1|Page
AHIP Medicare Certification
Exam 2026 Practice Questions –
Modules 1-5 with Detailed
Rationales
Prepare for the 2026 AHIP Medicare Certification Exam
with practice questions covering all five modules.
Includes Medicare basics, eligibility, Medicare Advantage
plan types (HMO, PPO, PFFS, SNP), Part D prescription
drug coverage, CMS marketing compliance, Scope of
Appointment rules, enrollment periods (AEP, MA OEP,
SEP, IEP), and Fraud, Waste, and Abuse. Each question
includes a detailed rationale. Updated for the current
plan year. Ideal for agents and brokers seeking
certification.
Topic 1: Medicare Program Basics & Eligibility
,2|Page
1. Mrs. Chen is turning 65 next month and asks which parts of Medicare are
provided directly by the federal government. Which is correct?
A) All four parts (A, B, C, and D) are provided directly by the federal government
B) Part A and Part B are provided directly by the federal government; Part C and Part
D are offered by private insurance companies
C) Only Part A is provided directly by the federal government; Parts B, C, and D are
offered by private insurance companies
D) Part A and Part D are provided directly by the federal government; Parts B and C
are offered by private insurance companies
B) Part A and Part B are provided directly by the federal government; Part C
and Part D are offered by private insurance companies
Rationale: Medicare Part A (Hospital Insurance) and Part B (Medical Insurance) are
administered directly by the federal government through CMS. Part C (Medicare
Advantage) and Part D (Prescription Drug Plans) are offered by private insurance
companies that contract with CMS.
2. Which individual is automatically entitled to premium-free Medicare Part A?
A) A 62-year-old who has paid Medicare taxes for 5 years
B) A 65-year-old who has paid Medicare taxes for at least 10 years (40 quarters) and
is receiving Social Security benefits
C) A 67-year-old who has never worked but is married to someone who has paid
Medicare taxes for 10 years
D) Both B and C
D) Both B and C
Rationale: Individuals age 65+ who paid Medicare taxes for at least 40 quarters qualify
for premium-free Part A. Additionally, individuals at least 65 entitled to Social Security
benefits based on a spouse's work record may also qualify for premium-free Part A.
,3|Page
3. Mr. Rodriguez is enrolled in Original Medicare and considering Medicare
Advantage. Which statement about Part C is correct?
A) Medicare Advantage plans are only available to individuals who also have
Medicaid
B) Medicare Advantage plans are offered by private companies that contract with
Medicare and must cover all services covered by Original Medicare
C) Medicare Advantage plans are not allowed to offer additional benefits beyond
what Original Medicare covers
D) Medicare Advantage plans replace Part A but not Part B
B) Medicare Advantage plans are offered by private companies that contract
with Medicare and must cover all services covered by Original Medicare
Rationale: MA plans must cover all services Original Medicare covers (except hospice
care, which remains under Part A). They may offer additional benefits such as vision,
dental, and hearing.
4. Medicare Part D provides coverage for:
A) Hospital inpatient services
B) Physician services and outpatient care
C) Prescription drugs
D) Long-term care services
C) Prescription drugs
Rationale: Part A covers hospital inpatient services; Part B covers physician services and
outpatient care; Part D specifically addresses prescription medications.
, 4|Page
5. What is the primary purpose of Medicare Advantage plans?
A) To replace Original Medicare entirely
B) To offer additional benefits beyond Original Medicare
C) To provide coverage only for prescription drugs
D) To serve only low-income beneficiaries
B) To offer additional benefits beyond Original Medicare
Rationale: MA plans provide all Part A and Part B benefits and often include extra
benefits not covered by Original Medicare, such as vision, hearing, dental, and
prescription drug coverage.
6. Which is a requirement for Medicare eligibility?
A) Having an annual income below the federal poverty level
B) Being employed full-time
C) Being a U.S. citizen or legal resident
D) Having a pre-existing chronic condition
C) Being a U.S. citizen or legal resident
Rationale: Medicare eligibility requires U.S. citizenship or legal permanent residency
(with at least five continuous years of residency). Most qualify based on age 65+,
disability (24 months of SSDI), or specific conditions (ESRD or ALS).
7. Juan Perez is turning 65 and intends to keep working at Smallcap, Inc., which
has 15 employees and offers employer-sponsored coverage. He contributed to
Medicare for over 20 years. What should you tell him?
