INSURANCE CERTIFICATION · OBJECTIVE ASSESSMENT
A+ VERIFIED
AHIP 2027 Modules 1-5 — Complete
Medicare Certification – Actual Questions & Answers (AHIP)
Official Exam
50 Questions Full Rationales Verified Answers
50 5 100%
QUESTIONS SECTIONS RATIONALES
Complete coverage Core exam domains Every answer explained
WHAT THIS COVERS
01 Medicare Basics
02 Medicare Advantage
03 Medicare Part D
04 Marketing & Sales Compliance
05 Fraud, Waste, and Abuse (FWA)
ABOUT THIS ASSESSMENT
Build mastery in Medicare certification — from Medicare Basics (Parts A, B, C, D)
to Medicare Advantage and Part D plan design, CMS marketing and sales compliance,
and Fraud, Waste, and Abuse prevention. This original study bank targets application
and analysis skills for the AHIP 2027 Modules 1-5 Final Exam, with full rationales
for every answer. For review use only; not an institutional proctored assessment.
PASSING SCORE LEVEL FORMAT
90% Intermediate (Professional Certification) Application / Analysis
STUVIA ACTUAL EXAM Page 1
, SECTION 1: Medicare Basics
Q1. A 66-year-old individual who has worked and paid Medicare taxes for 30 years is approaching age 65. The person
asks when Medicare Part A coverage will begin if no application is filed. Which statement is most accurate?
A. Part A begins only after a formal application is approved by the Social Security Administration
B. Part A never begins without a written request from the beneficiary
C. Most people are enrolled automatically in Part A (and usually Part B) at age 65 if they are already receiving Social
Security benefits
D. Automatic enrollment occurs only at age 70
Correct Answer: C
Rationale:
Individuals already receiving Social Security or Railroad Retirement benefits are generally auto-enrolled in Medicare Part A (and
Part B) effective the month they turn 65. Those not receiving benefits must actively apply.
Q2. A beneficiary is covered under Original Medicare and asks what Part B primarily covers. Which description is correct?
A. Inpatient hospital stays and skilled nursing facility care
B. Prescription drugs only
C. Physician services, outpatient care, preventive services, and durable medical equipment
D. Long-term custodial nursing home care
Correct Answer: C
Rationale:
Medicare Part B covers medically necessary physician services, outpatient hospital care, preventive services, clinical laboratory
services, and durable medical equipment. Inpatient hospital care is Part A; outpatient drugs are generally Part D.
Q3. A 64-year-old person who is still working and covered by an employer group health plan asks about the Initial
Enrollment Period (IEP) for Medicare. Which timing is correct for the IEP?
A. The seven-month period that includes the three months before the month of the 65th birthday, the birthday month,
and the three months after
B. The three months before the 65th birthday only
C. Any time after age 65 with no penalty
D. Only during the annual Open Enrollment Period
Correct Answer: A
Rationale:
The Initial Enrollment Period is a seven-month window centered on the month the individual turns 65 (or becomes eligible based
on disability). Missing it can result in delayed coverage and late-enrollment penalties for Part B.
Q4. A beneficiary with Original Medicare is admitted to a hospital for a covered stay. After 60 days the beneficiary is still
hospitalized. Which cost-sharing applies under Part A for days 61–90?
A. No cost-sharing; Part A pays 100%
B. The full Part A deductible again
C. A daily coinsurance amount set by Medicare for that year
D. A fixed $50 copayment per day
Correct Answer: C
Rationale:
After the Part A deductible is met, days 1–60 of a benefit period have no coinsurance. Days 61–90 require a daily coinsurance
amount that is adjusted annually by CMS.
Q5. An individual becomes eligible for Medicare because of end-stage renal disease (ESRD). Which statement about
Medicare eligibility based on ESRD is accurate?
A. ESRD never qualifies a person under age 65 for Medicare
B. ESRD eligibility begins the day dialysis starts with no waiting period
C. A person with ESRD can become entitled to Medicare regardless of age if certain work or dependent criteria are met
and a waiting period is satisfied
D. Only Part D is available to ESRD patients
Correct Answer: C
Rationale:
Medicare entitlement based on ESRD is available toSTUVIA
people of any ageEXAM
ACTUAL who meet specific
· Page 2 requirements related to Social Security
work credits (or are dependents) and who have completed the applicable waiting period after dialysis begins or a transplant
occurs.
, SECTION 1: Medicare Basics
Q5. An individual becomes eligible for Medicare because of end-stage renal disease (ESRD). Which statement about
Medicare eligibility based on ESRD is accurate?
