AHIP Final Exam 2027 | Questions
and Correct Answers| Latest
Update
Core Domains
1. Medicare Program Basics (Parts A, B, C, D)
2. Medicare Advantage (Part C) Plans
3. Medicare Part D Prescription Drug Plans
4. Eligibility, Enrollment, and Election Periods
5. Medigap and Medicare Supplement Insurance
6. Marketing, Communications, and CMS Compliance
7. Fraud, Waste, and Abuse (FWA)
8. Beneficiary Rights, Appeals, and Grievances
9. Scope of Appointment and Agent Responsibilities
Introduction
This comprehensive certification examination assesses the knowledge and
competency of insurance agents and brokers seeking to market Medicare
Advantage, Medicare Part D, and Medicare Supplement plans. The
assessment evaluates understanding of Medicare program fundamentals,
plan structures, enrollment rules, marketing compliance, fraud prevention,
and beneficiary protections. Multiple-choice and scenario-based questions
emphasize real-world application of CMS regulations, ethical marketing
practices, and accurate plan selection guidance. Content aligns with the AHIP
Medicare training curriculum and CMS guidelines, ensuring rigorous
preparation for professional certification and compliant beneficiary
interactions.
SECTION ONE: QUESTIONS 1–100
,1. A consumer is turning 65 in three months and has accumulated 42
quarters of Medicare-covered employment. What is their premium
status for Medicare Part A?
A. They must pay a partial monthly premium
B. They must pay the full standard monthly premium
C. They qualify for premium-free Medicare Part A
D. They must enroll in Medicare Part B first
C. They qualify for premium-free Medicare Part A
RATIONALE: An individual with at least 40 quarters (10 years) of
Medicare-covered employment is entitled to premium-free Part A upon
eligibility. The 42 quarters exceed the 40-quarter threshold.
2. Which individual is automatically enrolled in Medicare Parts A and
B?
A. An individual turning 65 who is actively working for a large employer
B. An individual receiving Social Security disability benefits for 24 months
C. An individual diagnosed with temporary acute kidney injury
D. A citizen turning 62 who applies for early retirement
B. An individual receiving Social Security disability benefits for 24 months
RATIONALE: Individuals receiving Social Security or Railroad Retirement
Board disability benefits are automatically enrolled in Parts A and B after 24
months of disability eligibility.
3. If a beneficiary is automatically enrolled in Part B but wishes to
decline it due to active employer coverage, what must they do?
A. Ignore the card; it deactivates automatically
B. Follow instructions on the Medicare card to sign the refusal notice and
return the card
C. Contact their employer's HR department for a waiver
D. Wait until the Annual Election Period to file an opt-out form
, B. Follow instructions on the Medicare card to sign the refusal notice and
return the card
RATIONALE: Because Part B carries a monthly premium, individuals
automatically enrolled may decline it by following the instructions provided
with their Medicare card.
4. Medicare Part A covers which of the following services?
A. Inpatient hospital care, skilled nursing facility care, hospice care, and
limited home health services
B. Outpatient diagnostic tests and physician visits
C. Routine dental extractions and hearing aids
D. Outpatient prescription drugs at retail pharmacies
A. Inpatient hospital care, skilled nursing facility care, hospice care, and
limited home health services
RATIONALE: Part A is hospital insurance covering inpatient stays,
qualifying SNF care, hospice, and limited home health. Outpatient services
fall under Part B.
5. Which service is primarily covered under Medicare Part B?
A. Inpatient psychiatric hospital stays
B. Long-term custodial care in a nursing home
C. Physician services, outpatient medical services, and preventive screenings
D. Retail prescription medications for chronic illnesses
C. Physician services, outpatient medical services, and preventive
screenings
RATIONALE: Part B covers medically necessary outpatient care, physician
services, durable medical equipment, and many preventive services.
6. A client is turning 65 on June 15, 2027. When does their Initial
Enrollment Period begin and end?
A. June 1 to June 30, 2027
B. March 1 to September 30, 2027
, C. April 1 to July 31, 2027
D. January 1 to December 31, 2027
B. March 1 to September 30, 2027
RATIONALE: The IEP is a 7-month window: 3 months before, the month
of, and 3 months after the 65th birthday month.
7. A client is 67 and covered by an employer group health plan with
100+ employees. They are considering Medicare. What should you
advise?
A. They must enroll in Part B immediately to avoid penalties
B. They can delay Part B without penalty while covered by the large
employer plan
C. They must enroll in Part A but can delay Part B
D. They should drop employer coverage and enroll in Medicare now
B. They can delay Part B without penalty while covered by the large
employer plan
RATIONALE: Individuals covered by an employer group health plan with
20+ employees can delay Part B enrollment without penalty. A Special
Enrollment Period is available when coverage ends.
8. Mrs. Chen will be 65 soon, has been a citizen for twelve years, and
has been employed full time paying taxes. She is concerned about
Part A eligibility because she was not born in the United States.
What should you tell her?
