AHIP Final Exam Latest (2026/2027) | 200 Verified Questions and
Correct Answers | A+ Graded
1. WhichpartofMedicarecoversinpatient hospital services?
Answer: Part A
Rationale: Medicare Part A pays for inpatient stays, skillednursing facility care, hospice, and
some h ome health.
2. A beneficiaryturning 65 and alreadyreceiving Social Securitybenefits is
t
aut omaticallyenrolled in:
Answer: Part A and Part Bt
Rationale:Automaticenrollment occurs whenreceivingSSA benefitspriorto65.
t t
3. Thepenaltyfordelaying Medicare Part B enrollment without creditable
t
co verage is:
Answer: 10% forevery 12 monthsdelayed
Rationale: CMS applies a 10% surcharge foreachfull uncovered year.
t
4. Medicare Advantageplansmust cover: t
Answer: AllservicescoveredbyOriginal Medicare
Rationale: MA plansare requiredtoprovide equalor greater coveragethan Parts A and B.
t t
,5. Whatis themainrequirementtojoina Medicare Advantageplan?
Answer: Must have both Part A and Part B
t t t
Rationale: Enrollmentin bothpartsismandatoryfor MA.
6. Thesix protected drugclassesunder Part Densure:
t
Answer: Broadaccessto criticalmedications
Rationale: Plansmust cover all or nearly all drugs in thesecategories.
t
7. An agent must obtaina Scopeof Appointment(SOA):
Answer:Beforediscussingspecificplanbenefits
Rationale: CMS requires SOA todocumentbeneficiarypermission.
t
8. LIS(Low-IncomeSubsidy) helpsbeneficiarieswith:
Answer: Part Dpremium,deductible,andcost-sharing
t
Rationale: LISreducesor eliminatesdrugplancosts forlow-income enrollees.
t
9. What is consideredmarketing?
Answer:Materials intendedtosteerbeneficiariestowardenrollment
Rationale: CMSdefinesmarketing byintentand content.
10. Medicare Part B covers:t
Answer:Outpatientservicesandpreventivecare
Rationale:Part Bincludes doctorvisits,screenings,DME,andoutpatientservices.
t
11. ASpecial Enrollment Period (SEP) for Part Bexists when:
,Answer: Abeneficiaryhascreditableemployercoverageanddelays enrollment
Rationale:SEPavoids penalties whencredibleemployerinsurance exists.
t
12. Medicare Advantageplansreceivepaymentfrom CMSthrough:
Answer: Monthlycapitatedpayments
Rationale: Plans getafixedper-memberamount regardlessof service use.
13. Upcodingbyaprovider is anexample of:
Answer: Fraud
Rationale:Intentionallycodinghigherlevels t ofserviceisdeceptiveandillegal.
14. Wasterefersto:
Answer:Over-utilizationofservices
Rationale:Wastedoesnot requireintent tobreakrules.
t
15. WhichprogramhelpspayMedicarecostsforindividualswith limited inc
ome?
Answer: Medicare Savings Programs(MSPs)
Rationale: MSPs coverPart A/Bpremiums andsometimescost-sharing.
t ts
16. A marketing eventallows an agent to:
Answer:Present plan-specificinformation
t
Rationale:Unlikeeducationalevents,marketingeventspermit discussingbenefits.
ts
17. A PPO Medicare Advantageplanallowsmembers to:
t
Answer:See out-of-networkprovidersat highercost t
Rationale:PPOs offerflexibility,but at increasedOOPcosts.
t t
, 18. Whichplantyperestrictsmemberstotheirnetworkfor all no
n-emergencycare?
Answer: HMO
Rationale: HMOsgenerallyrequirein-network providers.
t
19. Whichofthefollowing is required forenrollment in a Special Needs
t
Pla n (SNP)?
Answer: Must meet theSNP’s eligibilitycriteria
t
Rationale: SNPsrequirechronicconditions,institutionalstatus,ordualeligibility.
20. TheMedicare Part D coveragegap(“donut hole”) occursafter:
t
Answer: The initial coveragelimit is reached
t
Rationale: Afterthelimit,memberspayapercentageofdrugcosts untilcatastrophic coverage.
21. A permissible activityat an educationalevent is:
Answer: Givingout generalMedicare information
Rationale: Noplan-specific infoorenrollmentforms allowed.
t
22. Whichstatement is true about MA plans andemergencycare?
Answer: Emergencycare must be covered everywhere in the U.S.
ts
Rationale: CMSrequiresuniversalemergencycoverage.
23. A drug formularyis:
t
Answer: The list of drugs a Part D plan covers
t
Rationale: Formulariescategorizedrugsbytiersandcoveragerules.