A. ESRD never qualifies a person under age 65 for Medicare
B. ESRD eligibility begins the day dialysis starts with no waiting period
C. A person with ESRD can become entitled to Medicare regardless of age if certain work or dependent criteria are met
and a waiting period is satisfied
D. Only Part D is available to ESRD patients
Correct Answer: C
Rationale:
Medicare entitlement based on ESRD is available to people of any age who meet specific requirements related to Social Security
work credits (or are dependents) and who have completed the applicable waiting period after dialysis begins or a transplant
occurs.
Q6. A beneficiary is deciding between Original Medicare and a Medicare Advantage plan. Which feature is unique to
Original Medicare?
A. A closed provider network that requires referrals for specialists
B. A single plan that always includes prescription drug coverage
C. Capitated payments to a private insurer that manages all benefits
D. The ability to see any provider in the United States who accepts Medicare, without network restrictions
Correct Answer: D
Rationale:
Original Medicare allows beneficiaries to use any provider nationwide that accepts Medicare assignment. Medicare Advantage
plans typically use networks and may require referrals.
Q7. A person who delayed Part B enrollment because of active employer coverage is now retiring. Which special
enrollment period applies?
A. No special enrollment period exists; the person must wait for the General Enrollment Period
B. A two-month window only
C. Enrollment is possible only during the Annual Election Period
D. An eight-month Special Enrollment Period that begins the month after employment ends or group coverage ends,
whichever is earlier
Correct Answer: D
Rationale:
Individuals who delayed Part B because of current employer group coverage have an eight-month Special Enrollment Period after
the employment or coverage ends, allowing them to enroll without a late penalty.
Q8. A beneficiary asks whether Medicare covers long-term custodial care in a nursing home. Which response is
accurate?
A. Medicare generally does not cover long-term custodial care; coverage is limited to skilled care under specific
conditions and for limited periods
B. Medicare Part A covers unlimited custodial nursing home care
C. Part B pays for all custodial care after a $100 deductible
D. Custodial care is fully covered once the Part A deductible is met
Correct Answer: A
Rationale:
Medicare does not cover long-term custodial (non-skilled) care. Part A may cover skilled nursing facility care only after a qualifying
hospital stay and only while skilled services are required, subject to day limits and coinsurance.
STUVIA ACTUAL EXAM · Page 3
A+ VERIFIED
AHIP 2027 Modules 1-5 — Complete
Medicare Certification – Actual Questions & Answers (AHIP)
Official Exam
50 Questions Full Rationales Verified Answers
50 5 100%
QUESTIONS SECTIONS RATIONALES
Complete coverage Core exam domains Every answer explained
WHAT THIS COVERS
01 Medicare Basics
02 Medicare Advantage
03 Medicare Part D
04 Marketing & Sales Compliance
05 Fraud, Waste, and Abuse (FWA)
ABOUT THIS ASSESSMENT
Build mastery in Medicare certification — from Medicare Basics (Parts A, B, C, D)
to Medicare Advantage and Part D plan design, CMS marketing and sales compliance,
and Fraud, Waste, and Abuse prevention. This original study bank targets application
and analysis skills for the AHIP 2027 Modules 1-5 Final Exam, with full rationales
for every answer. For review use only; not an institutional proctored assessment.
PASSING SCORE LEVEL FORMAT
90% Intermediate (Professional Certification) Application / Analysis
STUVIA ACTUAL EXAM Page 1
, SECTION 1: Medicare Basics
Q1. A 66-year-old individual who has worked and paid Medicare taxes for 30 years is approaching age 65. The person
asks when Medicare Part A coverage will begin if no application is filed. Which statement is most accurate?
A. Part A begins only after a formal application is approved by the Social Security Administration
B. Part A never begins without a written request from the beneficiary
C. Most people are enrolled automatically in Part A (and usually Part B) at age 65 if they are already receiving Social
Security benefits
D. Automatic enrollment occurs only at age 70
Correct Answer: C
Rationale:
Individuals already receiving Social Security or Railroad Retirement benefits are generally auto-enrolled in Medicare Part A (and
Part B) effective the month they turn 65. Those not receiving benefits must actively apply.
Q2. A beneficiary is covered under Original Medicare and asks what Part B primarily covers. Which description is correct?
A. Inpatient hospital stays and skilled nursing facility care
B. Prescription drugs only
C. Physician services, outpatient care, preventive services, and durable medical equipment
D. Long-term custodial nursing home care
Correct Answer: C
Rationale:
Medicare Part B covers medically necessary physician services, outpatient hospital care, preventive services, clinical laboratory
services, and durable medical equipment. Inpatient hospital care is Part A; outpatient drugs are generally Part D.
