2026-2027 AHIP
Final Exam Study Guide
Medicare Certification — Actual Questions & Answers
UPDATED 2 0 2 6 - 2027 EDITION
4 Modules • 80 Practice Questions • 50-Question Final Exam
HOW TO USE THIS GUIDE
• Four modules cover all AHIP content: Medicare basics, enrollment, MA/Part D, marketing rules.
• 80 practice questions reinforce every key concept with detailed explanations.
• 50-question final exam simulates the actual AHIP certification exam.
• Appendices include 2027 Medicare premiums/deductibles, enrollment period quick reference, MA plan types, Star
Ratings.
• Aim for 90%+ on the final exam — the AHIP pass threshold.
, 2027 AHIP Final Exam | Medicare Certification Study Guide
Section 1: Medicare Foundations & the Four Parts of Medicare — Practice
Questions
These 20 questions cover Medicare basics: history, eligibility, the four parts of Medicare (A,
B, C, D), Original Medicare vs. Medicare Advantage, premiums, deductibles, and cost-sharing.
Master these foundational concepts before moving on to enrollment periods and plan details.
Q1. Which federal agency administers the Medicare program?
A. Social Security Administration (SSA)
B. Centers for Medicare & Medicaid Services (CMS)
C. Department of Veterans Affairs (VA)
D. Internal Revenue Service (IRS)
Correct Answer: B
Explanation: The Centers for Medicare & Medicaid Services (CMS), a federal agency within the
U.S. Department of Health and Human Services (HHS), administers the Medicare program. While
the Social Security Administration (SSA) handles Medicare enrollment and collects premiums, CMS
sets policy, contracts with plans, and oversees program operations. Agents often interact with both
agencies — CMS for plan and marketing rules, SSA for enrollment and premium-related issues.
Q2. Under what circumstances can an individual under age 65 qualify for Medicare?
A. Only if they have private insurance
B. After receiving Social Security Disability Insurance (SSDI) benefits for 24 months,
having ESRD, or having ALS
C. Only if they have ESRD
D. Only if they are eligible for Medicaid
Correct Answer: B
Explanation: Individuals under 65 can qualify for Medicare in three situations: (1) After receiving
SSDI benefits for 24 months, (2) Having End-Stage Renal Disease (ESRD, permanent kidney failure
requiring dialysis or transplant), or (3) Having Amyotrophic Lateral Sclerosis (ALS, Lou Gehrig's
disease), which eliminates the 24-month waiting period. Medicare eligibility is automatic for these
groups. Agents must know all paths to eligibility to advise clients correctly.
2027 AHIP Final Exam Study Guide | Page 2
, 2027 AHIP Final Exam | Medicare Certification Study Guide
Q3. How many quarters of Medicare-covered employment are required for premium-free Medicare
Part A?
A. 20 quarters (5 years)
B. 30 quarters (7.5 years)
C. 40 quarters (10 years)
D. 60 quarters (15 years)
Correct Answer: C
Explanation: Beneficiaries (or their spouse) must have 40 quarters (10 years) of Medicare-covered
employment to receive premium-free Part A. Those with 30-39 quarters pay a reduced monthly
premium ($285 in 2027), and those with fewer than 30 quarters pay the full premium ($518 in 2027).
Quarters are earned by paying Medicare payroll taxes during employment, similar to Social Security
credits. A spouse's work history can also qualify a beneficiary for premium-free Part A.
Q4. What does Medicare Part A primarily cover?
A. Physician services and outpatient care
B. Inpatient hospital care, skilled nursing facility care, hospice, and some home health care
C. Prescription drugs
D. Dental and vision care
Correct Answer: B
Explanation: Medicare Part A (Hospital Insurance) covers inpatient hospital care, skilled nursing
facility (SNF) care (after a 3-day inpatient stay), hospice care for terminally ill patients, and some
home health care. Part A does NOT cover physician services (Part B), prescription drugs (Part D),
or routine dental/vision care. Most beneficiaries receive Part A premium-free because they or their
spouse paid Medicare payroll taxes for at least 40 quarters.
Q5. What is the standard monthly premium for Medicare Part B in 2027?
A. $148.50
B. $170.10
C. $185.00
D. $257.00
Correct Answer: C
Explanation: The standard Medicare Part B premium in 2027 is $185.00 per month. Higher-income
beneficiaries pay more through Income-Related Monthly Adjustment Amounts (IRMAA), based on
modified adjusted gross income from two years prior. The Part B annual deductible in 2027 is $257.
