AHIP Final Exam – Questions with Answers &
Explanations | Latest 2026 Medicare Certification Prep
Guide
Description
AHIP Final Exam – Latest 2026 prep with 250 multiple-choice questions, verified answers,
and detailed explanations. Covers Medicare Parts A, B, C, D, Medicare Advantage, Part D,
marketing and enrollment rules, fraud/waste/abuse, and compliance. Perfect for AHIP
Medicare certification and guaranteed pass. Instant PDF download.
SECTION 1: MEDICARE BASICS — ELIGIBILITY, PART A, PART B (Questions 1–50)
1. Juan Perez is turning 65 next month, works full-time at a company with 15
employees, and has employer-sponsored coverage. He has paid Medicare taxes for
over 20 years. How would you explain his Medicare eligibility and coordination of
benefits?
A. Juan is not eligible for Medicare because he is still working
B. Juan is likely eligible for Medicare at 65, and Medicare would become the primary payor
because his employer has fewer than 20 employees
C. Juan is eligible but his employer plan remains primary
D. Juan must wait until he retires to enroll
,Answer: B. Individuals who have paid Medicare taxes for at least 40 quarters (10 years) are
entitled to premium-free Part A at age 65. Since Smallcap has fewer than 20 employees,
Medicare would be primary over the employer plan .
2. Margaret, age 68, is admitted for a hip replacement. She is inpatient for 5 days.
What will she pay out-of-pocket under Part A?
A. Nothing; Part A covers all inpatient costs after the deductible is met
B. The Part A deductible for the benefit period plus daily coinsurance for each day
C. Only the Part A deductible for the benefit period
D. 20% coinsurance of the total hospital bill
Answer: C. For hospital inpatient stays, Medicare Part A covers days 1–60 after the
beneficiary pays the single deductible for the benefit period. Since Margaret stayed 5 days,
she pays only the Part A deductible .
3. Robert, age 72, is discharged to a skilled nursing facility (SNF) after a stroke. He
has already used 5 days of his SNF benefit during a prior hospitalization this year.
How many SNF days remain fully covered by Medicare Part A before a daily
copayment is required?
A. 15 days
B. 20 days
C. 25 days
D. 100 days
Answer: A. Medicare Part A covers up to 100 days in a SNF per benefit period, with days 1–
20 fully covered. Since Robert used 5 days previously, 15 fully covered days remain before
the daily copayment begins on day 21 .
,4. Helen, age 70, visits her PCP for an annual wellness visit and a flu shot. She also
receives a diagnostic colonoscopy where a polyp is removed. Which service is NOT
covered under Medicare Part B?
A. Annual wellness visit
B. Flu shot
C. Diagnostic colonoscopy with polyp removal
D. Routine dental cleaning
Answer: D. Original Medicare does not cover routine dental services, including cleanings,
fillings, or dentures. Annual wellness visits, flu shots, and diagnostic colonoscopies are
covered under Part B .
5. George, age 66, enrolls in Medicare Part B with an annual income of $120,000.
Which statement about his Part B premium is accurate?
A. George will pay the standard Part B premium with no adjustments because he is newly
enrolled
B. George will pay an income-related monthly adjustment amount (IRMAA) in addition to the
standard premium
C. George is exempt from Part B premiums because he has 40 quarters of Medicare-
covered employment
D. George will pay only the Part B deductible, not the monthly premium
Answer: B. Beneficiaries with higher incomes (above $97,000 for individuals) pay an
income-related monthly adjustment amount (IRMAA) in addition to the standard Part B
premium. Option C is incorrect because premium-free Part A is based on work history, not
Part B .
6. Mrs. Foster is covered by Original Medicare and needs nursing and rehabilitative
care after a hip fracture. What should you tell her about Original Medicare's coverage
, of care in a skilled nursing facility?
A. Medicare covers skilled nursing care for up to 30 days with no copayment
B. Medicare will cover skilled nursing services during the first 20 days, after which she
would have a copay until she has been in the facility for 100 days
C. Medicare covers all skilled nursing care with no limit
D. Medicare does not cover skilled nursing care under any circumstances
Answer: B. Original Medicare covers 100% of skilled nursing facility costs for the first 20
days. Days 21–100 require a daily coinsurance payment. After 100 days, Medicare
coverage ends .
7. Ms. Kumar plans to retire at 65 and is concerned her considerable income will
make it impossible to qualify for Medicare. What should you tell her?
A. Her income will disqualify her from Medicare
B. She should apply for Medicaid instead
C. Medicare is a program for people age 65 or older and those under 65 with certain
disabilities, ESRD, and ALS, so she will be eligible regardless of income
D. She can only qualify for Medicare if her income is below a certain threshold
Answer: C. Medicare eligibility is based on age, disability status, or qualifying conditions—
not income. Higher income may affect Part B and Part D premium amounts (IRMAA) but
does not prevent eligibility .
8. Mr. Bauer is 49 years old but was declared disabled by the Social Security
Administration 18 months ago and has been receiving disability payments. Can he
obtain coverage under Medicare?
