A HI P | M EDI CA R E CE RT I FI CATIO N
2027 AHIP
Final Exam
Medicare Certification — Actual Questions & Answers
Guarantee Pass (Updated PDF)
2027 EDITION
A comprehensive study guide for the 2027 AHIP Final Exam — Medicare
Certification, covering Medicare basics and eligibility, Medicare Advantage
plans, Part D prescription drugs, Medigap policies, enrollment periods,
marketing and sales compliance, fraud/waste/abuse, appeals and
grievances, and special populations — with verified questions and detailed
rationales for every answer.
155
PRACTICE QUESTIONS
9
C O R E TO P I C S
100%
R AT I O N A L E S I N C L U D E D
Z.ai Insurance Education
AHIP Medicare Certification review series VOL. 12 | 2027 AHIP EDITION
,2027 AHIP Final Exam — Medicare Certification: 155 Practice Questions & Answers | 2027 Edition
Question 1.
Which of the following best describes Medicare Part A?
Outpatient medical insurance covering doctor visits and preventive services
Hospital insurance covering inpatient hospital stays, skilled nursing facility care, hospice, and some home
health care
Prescription drug coverage administered through private insurers
Medicare Advantage plans that combine Parts A and B through private insurers
Correct Answer: B
Rationale
Medicare Part A is HOSPITAL INSURANCE that covers: (1) Inpatient hospital stays (semi-private room, meals,
general nursing, drugs, supplies); (2) Skilled nursing facility (SNF) care (short-term, must follow a qualifying
hospital stay of at least 3 inpatient days); (3) Hospice care (terminal illness with life expectancy of 6 months or
less); (4) Home health care (intermittent skilled nursing, physical therapy, speech-language pathology,
occupational therapy, medical social services, home health aides, medical supplies); (5) Inpatient care in a
religious nonmedical health care institution. Part A is premium-free for most beneficiaries (those with 40+
quarters of Medicare-covered employment). Those with 30-39 quarters pay a reduced premium; those with fewer
than 30 quarters pay the full premium ($505/month in 2025). Part B covers outpatient/medical services; Part D
covers prescription drugs; Medicare Advantage (Part C) combines Parts A and B through private insurers.
Z.ai Insurance Education 2 2027 AHIP Edition
,2027 AHIP Final Exam — Medicare Certification: 155 Practice Questions & Answers | 2027 Edition
Question 2.
Most people become eligible for Medicare at age 65. How many quarters of Medicare-covered employment are
generally required to qualify for premium-free Part A?
10 quarters
20 quarters
30 quarters
40 quarters
Correct Answer: D
Rationale
To qualify for PREMIUM-FREE Medicare Part A, an individual generally needs 40 QUARTERS (10 years) of
Medicare-covered employment. Quarters are also called 'credits' or 'Social Security credits.' A worker earns one
credit for each $1,810 (2024 amount) in covered earnings, up to a maximum of 4 credits per year. Coverage tiers:
(1) 40+ quarters (10+ years): premium-free Part A; (2) 30-39 quarters (7.5-10 years): reduced Part A premium
($278/month in 2025); (3) Fewer than 30 quarters (less than 7.5 years): full Part A premium ($505/month in
2025). Spousal coverage: a person can qualify based on a current, divorced (if married 10+ years), or deceased
spouse's work record. Special eligibility: (a) People with disabilities who have received Social Security Disability
Insurance (SSDI) for 24 months; (b) People with End-Stage Renal Disease (ESRD)—permanent kidney failure
requiring dialysis or transplant—can qualify at any age; (c) People with ALS (Lou Gehrig's disease) qualify the
month disability benefits begin (no 24-month wait).
Question 3.
