AHIP FINAL EXAM 2027
QUESTIONS AND CORRECT
ANSWERS (VERIFIED ANSWERS)
PLUS RATIONALES 2026 Q&A |
INSTANT DOWNLOAD PDF.
Core Domains
• Medicare Program Basics (Parts A, B, C, D)
• Medicare Advantage (Part C) Plan Design and Compliance
• Medicare Part D Prescription Drug Coverage
• Eligibility, Enrollment Periods, and Special Enrollment
Periods
• Marketing, Communications, and CMS Compliance Rules
• Fraud, Waste, and Abuse (FWA) Prevention
• Beneficiary Rights, Appeals, and Grievances
• Scope of Appointment and Agent/Broker Responsibilities
Introduction
The AHIP Final Exam is the annual Medicare training and
certification requirement for licensed insurance agents who wish
to sell Medicare Advantage and Prescription Drug Plans. This
comprehensive assessment evaluates knowledge of Medicare
Parts A, B, C, and D, enrollment periods, CMS marketing
regulations, and Fraud, Waste, and Abuse compliance. Questions
,are structured as multiple-choice and scenario-based items
requiring application of Medicare rules to real-world situations.
Emphasis is placed on regulatory compliance, ethical marketing
practices, and beneficiary protections. A passing score of 90% is
required.
Section One: Questions 1–100
1. Mr. Schmidt would like to plan for retirement and has
asked you what is covered under Original Fee-for-Service
(FFS) Medicare. What could you tell him?
A. Only Part A is covered under Original Medicare
B. Only Part B is covered under Original Medicare
C. Part A (hospital, skilled nursing facility, hospice, home health)
and Part B (professional services such as those provided by a
doctor) are covered under Original Medicare
D. Parts A, B, C, and D are all covered under Original Medicare
Correct answer: C
RATIONALE: Original Medicare consists of Part A and Part B.
Part C (Medicare Advantage) and Part D (prescription drug
coverage) are offered through private insurance companies .
2. Which part of Medicare is also known as Medicare
Advantage?
A. Part A
B. Part C
C. Part B
D. Part D
, Correct answer: B
RATIONALE: Medicare Part C combines Part A, Part B, and
usually Part D coverage into one managed care plan run by
private insurance companies approved by Medicare .
3. Which of the following individuals is eligible to enroll in
a Medicare Advantage (MA) plan?
A. A 65-year-old with Medicare Part A only
B. A 72-year-old with Medicare Parts A and B who lives within the
plan's service area
C. A 60-year-old with employer group coverage only
D. A 68-year-old who permanently resides outside the United
States
Correct answer: B
RATIONALE: To enroll in an MA plan, a beneficiary must be
entitled to Part A, enrolled in Part B, and reside in the plan's
service area .
4. What is the primary goal of Medicare Advantage plans?
A. Replace Original Medicare with private coverage that adds
more out-of-pocket costs
B. Provide Medicare-covered benefits through private insurers
that meet CMS standards
C. Eliminate Part D coverage
D. Offer coverage only for hospital services
Correct answer: B
, RATIONALE: MA plans deliver Medicare benefits via CMS-
approved private insurers, often with additional benefits like
vision or dental .
5. Who is typically eligible for premium-free Medicare Part
A?
A. Anyone who reaches the age of 65
B. Individuals aged 65 or older who have worked at least 40
quarters (10 years) in Medicare-covered employment
C. Anyone enrolled in Medicaid
D. Only federal government retirees
Correct answer: B
RATIONALE: Most individuals who are citizens and over age 65
are covered under Part A by virtue of having paid Medicare taxes
while working for at least 40 quarters .
6. Mrs. West wears glasses and dentures and has enjoyed
considerable pain relief from arthritis through
acupuncture. She is concerned about whether or not
Medicare will cover these items and services. What should
you tell her?
A. Medicare covers acupuncture, glasses, and dentures
B. Medicare covers acupuncture only
C. Medicare covers glasses and dentures only
D. Medicare does not cover acupuncture, or, in general, glasses or
dentures
Correct answer: D
QUESTIONS AND CORRECT
ANSWERS (VERIFIED ANSWERS)
PLUS RATIONALES 2026 Q&A |
INSTANT DOWNLOAD PDF.