After the deductible, beneficiaries typically pay 20% coinsurance for most covered services, with no
annual out-of-pocket maximum in Original Medicare.
2027 AHIP Final Exam Study Guide | Page 3
, 2027 AHIP Final Exam | Medicare Certification Study Guide
Q6. What is the Medicare Part B coinsurance percentage for most covered services after the annual
deductible is met?
A. 10%
B. 20%
C. 50%
D. 100%
Correct Answer: B
Explanation: After the annual deductible is met, Medicare Part B beneficiaries typically pay 20%
coinsurance for most covered services, with Medicare paying the remaining 80%. Unlike Medicare
Advantage plans, Original Medicare Part B has no annual out-of-pocket maximum — beneficiaries
are responsible for the 20% coinsurance without limit. This is why many beneficiaries purchase
Medigap policies or enroll in Medicare Advantage plans, both of which can limit out-of-pocket costs.
Q7. Which Medicare part covers prescription drugs?
A. Part A
B. Part B
C. Part C
D. Part D
Correct Answer: D
Explanation: Medicare Part D covers prescription drugs. Part D is voluntary and is provided through
private insurance companies that contract with Medicare — either as stand-alone Prescription Drug
Plans (PDPs) for beneficiaries in Original Medicare, or as part of Medicare Advantage Prescription
Drug (MA-PD) plans. Beneficiaries must enroll in Part D when first eligible or face late enrollment
penalties. Coverage includes formulary drugs organized into tiers with different cost-sharing levels.
Q8. What is the Medicare Advantage program also known as?
A. Medicare Part A
B. Medicare Part B
C. Medicare Part C
D. Medicare Part D
Correct Answer: C
Explanation: Medicare Advantage is also known as Medicare Part C. Created by the Balanced
Budget Act of 1997, Part C allows beneficiaries to receive Medicare Part A and Part B benefits
through private health plans approved by Medicare. MA plans must cover all services that Original
Medicare covers, and most also include Part D drug coverage. MA plans may offer additional
benefits like dental, vision, and hearing not covered by Original Medicare.
2027 AHIP Final Exam Study Guide | Page 4
Final Exam Study Guide
Medicare Certification — Actual Questions & Answers
UPDATED 2 0 2 6 - 2027 EDITION
4 Modules • 80 Practice Questions • 50-Question Final Exam
HOW TO USE THIS GUIDE
• Four modules cover all AHIP content: Medicare basics, enrollment, MA/Part D, marketing rules.
• 80 practice questions reinforce every key concept with detailed explanations.
• 50-question final exam simulates the actual AHIP certification exam.
• Appendices include 2027 Medicare premiums/deductibles, enrollment period quick reference, MA plan types, Star
Ratings.
• Aim for 90%+ on the final exam — the AHIP pass threshold.
, 2027 AHIP Final Exam | Medicare Certification Study Guide
Section 1: Medicare Foundations & the Four Parts of Medicare — Practice
Questions
These 20 questions cover Medicare basics: history, eligibility, the four parts of Medicare (A,
B, C, D), Original Medicare vs. Medicare Advantage, premiums, deductibles, and cost-sharing.
Master these foundational concepts before moving on to enrollment periods and plan details.
Q1. Which federal agency administers the Medicare program?
A. Social Security Administration (SSA)
B. Centers for Medicare & Medicaid Services (CMS)
C. Department of Veterans Affairs (VA)
D. Internal Revenue Service (IRS)
Correct Answer: B
Explanation: The Centers for Medicare & Medicaid Services (CMS), a federal agency within the
U.S. Department of Health and Human Services (HHS), administers the Medicare program. While
the Social Security Administration (SSA) handles Medicare enrollment and collects premiums, CMS
sets policy, contracts with plans, and oversees program operations. Agents often interact with both
agencies — CMS for plan and marketing rules, SSA for enrollment and premium-related issues.
Q2. Under what circumstances can an individual under age 65 qualify for Medicare?
A. Only if they have private insurance
B. After receiving Social Security Disability Insurance (SSDI) benefits for 24 months,
having ESRD, or having ALS
C. Only if they have ESRD
D. Only if they are eligible for Medicaid
Correct Answer: B
Explanation: Individuals under 65 can qualify for Medicare in three situations: (1) After receiving
SSDI benefits for 24 months, (2) Having End-Stage Renal Disease (ESRD, permanent kidney failure
requiring dialysis or transplant), or (3) Having Amyotrophic Lateral Sclerosis (ALS, Lou Gehrig's
disease), which eliminates the 24-month waiting period. Medicare eligibility is automatic for these
groups. Agents must know all paths to eligibility to advise clients correctly.