An individual who is receiving Social Security Disability Insurance (SSDI) benefits becomes eligible for Medicare
after:
Immediately upon approval of SSDI benefits
12 months after SSDI benefits begin
24 months after SSDI benefits begin
At age 65 regardless of disability status
Correct Answer: C
Rationale
Individuals receiving Social Security Disability Insurance (SSDI) benefits become eligible for Medicare after a
24-MONTH WAITING PERIOD. The 24-month waiting period begins the month after the individual's SSDI
waiting period ends (SSDI itself has a 5-month waiting period from the onset of disability). EXCEPTIONS to the
24-month waiting period: (1) End-Stage Renal Disease (ESRD)—individuals with permanent kidney failure
requiring dialysis or kidney transplant are eligible for Medicare regardless of age, with coverage beginning: (a)
The first day of the fourth month of dialysis (if dialysis is in a facility); (b) The month of dialysis if dialysis is
self-administered home dialysis training program completed; (c) The month of kidney transplant or 2 months
before if hospitalized earlier; (2) Amyotrophic Lateral Sclerosis (ALS, Lou Gehrig's disease)—individuals with
ALS qualify for Medicare the month SSDI benefits begin (NO 24-month wait). SSDI recipients receive a Medicare
card in the mail approximately 3 months before their Medicare eligibility date, with coverage effective the first day
of their 25th month of SSDI cash benefits.
Z.ai Insurance Education 3 2027 AHIP Edition
, 2027 AHIP Final Exam — Medicare Certification: 155 Practice Questions & Answers | 2027 Edition
Question 4.
Which of the following is NOT covered by Original Medicare (Part A or Part B)?
Inpatient hospital stays
Doctor visits and outpatient services
Routine dental, vision, and hearing services (including eyeglasses and hearing aids)
Durable medical equipment (DME)
Correct Answer: C
Rationale
Original Medicare (Parts A and B) does NOT cover ROUTINE DENTAL, VISION, OR HEARING services,
including: (1) Routine eye exams, eyeglasses, contact lenses (except after cataract surgery—intraocular lenses
covered); (2) Routine hearing exams, hearing aids, fitting exams for hearing aids; (3) Routine dental exams,
cleanings, fillings, extractions, dentures; (4) Routine foot care (unless related to diabetes or peripheral vascular
disease); (5) Cosmetic surgery; (6) Long-term care (custodial care—help with activities of daily living); (7)
Acupuncture (limited coverage—now covers up to 12 sessions per year for chronic low back pain); (8) Most
prescription drugs (covered under Part D); (9) Health care outside the United States (limited exceptions). Original
Medicare coverage: Part A—inpatient hospital, SNF, hospice, home health; Part B—doctor visits, outpatient
services, preventive care (annual wellness visit, flu/pneumococcal vaccines, mammograms, colonoscopies,
cardiovascular screenings), DME (wheelchairs, walkers, oxygen), ambulance services, some mental health
services, certain preventive screenings. Medicare Advantage (Part C) plans MAY offer additional benefits (dental,
vision, hearing, wellness) as supplemental benefits.
Question 5.
What is the standard Medicare Part B monthly premium for most beneficiaries in 2025?
$174.70
$185.00
$164.90
$148.50
Correct Answer: B
Rationale
The standard Medicare Part B monthly premium for 2025 is $185.00 (increased from $174.70 in 2024). The
premium is adjusted annually based on projected health care costs. INCOME-RELATED MONTHLY
ADJUSTMENT AMOUNT (IRMAA): beneficiaries with modified adjusted gross income (MAGI) above certain
thresholds pay higher premiums. 2025 IRMAA brackets (based on 2023 tax return MAGI for individual/joint filer):
(1) ≤$106,000 / ≤$212,000: $185.00 standard; (2) $106,001-$133,000 / $212,001-$266,000: $259.00; (3)
$133,001-$167,000 / $266,001-$334,000: $370.00; (4) $167,001-$200,000 / $334,001-$400,000: $480.90; (5)
$200,001-$500,000 / $400,001-$750,000: $591.90; (6) ≥$500,001 / ≥$750,001: $628.90. Social Security
Administration (SSA) determines IRMAA based on tax return data; beneficiaries receive notice (Form SSA-44) if
IRMAA applies. Life-changing events that allow IRMAA reduction appeal: marriage, divorce, death of spouse,
work stoppage/reduction, loss of income-producing property, loss of pension, employer settlement. Part B also has
an annual deductible ($257 in 2025) before coverage begins, then 20% coinsurance for most services.
