✅ AHIP FINAL EXAM PRACTICE SET
(2025/2026)
50 Verified-Style Questions + Correct Answers
Section 1 — Medicare Basics & Eligibility
1. What is the earliest age most individuals become eligible for Medicare
Part A based on age alone?
Answer: 65
2. Which of the following individuals may qualify for Medicare before age
65?
A. Person with ESRD
B. Person with ALS
C. Person with 5-year employer coverage
D. Person with high income
Answer: A and B
3. Medicare Part A primarily covers:
A. Doctor visits
B. Hospital inpatient services
C. Durable medical equipment
D. Outpatient surgery
Answer: B
4. Enrollment in Medicare Part A is automatic for most people because:
,Answer: They receive Social Security benefits.
5. Which part of Medicare covers preventive screenings such as
mammograms?
Answer: Part B
6. The penalty for late enrollment into Part B is calculated:
Answer: 10% for each full 12-month period delayed.
7. Which program helps low-income beneficiaries pay Medicare premiums?
Answer: Medicare Savings Programs (MSPs)
8. When someone delays Part B due to having creditable employer
coverage, they qualify for:
Answer: Special Enrollment Period (SEP)
9. Medicare Advantage plans are also known as:
Answer: Part C
10. What is the “donut hole” associated with?
Answer: Medicare Part D coverage gap
Section 2 — Medicare Advantage (Part C)
11. To enroll in a Medicare Advantage plan, a person must:
Answer: Have both Part A and Part B
12. Medicare Advantage plans must cover:
Answer: Everything Original Medicare covers (except hospice)
13. A PPO allows members to:
Answer: See out-of-network providers at higher cost
, 14. Extra benefits such as dental and vision are known as:
Answer: Supplemental benefits
15. When can beneficiaries switch from MA to Original Medicare?
Answer: Annual Election Period (AEP)
16. The Out-of-Pocket Maximum (MOOP) applies to:
Answer: Medicare Advantage Part A and B services
17. Chronic Condition Special Needs Plans (C-SNPs) enroll:
Answer: Individuals with qualifying severe or disabling conditions
18. MA plans receive payment from CMS through:
Answer: Capitated per-member-per-month payments
19. MA plans may include prescription drug coverage known as:
Answer: MAPD plans
20. An MA enrollee must remain in the plan for a year unless:
Answer: They qualify for an SEP
Section 3 — Part D Prescription Drug Plans
21. Part D plans must offer at least:
Answer: A standard coverage model or actuarially equivalent design
22. The Part D late enrollment penalty is based on:
Answer: 1% of the national base premium per month without creditable coverage
23. Which drug type is NOT covered under Part D?
A. Weight-loss drugs
B. Chemotherapy
(2025/2026)
50 Verified-Style Questions + Correct Answers
Section 1 — Medicare Basics & Eligibility
1. What is the earliest age most individuals become eligible for Medicare
Part A based on age alone?
Answer: 65
2. Which of the following individuals may qualify for Medicare before age
65?
A. Person with ESRD
B. Person with ALS
C. Person with 5-year employer coverage
D. Person with high income
Answer: A and B
3. Medicare Part A primarily covers:
A. Doctor visits
B. Hospital inpatient services
C. Durable medical equipment
D. Outpatient surgery
Answer: B
4. Enrollment in Medicare Part A is automatic for most people because:
,Answer: They receive Social Security benefits.
5. Which part of Medicare covers preventive screenings such as
mammograms?
Answer: Part B
6. The penalty for late enrollment into Part B is calculated:
Answer: 10% for each full 12-month period delayed.
7. Which program helps low-income beneficiaries pay Medicare premiums?
Answer: Medicare Savings Programs (MSPs)
8. When someone delays Part B due to having creditable employer
coverage, they qualify for:
Answer: Special Enrollment Period (SEP)
9. Medicare Advantage plans are also known as:
Answer: Part C
10. What is the “donut hole” associated with?
Answer: Medicare Part D coverage gap
Section 2 — Medicare Advantage (Part C)
11. To enroll in a Medicare Advantage plan, a person must:
Answer: Have both Part A and Part B
12. Medicare Advantage plans must cover:
Answer: Everything Original Medicare covers (except hospice)
13. A PPO allows members to:
Answer: See out-of-network providers at higher cost
, 14. Extra benefits such as dental and vision are known as:
Answer: Supplemental benefits
15. When can beneficiaries switch from MA to Original Medicare?
Answer: Annual Election Period (AEP)
16. The Out-of-Pocket Maximum (MOOP) applies to:
Answer: Medicare Advantage Part A and B services
17. Chronic Condition Special Needs Plans (C-SNPs) enroll:
Answer: Individuals with qualifying severe or disabling conditions
18. MA plans receive payment from CMS through:
Answer: Capitated per-member-per-month payments
19. MA plans may include prescription drug coverage known as:
Answer: MAPD plans
20. An MA enrollee must remain in the plan for a year unless:
Answer: They qualify for an SEP
Section 3 — Part D Prescription Drug Plans
21. Part D plans must offer at least:
Answer: A standard coverage model or actuarially equivalent design
22. The Part D late enrollment penalty is based on:
Answer: 1% of the national base premium per month without creditable coverage
23. Which drug type is NOT covered under Part D?
A. Weight-loss drugs
B. Chemotherapy