Q3. A 64-year-old person who is still working and covered by an employer group health plan asks about the Initial
Enrollment Period (IEP) for Medicare. Which timing is correct for the IEP?
A. The seven-month period that includes the three months before the month of the 65th birthday, the birthday month,
and the three months after
B. The three months before the 65th birthday only
C. Any time after age 65 with no penalty
D. Only during the annual Open Enrollment Period
Correct Answer: A
Rationale:
The Initial Enrollment Period is a seven-month window centered on the month the individual turns 65 (or becomes eligible based
on disability). Missing it can result in delayed coverage and late-enrollment penalties for Part B.
Q4. A beneficiary with Original Medicare is admitted to a hospital for a covered stay. After 60 days the beneficiary is still
hospitalized. Which cost-sharing applies under Part A for days 61–90?
A. No cost-sharing; Part A pays 100%
B. The full Part A deductible again
C. A daily coinsurance amount set by Medicare for that year
D. A fixed $50 copayment per day
Correct Answer: C
Rationale:
After the Part A deductible is met, days 1–60 of a benefit period have no coinsurance. Days 61–90 require a daily coinsurance
amount that is adjusted annually by CMS.
Q5. An individual becomes eligible for Medicare because of end-stage renal disease (ESRD). Which statement about
Medicare eligibility based on ESRD is accurate?
A. ESRD never qualifies a person under age 65 for Medicare
B. ESRD eligibility begins the day dialysis starts with no waiting period
C. A person with ESRD can become entitled to Medicare regardless of age if certain work or dependent criteria are met
and a waiting period is satisfied
D. Only Part D is available to ESRD patients
Correct Answer: C
Rationale:
Medicare entitlement based on ESRD is available toSTUVIA
people of any ageEXAM
ACTUAL who meet specific
· Page 2 requirements related to Social Security
work credits (or are dependents) and who have completed the applicable waiting period after dialysis begins or a transplant
occurs.
, SECTION 1: Medicare Basics
Q5. An individual becomes eligible for Medicare because of end-stage renal disease (ESRD). Which statement about
Medicare eligibility based on ESRD is accurate?
A. ESRD never qualifies a person under age 65 for Medicare
B. ESRD eligibility begins the day dialysis starts with no waiting period
C. A person with ESRD can become entitled to Medicare regardless of age if certain work or dependent criteria are met
and a waiting period is satisfied
D. Only Part D is available to ESRD patients
Correct Answer: C
Rationale:
Medicare entitlement based on ESRD is available to people of any age who meet specific requirements related to Social Security
work credits (or are dependents) and who have completed the applicable waiting period after dialysis begins or a transplant
occurs.
Q6. A beneficiary is deciding between Original Medicare and a Medicare Advantage plan. Which feature is unique to
Original Medicare?
A. A closed provider network that requires referrals for specialists
B. A single plan that always includes prescription drug coverage
C. Capitated payments to a private insurer that manages all benefits
D. The ability to see any provider in the United States who accepts Medicare, without network restrictions
Correct Answer: D
Rationale:
Original Medicare allows beneficiaries to use any provider nationwide that accepts Medicare assignment. Medicare Advantage
plans typically use networks and may require referrals.
Q7. A person who delayed Part B enrollment because of active employer coverage is now retiring. Which special
enrollment period applies?
A. No special enrollment period exists; the person must wait for the General Enrollment Period
B. A two-month window only
C. Enrollment is possible only during the Annual Election Period
D. An eight-month Special Enrollment Period that begins the month after employment ends or group coverage ends,
whichever is earlier
Correct Answer: D
Rationale:
Individuals who delayed Part B because of current employer group coverage have an eight-month Special Enrollment Period after
the employment or coverage ends, allowing them to enroll without a late penalty.
Q8. A beneficiary asks whether Medicare covers long-term custodial care in a nursing home. Which response is
accurate?
A. Medicare generally does not cover long-term custodial care; coverage is limited to skilled care under specific
conditions and for limited periods
B. Medicare Part A covers unlimited custodial nursing home care
C. Part B pays for all custodial care after a $100 deductible
D. Custodial care is fully covered once the Part A deductible is met
Correct Answer: A
Rationale:
Medicare does not cover long-term custodial (non-skilled) care. Part A may cover skilled nursing facility care only after a qualifying
hospital stay and only while skilled services are required, subject to day limits and coinsurance.
STUVIA ACTUAL EXAM · Page 3