A. All citizens age 65 or over are covered under Part A
B. Citizens age 65 or over must pay a monthly premium for Part A
C. Citizens age 65 or over must enroll in a Medicare Advantage Plan
D. Most citizens age 65 or over are covered under Part A by virtue of having
paid Medicare taxes while working
D. Most citizens age 65 or over are covered under Part A by virtue of
having paid Medicare taxes while working
and Correct Answers| Latest
Update
Core Domains
1. Medicare Program Basics (Parts A, B, C, D)
2. Medicare Advantage (Part C) Plans
3. Medicare Part D Prescription Drug Plans
4. Eligibility, Enrollment, and Election Periods
5. Medigap and Medicare Supplement Insurance
6. Marketing, Communications, and CMS Compliance
7. Fraud, Waste, and Abuse (FWA)
8. Beneficiary Rights, Appeals, and Grievances
9. Scope of Appointment and Agent Responsibilities
Introduction
This comprehensive certification examination assesses the knowledge and
competency of insurance agents and brokers seeking to market Medicare
Advantage, Medicare Part D, and Medicare Supplement plans. The
assessment evaluates understanding of Medicare program fundamentals,
plan structures, enrollment rules, marketing compliance, fraud prevention,
and beneficiary protections. Multiple-choice and scenario-based questions
emphasize real-world application of CMS regulations, ethical marketing
practices, and accurate plan selection guidance. Content aligns with the AHIP
Medicare training curriculum and CMS guidelines, ensuring rigorous
preparation for professional certification and compliant beneficiary
interactions.
SECTION ONE: QUESTIONS 1–100
,1. A consumer is turning 65 in three months and has accumulated 42
quarters of Medicare-covered employment. What is their premium
status for Medicare Part A?
A. They must pay a partial monthly premium
B. They must pay the full standard monthly premium
C. They qualify for premium-free Medicare Part A
D. They must enroll in Medicare Part B first
C. They qualify for premium-free Medicare Part A
RATIONALE: An individual with at least 40 quarters (10 years) of
Medicare-covered employment is entitled to premium-free Part A upon
eligibility. The 42 quarters exceed the 40-quarter threshold.
2. Which individual is automatically enrolled in Medicare Parts A and
B?
A. An individual turning 65 who is actively working for a large employer
B. An individual receiving Social Security disability benefits for 24 months
C. An individual diagnosed with temporary acute kidney injury
D. A citizen turning 62 who applies for early retirement
B. An individual receiving Social Security disability benefits for 24 months
RATIONALE: Individuals receiving Social Security or Railroad Retirement
Board disability benefits are automatically enrolled in Parts A and B after 24
months of disability eligibility.
3. If a beneficiary is automatically enrolled in Part B but wishes to
decline it due to active employer coverage, what must they do?
A. Ignore the card; it deactivates automatically
B. Follow instructions on the Medicare card to sign the refusal notice and
return the card
C. Contact their employer's HR department for a waiver
D. Wait until the Annual Election Period to file an opt-out form
, B. Follow instructions on the Medicare card to sign the refusal notice and
return the card
RATIONALE: Because Part B carries a monthly premium, individuals
automatically enrolled may decline it by following the instructions provided
with their Medicare card.
4. Medicare Part A covers which of the following services?
A. Inpatient hospital care, skilled nursing facility care, hospice care, and
limited home health services
B. Outpatient diagnostic tests and physician visits
C. Routine dental extractions and hearing aids
D. Outpatient prescription drugs at retail pharmacies
A. Inpatient hospital care, skilled nursing facility care, hospice care, and
limited home health services
RATIONALE: Part A is hospital insurance covering inpatient stays,
qualifying SNF care, hospice, and limited home health. Outpatient services
fall under Part B.
5. Which service is primarily covered under Medicare Part B?
A. Inpatient psychiatric hospital stays
B. Long-term custodial care in a nursing home
C. Physician services, outpatient medical services, and preventive screenings
D. Retail prescription medications for chronic illnesses
C. Physician services, outpatient medical services, and preventive
screenings
RATIONALE: Part B covers medically necessary outpatient care, physician
services, durable medical equipment, and many preventive services.
6. A client is turning 65 on June 15, 2027. When does their Initial
Enrollment Period begin and end?
A. June 1 to June 30, 2027
B. March 1 to September 30, 2027
, C. April 1 to July 31, 2027
D. January 1 to December 31, 2027
B. March 1 to September 30, 2027
RATIONALE: The IEP is a 7-month window: 3 months before, the month
of, and 3 months after the 65th birthday month.
7. A client is 67 and covered by an employer group health plan with
100+ employees. They are considering Medicare. What should you
advise?
A. They must enroll in Part B immediately to avoid penalties
B. They can delay Part B without penalty while covered by the large
employer plan
C. They must enroll in Part A but can delay Part B
D. They should drop employer coverage and enroll in Medicare now
B. They can delay Part B without penalty while covered by the large
employer plan
RATIONALE: Individuals covered by an employer group health plan with
20+ employees can delay Part B enrollment without penalty. A Special
Enrollment Period is available when coverage ends.
8. Mrs. Chen will be 65 soon, has been a citizen for twelve years, and
has been employed full time paying taxes. She is concerned about
Part A eligibility because she was not born in the United States.
What should you tell her?
A. All citizens age 65 or over are covered under Part A
B. Citizens age 65 or over must pay a monthly premium for Part A
C. Citizens age 65 or over must enroll in a Medicare Advantage Plan
D. Most citizens age 65 or over are covered under Part A by virtue of having
paid Medicare taxes while working
D. Most citizens age 65 or over are covered under Part A by virtue of
having paid Medicare taxes while working
