AHIP EXAM 200 ACTUAL QUESTIONS AND CORRECT
ANSWERS WITH RATIONALE LATEST 2026 ALREADY
GRADED A+
This comprehensive collection of 200 unique questions is specifically designed
to mirror the content and complexity of the 2027 AHIP Medicare and Fraud,
Waste, and Abuse (FWA) certification exam. The questions systematically
cover all core domains, including Medicare eligibility and enrollment periods
(IEP, AEP, SEP, GEP, MA OEP), Medicare Advantage and Part D plan
structures and cost-sharing, Medigap supplemental policies, and the critical
identification, reporting, and prevention of fraud, waste, and abuse under
federal regulations. The set thoroughly tests your knowledge of CMS
marketing compliance, beneficiary rights, and plan coordination rules. Each
question is accompanied by a correct answer and a detailed rationale to
reinforce key concepts, ensuring you are well-prepared for the exam's focus
on consumer protection and regulatory adherence.
1. Mr. Capadona would like to purchase a Medicare Advantage (MA) plan and a
Medigap plan to pick up costs not covered by that plan. What should you tell him?
A. You can sell him a Medigap plan to help with costs not covered under Medicare
Advantage.
B. It is illegal for you to sell Mr. Capadona a Medigap plan if he is enrolled in an
MA plan, and besides, Medigap only works with Original Medicare.
C. Medigap plans are designed to work alongside Medicare Advantage plans.
D. He must disenroll from his MA plan before buying a Medigap plan.
Answer: B
Rationale: Medigap plans are supplemental policies that fill gaps in Original
Medicare (Parts A and B). Federal law prohibits issuing a Medigap policy to
anyone currently enrolled in a Medicare Advantage plan, as Medigap cannot pay
costs associated with MA .
2. Mr. Diaz continued working with his company and was insured under his
employer's group plan until he reached age 68. He has heard that there is a
premium penalty for those who did not sign up for Part B when first eligible and
wants to know how much he will have to pay. What should you tell him?
A. Mr. Diaz will pay a 10% penalty for each year he delayed enrollment.
,B. Mr. Diaz will not pay any penalty because he had continuous coverage under
his employer's plan.
C. Mr. Diaz will pay a 20% penalty for each year he delayed enrollment.
D. Mr. Diaz must pay the full Part B premium with no penalty.
Answer: B
Rationale: Individuals who have continuous creditable coverage under an
employer-sponsored group health plan are not subject to the Part B late enrollment
penalty when they eventually enroll .
3. Madeline Martinez was widowed several years ago. Her husband worked for
many years and contributed into the Medicare system. He also left a substantial
estate which provides Madeline with an annual income of approximately $130,000.
Madeline, who has only worked part-time for the last three years, will soon turn
age 65 and hopes to enroll in Original Medicare. What should you tell her?
A. Madeline will not qualify for Medicare because she has not worked enough.
B. Madeline will be able to enroll in Medicare Part A without paying monthly
premiums due to her husband's long work record. She will pay Part B premiums at
more than the standard lowest rate but less than the highest rate due to her
substantial income.
C. Madeline will have to pay full premiums for both Part A and Part B.
D. Madeline should apply for Medicaid instead of Medicare.
Answer: B
Rationale: Madeline qualifies for premium-free Part A based on her husband's
work record. Part B premiums are income-adjusted under IRMAA (Income-
Related Monthly Adjustment Amount). Her income of $130,000 exceeds the
standard threshold, so she will pay more than the base premium but less than the
highest rate .
4. Mr. Moy will soon turn age 65. He wants to understand what coverage
Medicare Supplemental Insurance (Medigap) provides. What could you tell Mr.
Moy?
A. It covers everything Original Medicare does not.
B. It provides prescription drug coverage.
C. Medicare Supplemental Insurance would help cover his Part A deductible and
Part B coinsurance or copayments in Original Fee-for-Service (FFS) Medicare as
well as possibly some services that Medicare does not cover.
D. It is only available for Medicare Advantage enrollees.
Answer: C
Rationale: Medigap policies pay many out-of-pocket costs not covered by Original
Medicare, such as deductibles, coinsurance, and copayments. Some plans also
,cover foreign travel emergency care. Medigap does not cover long-term care,
vision, dental, hearing aids, or private nursing .
5. Which of the following statements best describes the relationship between
Medicare Advantage (Part C) and Medigap?
A. Medigap plans can be used to pay Medicare Advantage copayments.
B. Beneficiaries can enroll in both a Medicare Advantage plan and a Medigap plan
simultaneously.
C. It is illegal to sell a Medigap plan to a beneficiary enrolled in a Medicare
Advantage plan.
D. Medigap plans automatically convert to Medicare Advantage plans at age 65.
Answer: C
Rationale: Federal law prohibits the sale of a Medigap policy to someone enrolled
in a Medicare Advantage plan. Medigap only works with Original Medicare .