Core Domains
• Medicare Program Basics (Parts A, B, C, D)
• Medicare Advantage (Part C) Plan Design and Compliance
• Medicare Part D Prescription Drug Coverage
• Eligibility, Enrollment Periods, and Special Enrollment
Periods
• Marketing, Communications, and CMS Compliance Rules
• Fraud, Waste, and Abuse (FWA) Prevention
• Beneficiary Rights, Appeals, and Grievances
• Scope of Appointment and Agent/Broker Responsibilities
Introduction
The AHIP Final Exam is the annual Medicare training and
certification requirement for licensed insurance agents who wish
to sell Medicare Advantage and Prescription Drug Plans. This
comprehensive assessment evaluates knowledge of Medicare
Parts A, B, C, and D, enrollment periods, CMS marketing
regulations, and Fraud, Waste, and Abuse compliance. Questions
,are structured as multiple-choice and scenario-based items
requiring application of Medicare rules to real-world situations.
Emphasis is placed on regulatory compliance, ethical marketing
practices, and beneficiary protections. A passing score of 90% is
required.
Section One: Questions 1–100
1. Mr. Schmidt would like to plan for retirement and has
asked you what is covered under Original Fee-for-Service
(FFS) Medicare. What could you tell him?
A. Only Part A is covered under Original Medicare
B. Only Part B is covered under Original Medicare
C. Part A (hospital, skilled nursing facility, hospice, home health)
and Part B (professional services such as those provided by a
doctor) are covered under Original Medicare
D. Parts A, B, C, and D are all covered under Original Medicare
Correct answer: C
RATIONALE: Original Medicare consists of Part A and Part B.
Part C (Medicare Advantage) and Part D (prescription drug
coverage) are offered through private insurance companies .
2. Which part of Medicare is also known as Medicare
Advantage?
A. Part A
B. Part C
C. Part B
D. Part D
, Correct answer: B
RATIONALE: Medicare Part C combines Part A, Part B, and
usually Part D coverage into one managed care plan run by
private insurance companies approved by Medicare .
3. Which of the following individuals is eligible to enroll in
a Medicare Advantage (MA) plan?
A. A 65-year-old with Medicare Part A only
B. A 72-year-old with Medicare Parts A and B who lives within the
plan's service area
C. A 60-year-old with employer group coverage only
D. A 68-year-old who permanently resides outside the United
States
Correct answer: B
RATIONALE: To enroll in an MA plan, a beneficiary must be
entitled to Part A, enrolled in Part B, and reside in the plan's
service area .
4. What is the primary goal of Medicare Advantage plans?
A. Replace Original Medicare with private coverage that adds
more out-of-pocket costs
B. Provide Medicare-covered benefits through private insurers
that meet CMS standards
C. Eliminate Part D coverage
D. Offer coverage only for hospital services
Correct answer: B
, RATIONALE: MA plans deliver Medicare benefits via CMS-
approved private insurers, often with additional benefits like
vision or dental .
5. Who is typically eligible for premium-free Medicare Part
A?
A. Anyone who reaches the age of 65
B. Individuals aged 65 or older who have worked at least 40
quarters (10 years) in Medicare-covered employment
C. Anyone enrolled in Medicaid
D. Only federal government retirees
Correct answer: B
RATIONALE: Most individuals who are citizens and over age 65
are covered under Part A by virtue of having paid Medicare taxes
while working for at least 40 quarters .
6. Mrs. West wears glasses and dentures and has enjoyed
considerable pain relief from arthritis through
acupuncture. She is concerned about whether or not
Medicare will cover these items and services. What should
you tell her?
A. Medicare covers acupuncture, glasses, and dentures
B. Medicare covers acupuncture only
C. Medicare covers glasses and dentures only
D. Medicare does not cover acupuncture, or, in general, glasses or
dentures
Correct answer: D