A. No, he must wait until age 65
B. After receiving disability payments for 24 months, he will be automatically enrolled in
Medicare, regardless of age
Explanations | Latest 2026 Medicare Certification Prep
Guide
Description
AHIP Final Exam – Latest 2026 prep with 250 multiple-choice questions, verified answers,
and detailed explanations. Covers Medicare Parts A, B, C, D, Medicare Advantage, Part D,
marketing and enrollment rules, fraud/waste/abuse, and compliance. Perfect for AHIP
Medicare certification and guaranteed pass. Instant PDF download.
SECTION 1: MEDICARE BASICS — ELIGIBILITY, PART A, PART B (Questions 1–50)
1. Juan Perez is turning 65 next month, works full-time at a company with 15
employees, and has employer-sponsored coverage. He has paid Medicare taxes for
over 20 years. How would you explain his Medicare eligibility and coordination of
benefits?
A. Juan is not eligible for Medicare because he is still working
B. Juan is likely eligible for Medicare at 65, and Medicare would become the primary payor
because his employer has fewer than 20 employees
C. Juan is eligible but his employer plan remains primary
D. Juan must wait until he retires to enroll
,Answer: B. Individuals who have paid Medicare taxes for at least 40 quarters (10 years) are
entitled to premium-free Part A at age 65. Since Smallcap has fewer than 20 employees,
Medicare would be primary over the employer plan .
2. Margaret, age 68, is admitted for a hip replacement. She is inpatient for 5 days.
What will she pay out-of-pocket under Part A?
A. Nothing; Part A covers all inpatient costs after the deductible is met
B. The Part A deductible for the benefit period plus daily coinsurance for each day
C. Only the Part A deductible for the benefit period
D. 20% coinsurance of the total hospital bill
Answer: C. For hospital inpatient stays, Medicare Part A covers days 1–60 after the
beneficiary pays the single deductible for the benefit period. Since Margaret stayed 5 days,
she pays only the Part A deductible .
3. Robert, age 72, is discharged to a skilled nursing facility (SNF) after a stroke. He
has already used 5 days of his SNF benefit during a prior hospitalization this year.
How many SNF days remain fully covered by Medicare Part A before a daily
copayment is required?
A. 15 days
B. 20 days
C. 25 days
D. 100 days
Answer: A. Medicare Part A covers up to 100 days in a SNF per benefit period, with days 1–
20 fully covered. Since Robert used 5 days previously, 15 fully covered days remain before
the daily copayment begins on day 21 .
,4. Helen, age 70, visits her PCP for an annual wellness visit and a flu shot. She also
receives a diagnostic colonoscopy where a polyp is removed. Which service is NOT
covered under Medicare Part B?
A. Annual wellness visit
B. Flu shot
C. Diagnostic colonoscopy with polyp removal
D. Routine dental cleaning
Answer: D. Original Medicare does not cover routine dental services, including cleanings,
fillings, or dentures. Annual wellness visits, flu shots, and diagnostic colonoscopies are
covered under Part B .
5. George, age 66, enrolls in Medicare Part B with an annual income of $120,000.
Which statement about his Part B premium is accurate?
A. George will pay the standard Part B premium with no adjustments because he is newly
enrolled
B. George will pay an income-related monthly adjustment amount (IRMAA) in addition to the
standard premium
C. George is exempt from Part B premiums because he has 40 quarters of Medicare-
covered employment
D. George will pay only the Part B deductible, not the monthly premium
Answer: B. Beneficiaries with higher incomes (above $97,000 for individuals) pay an
income-related monthly adjustment amount (IRMAA) in addition to the standard Part B
premium. Option C is incorrect because premium-free Part A is based on work history, not
Part B .
6. Mrs. Foster is covered by Original Medicare and needs nursing and rehabilitative
care after a hip fracture. What should you tell her about Original Medicare's coverage
, of care in a skilled nursing facility?
A. Medicare covers skilled nursing care for up to 30 days with no copayment
B. Medicare will cover skilled nursing services during the first 20 days, after which she
would have a copay until she has been in the facility for 100 days
C. Medicare covers all skilled nursing care with no limit
D. Medicare does not cover skilled nursing care under any circumstances
Answer: B. Original Medicare covers 100% of skilled nursing facility costs for the first 20
days. Days 21–100 require a daily coinsurance payment. After 100 days, Medicare
coverage ends .
7. Ms. Kumar plans to retire at 65 and is concerned her considerable income will
make it impossible to qualify for Medicare. What should you tell her?
A. Her income will disqualify her from Medicare
B. She should apply for Medicaid instead
C. Medicare is a program for people age 65 or older and those under 65 with certain
disabilities, ESRD, and ALS, so she will be eligible regardless of income
D. She can only qualify for Medicare if her income is below a certain threshold
Answer: C. Medicare eligibility is based on age, disability status, or qualifying conditions—
not income. Higher income may affect Part B and Part D premium amounts (IRMAA) but
does not prevent eligibility .
8. Mr. Bauer is 49 years old but was declared disabled by the Social Security
Administration 18 months ago and has been receiving disability payments. Can he
obtain coverage under Medicare?
A. No, he must wait until age 65
B. After receiving disability payments for 24 months, he will be automatically enrolled in
Medicare, regardless of age