Z.ai Insurance Education 4 2027 AHIP Edition
2027 AHIP
Final Exam
Medicare Certification — Actual Questions & Answers
Guarantee Pass (Updated PDF)
2027 EDITION
A comprehensive study guide for the 2027 AHIP Final Exam — Medicare
Certification, covering Medicare basics and eligibility, Medicare Advantage
plans, Part D prescription drugs, Medigap policies, enrollment periods,
marketing and sales compliance, fraud/waste/abuse, appeals and
grievances, and special populations — with verified questions and detailed
rationales for every answer.
155
PRACTICE QUESTIONS
9
C O R E TO P I C S
100%
R AT I O N A L E S I N C L U D E D
Z.ai Insurance Education
AHIP Medicare Certification review series VOL. 12 | 2027 AHIP EDITION
,2027 AHIP Final Exam — Medicare Certification: 155 Practice Questions & Answers | 2027 Edition
Question 1.
Which of the following best describes Medicare Part A?
Outpatient medical insurance covering doctor visits and preventive services
Hospital insurance covering inpatient hospital stays, skilled nursing facility care, hospice, and some home
health care
Prescription drug coverage administered through private insurers
Medicare Advantage plans that combine Parts A and B through private insurers
Correct Answer: B
Rationale
Medicare Part A is HOSPITAL INSURANCE that covers: (1) Inpatient hospital stays (semi-private room, meals,
general nursing, drugs, supplies); (2) Skilled nursing facility (SNF) care (short-term, must follow a qualifying
hospital stay of at least 3 inpatient days); (3) Hospice care (terminal illness with life expectancy of 6 months or
less); (4) Home health care (intermittent skilled nursing, physical therapy, speech-language pathology,
occupational therapy, medical social services, home health aides, medical supplies); (5) Inpatient care in a
religious nonmedical health care institution. Part A is premium-free for most beneficiaries (those with 40+
quarters of Medicare-covered employment). Those with 30-39 quarters pay a reduced premium; those with fewer
than 30 quarters pay the full premium ($505/month in 2025). Part B covers outpatient/medical services; Part D
covers prescription drugs; Medicare Advantage (Part C) combines Parts A and B through private insurers.
Z.ai Insurance Education 2 2027 AHIP Edition
,2027 AHIP Final Exam — Medicare Certification: 155 Practice Questions & Answers | 2027 Edition
Question 2.
Most people become eligible for Medicare at age 65. How many quarters of Medicare-covered employment are
generally required to qualify for premium-free Part A?
10 quarters
20 quarters
30 quarters
40 quarters
Correct Answer: D
Rationale
To qualify for PREMIUM-FREE Medicare Part A, an individual generally needs 40 QUARTERS (10 years) of
Medicare-covered employment. Quarters are also called 'credits' or 'Social Security credits.' A worker earns one
credit for each $1,810 (2024 amount) in covered earnings, up to a maximum of 4 credits per year. Coverage tiers:
(1) 40+ quarters (10+ years): premium-free Part A; (2) 30-39 quarters (7.5-10 years): reduced Part A premium
($278/month in 2025); (3) Fewer than 30 quarters (less than 7.5 years): full Part A premium ($505/month in
2025). Spousal coverage: a person can qualify based on a current, divorced (if married 10+ years), or deceased
spouse's work record. Special eligibility: (a) People with disabilities who have received Social Security Disability
Insurance (SSDI) for 24 months; (b) People with End-Stage Renal Disease (ESRD)—permanent kidney failure
requiring dialysis or transplant—can qualify at any age; (c) People with ALS (Lou Gehrig's disease) qualify the
month disability benefits begin (no 24-month wait).
Question 3.
