Correct Answer: B
Rationale: Individuals under 65 may qualify for Medicare after receiving SSDI benefits
for a required waiting period, or immediately in certain cases involving End-Stage
Renal Disease (ESRD) or ALS (Lou Gehrig's disease).
, 9. What is the Initial Enrollment Period (IEP) for Medicare?
A. A single day only, the beneficiary's 65th birthday
B. A 7-month window surrounding a person's 65th birthday (3 months before, the
birthday month, and 3 months after)
C. A period that only occurs once every 10 years
D. A period only available to veterans
Correct Answer: B
Rationale: The IEP is a 7-month period that begins 3 months before the month a
person turns 65, includes their birthday month, and ends 3 months after, during which
they can first enroll in Medicare.
10. What is the Annual Election Period (AEP) for Medicare Advantage and Part D
plans?
A. January 1 – March 31
B. October 15 – December 7
C. June 1 – August 31
D. There is no annual election period
Correct Answer: B
Rationale: The Annual Election Period runs from October 15 through December 7 each
year, during which beneficiaries can join, switch, or drop Medicare Advantage and Part
D plans for coverage effective the following January 1.
11. What is the Medicare Advantage Open Enrollment Period (MA OEP)?
A. October 15 – December 7, allowing unlimited plan changes
B. January 1 – March 31, allowing MA enrollees one opportunity to switch plans or
return to Original Medicare
C. A period exclusively for new Medicare beneficiaries
D. A period that only allows switching from Original Medicare to Medicare
Advantage
Correct Answer: B
Rationale: The MA OEP runs January 1 through March 31 and allows individuals
already enrolled in a Medicare Advantage plan to make one election to switch to a
different MA plan or disenroll to Original Medicare (with the option to add a Part D
plan).
PRACTICE EXAM
120 Multiple-Choice Questions with Answers and Rationales
1. What is Medicare?
A. A means-tested welfare program for low-income families
B. A federal health insurance program primarily for people age 65 or older and
certain younger people with disabilities or ESRD
C. A state-run program that varies completely by state with no federal involvement
D. A private insurance product sold only by employers
Correct Answer: B
Rationale: Medicare is a federal health insurance program administered by CMS that
primarily covers people 65 and older, along with certain younger individuals with
qualifying disabilities or End-Stage Renal Disease (ESRD).
2. Which federal agency administers the Medicare program?
A. Department of Labor
B. Centers for Medicare & Medicaid Services (CMS)
C. Social Security Administration only, with no CMS involvement
D. Department of Veterans Affairs
Correct Answer: B
Rationale: CMS, an agency within the U.S. Department of Health and Human Services,
is responsible for administering Medicare, Medicaid, and the Health Insurance
Marketplace.
,3. What does Medicare Part A primarily cover?
A. Outpatient physician visits
B. Inpatient hospital care, skilled nursing facility care, hospice, and some home
health care
C. Prescription drugs only
D. Dental and vision care
Correct Answer: B
Rationale: Part A is often called 'hospital insurance' and covers inpatient hospital stays,
skilled nursing facility care (under certain conditions), hospice care, and some home
health services.
4. What does Medicare Part B primarily cover?
A. Inpatient hospital stays only
B. Medically necessary outpatient services, physician visits, preventive services,
and durable medical equipment
C. Long-term custodial nursing home care
D. Prescription drugs dispensed at retail pharmacies
Correct Answer: B
Rationale: Part B is 'medical insurance,' covering outpatient care, doctor visits,
preventive services, and durable medical equipment, generally requiring a monthly
premium and subject to deductibles and coinsurance.
5. What is Medicare Part C also known as?
A. Original Medicare
B. Medicare Advantage
C. Medigap
D. Medicaid
Correct Answer: B
Rationale: Medicare Part C, known as Medicare Advantage, allows beneficiaries to
receive their Part A and Part B benefits (and often Part D) through private plans
approved by Medicare.
,6. What does Medicare Part D provide?
A. Inpatient hospital coverage
B. Outpatient prescription drug coverage
C. Dental coverage only
D. Long-term care insurance
Correct Answer: B
Rationale: Part D provides outpatient prescription drug coverage, offered through
private plans approved by Medicare, either as stand-alone Prescription Drug Plans
(PDPs) or bundled into Medicare Advantage plans (MA-PD).
7. Which of the following individuals is generally eligible for Medicare based on
age?
A. Anyone age 55 or older, regardless of work history
B. U.S. citizens or qualifying legal residents who are age 65 or older and meet
eligibility requirements
C. Only veterans age 65 or older
D. Only individuals with private insurance
Correct Answer: B
Rationale: Age-based Medicare eligibility generally applies to U.S. citizens and
qualifying legal permanent residents who turn 65 and meet work history or other
qualifying requirements.
8. Besides age 65, which of the following can also make someone eligible for
Medicare?
A. Having a household income above a certain threshold
B. Receiving Social Security Disability Insurance (SSDI) for a required period, or
having ESRD or ALS
C. Being unemployed for more than six months
D. Owning a small business
Correct Answer: B
Rationale: Individuals under 65 may qualify for Medicare after receiving SSDI benefits
for a required waiting period, or immediately in certain cases involving End-Stage
Renal Disease (ESRD) or ALS (Lou Gehrig's disease).
, 9. What is the Initial Enrollment Period (IEP) for Medicare?
A. A single day only, the beneficiary's 65th birthday
B. A 7-month window surrounding a person's 65th birthday (3 months before, the
birthday month, and 3 months after)
C. A period that only occurs once every 10 years
D. A period only available to veterans
Correct Answer: B
Rationale: The IEP is a 7-month period that begins 3 months before the month a
person turns 65, includes their birthday month, and ends 3 months after, during which
they can first enroll in Medicare.
10. What is the Annual Election Period (AEP) for Medicare Advantage and Part D
plans?
A. January 1 – March 31
B. October 15 – December 7
C. June 1 – August 31
D. There is no annual election period
Correct Answer: B
Rationale: The Annual Election Period runs from October 15 through December 7 each
year, during which beneficiaries can join, switch, or drop Medicare Advantage and Part
D plans for coverage effective the following January 1.
11. What is the Medicare Advantage Open Enrollment Period (MA OEP)?
A. October 15 – December 7, allowing unlimited plan changes
B. January 1 – March 31, allowing MA enrollees one opportunity to switch plans or
return to Original Medicare
C. A period exclusively for new Medicare beneficiaries
D. A period that only allows switching from Original Medicare to Medicare
Advantage
Correct Answer: B
Rationale: The MA OEP runs January 1 through March 31 and allows individuals
already enrolled in a Medicare Advantage plan to make one election to switch to a
different MA plan or disenroll to Original Medicare (with the option to add a Part D
plan).