Correct Answers | A+ Graded
1. WhichpartofMedicarecoversinpatient hospital services?
Answer: Part A
Rationale: Medicare Part A pays for inpatient stays, skillednursing facility care, hospice, and
some h ome health.
2. A beneficiaryturning 65 and alreadyreceiving Social Securitybenefits is
t
aut omaticallyenrolled in:
Answer: Part A and Part Bt
Rationale:Automaticenrollment occurs whenreceivingSSA benefitspriorto65.
t t
3. Thepenaltyfordelaying Medicare Part B enrollment without creditable
t
co verage is:
Answer: 10% forevery 12 monthsdelayed
Rationale: CMS applies a 10% surcharge foreachfull uncovered year.
t
4. Medicare Advantageplansmust cover: t
Answer: AllservicescoveredbyOriginal Medicare
Rationale: MA plansare requiredtoprovide equalor greater coveragethan Parts A and B.
t t
,5. Whatis themainrequirementtojoina Medicare Advantageplan?
Answer: Must have both Part A and Part B
t t t
Rationale: Enrollmentin bothpartsismandatoryfor MA.
6. Thesix protected drugclassesunder Part Densure:
t
Answer: Broadaccessto criticalmedications
Rationale: Plansmust cover all or nearly all drugs in thesecategories.
t
7. An agent must obtaina Scopeof Appointment(SOA):
Answer:Beforediscussingspecificplanbenefits
Rationale: CMS requires SOA todocumentbeneficiarypermission.
t
8. LIS(Low-IncomeSubsidy) helpsbeneficiarieswith:
Answer: Part Dpremium,deductible,andcost-sharing
t
Rationale: LISreducesor eliminatesdrugplancosts forlow-income enrollees.
t
9. What is consideredmarketing?
Answer:Materials intendedtosteerbeneficiariestowardenrollment
Rationale: CMSdefinesmarketing byintentand content.
10. Medicare Part B covers:t
Answer:Outpatientservicesandpreventivecare
Rationale:Part Bincludes doctorvisits,screenings,DME,andoutpatientservices.
t
11. ASpecial Enrollment Period (SEP) for Part Bexists when:
,Answer: Abeneficiaryhascreditableemployercoverageanddelays enrollment
Rationale:SEPavoids penalties whencredibleemployerinsurance exists.
t
12. Medicare Advantageplansreceivepaymentfrom CMSthrough:
Answer: Monthlycapitatedpayments
Rationale: Plans getafixedper-memberamount regardlessof service use.
13. Upcodingbyaprovider is anexample of:
Answer: Fraud
Rationale:Intentionallycodinghigherlevels t ofserviceisdeceptiveandillegal.
14. Wasterefersto:
Answer:Over-utilizationofservices
Rationale:Wastedoesnot requireintent tobreakrules.
t
15. WhichprogramhelpspayMedicarecostsforindividualswith limited inc
ome?
Answer: Medicare Savings Programs(MSPs)
Rationale: MSPs coverPart A/Bpremiums andsometimescost-sharing.
t ts
16. A marketing eventallows an agent to:
Answer:Present plan-specificinformation
t
Rationale:Unlikeeducationalevents,marketingeventspermit discussingbenefits.
ts
17. A PPO Medicare Advantageplanallowsmembers to:
t
Answer:See out-of-networkprovidersat highercost t
Rationale:PPOs offerflexibility,but at increasedOOPcosts.
t t
, 18. Whichplantyperestrictsmemberstotheirnetworkfor all no
n-emergencycare?
Answer: HMO
Rationale: HMOsgenerallyrequirein-network providers.
t
19. Whichofthefollowing is required forenrollment in a Special Needs
t
Pla n (SNP)?
Answer: Must meet theSNP’s eligibilitycriteria
t
Rationale: SNPsrequirechronicconditions,institutionalstatus,ordualeligibility.
20. TheMedicare Part D coveragegap(“donut hole”) occursafter:
t
Answer: The initial coveragelimit is reached
t
Rationale: Afterthelimit,memberspayapercentageofdrugcosts untilcatastrophic coverage.
21. A permissible activityat an educationalevent is:
Answer: Givingout generalMedicare information
Rationale: Noplan-specific infoorenrollmentforms allowed.
t
22. Whichstatement is true about MA plans andemergencycare?
Answer: Emergencycare must be covered everywhere in the U.S.
ts
Rationale: CMSrequiresuniversalemergencycoverage.
23. A drug formularyis:
t
Answer: The list of drugs a Part D plan covers
t
Rationale: Formulariescategorizedrugsbytiersandcoveragerules.