An individual who is receiving Social Security Disability Insurance (SSDI) benefits becomes eligible for Medicare
after:
Immediately upon approval of SSDI benefits
12 months after SSDI benefits begin
24 months after SSDI benefits begin
At age 65 regardless of disability status
Correct Answer: C
Rationale
Individuals receiving Social Security Disability Insurance (SSDI) benefits become eligible for Medicare after a
24-MONTH WAITING PERIOD. The 24-month waiting period begins the month after the individual's SSDI
waiting period ends (SSDI itself has a 5-month waiting period from the onset of disability). EXCEPTIONS to the
24-month waiting period: (1) End-Stage Renal Disease (ESRD)—individuals with permanent kidney failure
requiring dialysis or kidney transplant are eligible for Medicare regardless of age, with coverage beginning: (a)
The first day of the fourth month of dialysis (if dialysis is in a facility); (b) The month of dialysis if dialysis is
self-administered home dialysis training program completed; (c) The month of kidney transplant or 2 months
before if hospitalized earlier; (2) Amyotrophic Lateral Sclerosis (ALS, Lou Gehrig's disease)—individuals with
ALS qualify for Medicare the month SSDI benefits begin (NO 24-month wait). SSDI recipients receive a Medicare
card in the mail approximately 3 months before their Medicare eligibility date, with coverage effective the first day
of their 25th month of SSDI cash benefits.
Z.ai Insurance Education 3 2027 AHIP Edition
, 2027 AHIP Final Exam — Medicare Certification: 155 Practice Questions & Answers | 2027 Edition
Question 4.
Which of the following is NOT covered by Original Medicare (Part A or Part B)?
Inpatient hospital stays
Doctor visits and outpatient services
Routine dental, vision, and hearing services (including eyeglasses and hearing aids)
Durable medical equipment (DME)
Correct Answer: C
Rationale
Original Medicare (Parts A and B) does NOT cover ROUTINE DENTAL, VISION, OR HEARING services,
including: (1) Routine eye exams, eyeglasses, contact lenses (except after cataract surgery—intraocular lenses
covered); (2) Routine hearing exams, hearing aids, fitting exams for hearing aids; (3) Routine dental exams,
cleanings, fillings, extractions, dentures; (4) Routine foot care (unless related to diabetes or peripheral vascular
disease); (5) Cosmetic surgery; (6) Long-term care (custodial care—help with activities of daily living); (7)
Acupuncture (limited coverage—now covers up to 12 sessions per year for chronic low back pain); (8) Most
prescription drugs (covered under Part D); (9) Health care outside the United States (limited exceptions). Original
Medicare coverage: Part A—inpatient hospital, SNF, hospice, home health; Part B—doctor visits, outpatient
services, preventive care (annual wellness visit, flu/pneumococcal vaccines, mammograms, colonoscopies,
cardiovascular screenings), DME (wheelchairs, walkers, oxygen), ambulance services, some mental health
services, certain preventive screenings. Medicare Advantage (Part C) plans MAY offer additional benefits (dental,
vision, hearing, wellness) as supplemental benefits.
Question 5.
What is the standard Medicare Part B monthly premium for most beneficiaries in 2025?
$174.70
$185.00
$164.90
$148.50
Correct Answer: B
Rationale
The standard Medicare Part B monthly premium for 2025 is $185.00 (increased from $174.70 in 2024). The
premium is adjusted annually based on projected health care costs. INCOME-RELATED MONTHLY
ADJUSTMENT AMOUNT (IRMAA): beneficiaries with modified adjusted gross income (MAGI) above certain
thresholds pay higher premiums. 2025 IRMAA brackets (based on 2023 tax return MAGI for individual/joint filer):
(1) ≤$106,000 / ≤$212,000: $185.00 standard; (2) $106,001-$133,000 / $212,001-$266,000: $259.00; (3)
$133,001-$167,000 / $266,001-$334,000: $370.00; (4) $167,001-$200,000 / $334,001-$400,000: $480.90; (5)
$200,001-$500,000 / $400,001-$750,000: $591.90; (6) ≥$500,001 / ≥$750,001: $628.90. Social Security
Administration (SSA) determines IRMAA based on tax return data; beneficiaries receive notice (Form SSA-44) if
IRMAA applies. Life-changing events that allow IRMAA reduction appeal: marriage, divorce, death of spouse,
work stoppage/reduction, loss of income-producing property, loss of pension, employer settlement. Part B also has
an annual deductible ($257 in 2025) before coverage begins, then 20% coinsurance for most services.
Z.ai Insurance Education 4 2027 AHIP Edition