2027 AHIP Final Exam Study Guide | Page 2
, 2027 AHIP Final Exam | Medicare Certification Study Guide
Q3. How many quarters of Medicare-covered employment are required for premium-free Medicare
Part A?
A. 20 quarters (5 years)
B. 30 quarters (7.5 years)
C. 40 quarters (10 years)
D. 60 quarters (15 years)
Correct Answer: C
Explanation: Beneficiaries (or their spouse) must have 40 quarters (10 years) of Medicare-covered
employment to receive premium-free Part A. Those with 30-39 quarters pay a reduced monthly
premium ($285 in 2027), and those with fewer than 30 quarters pay the full premium ($518 in 2027).
Quarters are earned by paying Medicare payroll taxes during employment, similar to Social Security
credits. A spouse's work history can also qualify a beneficiary for premium-free Part A.
Q4. What does Medicare Part A primarily cover?
A. Physician services and outpatient care
B. Inpatient hospital care, skilled nursing facility care, hospice, and some home health care
C. Prescription drugs
D. Dental and vision care
Correct Answer: B
Explanation: Medicare Part A (Hospital Insurance) covers inpatient hospital care, skilled nursing
facility (SNF) care (after a 3-day inpatient stay), hospice care for terminally ill patients, and some
home health care. Part A does NOT cover physician services (Part B), prescription drugs (Part D),
or routine dental/vision care. Most beneficiaries receive Part A premium-free because they or their
spouse paid Medicare payroll taxes for at least 40 quarters.
Q5. What is the standard monthly premium for Medicare Part B in 2027?
A. $148.50
B. $170.10
C. $185.00
D. $257.00
Correct Answer: C
Explanation: The standard Medicare Part B premium in 2027 is $185.00 per month. Higher-income
beneficiaries pay more through Income-Related Monthly Adjustment Amounts (IRMAA), based on
modified adjusted gross income from two years prior. The Part B annual deductible in 2027 is $257.
After the deductible, beneficiaries typically pay 20% coinsurance for most covered services, with no
annual out-of-pocket maximum in Original Medicare.
2027 AHIP Final Exam Study Guide | Page 3
, 2027 AHIP Final Exam | Medicare Certification Study Guide
Q6. What is the Medicare Part B coinsurance percentage for most covered services after the annual
deductible is met?
A. 10%
B. 20%
C. 50%
D. 100%
Correct Answer: B
Explanation: After the annual deductible is met, Medicare Part B beneficiaries typically pay 20%
coinsurance for most covered services, with Medicare paying the remaining 80%. Unlike Medicare
Advantage plans, Original Medicare Part B has no annual out-of-pocket maximum — beneficiaries
are responsible for the 20% coinsurance without limit. This is why many beneficiaries purchase
Medigap policies or enroll in Medicare Advantage plans, both of which can limit out-of-pocket costs.
Q7. Which Medicare part covers prescription drugs?
A. Part A
B. Part B
C. Part C
D. Part D
Correct Answer: D
Explanation: Medicare Part D covers prescription drugs. Part D is voluntary and is provided through
private insurance companies that contract with Medicare — either as stand-alone Prescription Drug
Plans (PDPs) for beneficiaries in Original Medicare, or as part of Medicare Advantage Prescription
Drug (MA-PD) plans. Beneficiaries must enroll in Part D when first eligible or face late enrollment
penalties. Coverage includes formulary drugs organized into tiers with different cost-sharing levels.
Q8. What is the Medicare Advantage program also known as?
A. Medicare Part A
B. Medicare Part B
C. Medicare Part C
D. Medicare Part D
Correct Answer: C
Explanation: Medicare Advantage is also known as Medicare Part C. Created by the Balanced
Budget Act of 1997, Part C allows beneficiaries to receive Medicare Part A and Part B benefits
through private health plans approved by Medicare. MA plans must cover all services that Original
Medicare covers, and most also include Part D drug coverage. MA plans may offer additional
benefits like dental, vision, and hearing not covered by Original Medicare.
2027 AHIP Final Exam Study Guide | Page 4