AHIP Medicare Certification
Exam 2026 Practice Questions –
Modules 1-5 with Detailed
Rationales
Prepare for the 2026 AHIP Medicare Certification Exam
with practice questions covering all five modules.
Includes Medicare basics, eligibility, Medicare Advantage
plan types (HMO, PPO, PFFS, SNP), Part D prescription
drug coverage, CMS marketing compliance, Scope of
Appointment rules, enrollment periods (AEP, MA OEP,
SEP, IEP), and Fraud, Waste, and Abuse. Each question
includes a detailed rationale. Updated for the current
plan year. Ideal for agents and brokers seeking
certification.
Topic 1: Medicare Program Basics & Eligibility
,2|Page
1. Mrs. Chen is turning 65 next month and asks which parts of Medicare are
provided directly by the federal government. Which is correct?
A) All four parts (A, B, C, and D) are provided directly by the federal government
B) Part A and Part B are provided directly by the federal government; Part C and Part
D are offered by private insurance companies
C) Only Part A is provided directly by the federal government; Parts B, C, and D are
offered by private insurance companies
D) Part A and Part D are provided directly by the federal government; Parts B and C
are offered by private insurance companies
B) Part A and Part B are provided directly by the federal government; Part C
and Part D are offered by private insurance companies
Rationale: Medicare Part A (Hospital Insurance) and Part B (Medical Insurance) are
administered directly by the federal government through CMS. Part C (Medicare
Advantage) and Part D (Prescription Drug Plans) are offered by private insurance
companies that contract with CMS.
2. Which individual is automatically entitled to premium-free Medicare Part A?
A) A 62-year-old who has paid Medicare taxes for 5 years
B) A 65-year-old who has paid Medicare taxes for at least 10 years (40 quarters) and
is receiving Social Security benefits
C) A 67-year-old who has never worked but is married to someone who has paid
Medicare taxes for 10 years
D) Both B and C
D) Both B and C
Rationale: Individuals age 65+ who paid Medicare taxes for at least 40 quarters qualify
for premium-free Part A. Additionally, individuals at least 65 entitled to Social Security
benefits based on a spouse's work record may also qualify for premium-free Part A.
,3|Page
3. Mr. Rodriguez is enrolled in Original Medicare and considering Medicare
Advantage. Which statement about Part C is correct?
A) Medicare Advantage plans are only available to individuals who also have
Medicaid
B) Medicare Advantage plans are offered by private companies that contract with
Medicare and must cover all services covered by Original Medicare
C) Medicare Advantage plans are not allowed to offer additional benefits beyond
what Original Medicare covers
D) Medicare Advantage plans replace Part A but not Part B
B) Medicare Advantage plans are offered by private companies that contract
with Medicare and must cover all services covered by Original Medicare
Rationale: MA plans must cover all services Original Medicare covers (except hospice
care, which remains under Part A). They may offer additional benefits such as vision,
dental, and hearing.
4. Medicare Part D provides coverage for:
A) Hospital inpatient services
B) Physician services and outpatient care
C) Prescription drugs
D) Long-term care services
C) Prescription drugs
Rationale: Part A covers hospital inpatient services; Part B covers physician services and
outpatient care; Part D specifically addresses prescription medications.
, 4|Page
5. What is the primary purpose of Medicare Advantage plans?
A) To replace Original Medicare entirely
B) To offer additional benefits beyond Original Medicare
C) To provide coverage only for prescription drugs
D) To serve only low-income beneficiaries
B) To offer additional benefits beyond Original Medicare
Rationale: MA plans provide all Part A and Part B benefits and often include extra
benefits not covered by Original Medicare, such as vision, hearing, dental, and
prescription drug coverage.
6. Which is a requirement for Medicare eligibility?
A) Having an annual income below the federal poverty level
B) Being employed full-time
C) Being a U.S. citizen or legal resident
D) Having a pre-existing chronic condition
C) Being a U.S. citizen or legal resident
Rationale: Medicare eligibility requires U.S. citizenship or legal permanent residency
(with at least five continuous years of residency). Most qualify based on age 65+,
disability (24 months of SSDI), or specific conditions (ESRD or ALS).
7. Juan Perez is turning 65 and intends to keep working at Smallcap, Inc., which
has 15 employees and offers employer-sponsored coverage. He contributed to
Medicare for over 20 years. What should you tell him?