6. Ms. Kumar is concerned that her income will make her ineligible for Medicare
at age 65. What could you tell her?
A. High income makes one ineligible for Medicare.
B. Only low-income individuals qualify for Medicare.
C. Medicare is a program for people age 65 or older and those under age 65 with
certain disabilities, ESRD, and ALS, so she will be eligible for Medicare.
D. She should apply for Medicaid instead.
Answer: C
Rationale: Eligibility for Medicare is based on age (65+), certain disabilities, and
specific diseases like ESRD and ALS, not income. Higher income can affect Part B
and D premiums through IRMAA but does not preclude eligibility itself .
7. Edward IP suffered from serious kidney disease. As a result, Edward became
eligible for Medicare coverage due to end-stage renal disease (ESRD). A close
relative donated their kidney and Edward successfully underwent transplant
surgery 12 months ago. Edward is now age 50 and asks you if his Medicare
coverage will continue. What should you tell him?
A. Edward's Medicare coverage will end immediately after the transplant.
B. Edward's Medicare coverage will continue for a period following the transplant,
typically 36 months after successful transplantation.
C. Edward's Medicare coverage will continue indefinitely.
D. Edward must reapply for Medicare after the transplant.
Answer: B
Rationale: Medicare coverage for individuals with ESRD continues for a specified
period following successful kidney transplantation, generally 36 months. After this
, period, coverage may end unless the individual qualifies for Medicare on another
basis .
8. Mr. Wu is eligible for Medicare. He has limited financial resources but failed to
qualify for the Part D low-income subsidy. Where might he turn for help with his
prescription drug costs?
A. Apply for Medicaid to cover prescription costs.
B. Seek assistance from pharmaceutical company discount programs.
C. Mr. Wu may still qualify for help in paying Part D costs through his State
Pharmaceutical Assistance Program (SPAP).
D. Try to enroll in a Medigap plan with drug coverage.
Answer: C
Rationale: States may offer State Pharmaceutical Assistance Programs (SPAPs) to
assist residents who do not qualify for the federal Low Income Subsidy but still
need help with Part D drug costs. Eligibility and benefits vary by state .
9. Mr. Vasquez is in good health and wants to understand the health care costs for
inpatient hospital services under Original Medicare. What could you tell him?
A. He pays no deductible if admitted to a hospital.
B. He is responsible for a copayment every day in the hospital.
C. Under Original Medicare, there is a single deductible amount due for the first 60
days of any inpatient hospital stay, after which it converts into a per-day
coinsurance amount through day 90. After day 90, he would pay a daily amount up
to 60 days over his lifetime, after which he would be responsible for all costs.
D. Medicare covers 100% of inpatient hospitalization with no out-of-pocket
expense.
Answer: C
Rationale: Medicare Part A has a deductible for the first 60 days of an inpatient
stay. Days 61-90 have a daily coinsurance, and days 91-150 use lifetime reserve
days with a higher daily coinsurance. After that, the beneficiary pays all costs .
10. Mrs. Paterson is concerned about the deductibles and coinsurance associated
with Original Medicare. What can she do to protect herself from such costs?
A. Enroll in a Medicare Advantage plan that offers supplemental benefits.
B. Enroll in a Medicare Supplemental Insurance (Medigap) plan that covers some
of the out-of-pocket costs not covered by Original Medicare.
C. Enroll in a Medicare prescription drug plan.
D. Enroll in a Medicare Cost Plan.
Answer: B
ANSWERS WITH RATIONALE LATEST 2026 ALREADY
GRADED A+
This comprehensive collection of 200 unique questions is specifically designed
to mirror the content and complexity of the 2027 AHIP Medicare and Fraud,
Waste, and Abuse (FWA) certification exam. The questions systematically
cover all core domains, including Medicare eligibility and enrollment periods
(IEP, AEP, SEP, GEP, MA OEP), Medicare Advantage and Part D plan
structures and cost-sharing, Medigap supplemental policies, and the critical
identification, reporting, and prevention of fraud, waste, and abuse under
federal regulations. The set thoroughly tests your knowledge of CMS
marketing compliance, beneficiary rights, and plan coordination rules. Each
question is accompanied by a correct answer and a detailed rationale to
reinforce key concepts, ensuring you are well-prepared for the exam's focus
on consumer protection and regulatory adherence.
1. Mr. Capadona would like to purchase a Medicare Advantage (MA) plan and a
Medigap plan to pick up costs not covered by that plan. What should you tell him?
A. You can sell him a Medigap plan to help with costs not covered under Medicare
Advantage.
B. It is illegal for you to sell Mr. Capadona a Medigap plan if he is enrolled in an
MA plan, and besides, Medigap only works with Original Medicare.
C. Medigap plans are designed to work alongside Medicare Advantage plans.
D. He must disenroll from his MA plan before buying a Medigap plan.
Answer: B
Rationale: Medigap plans are supplemental policies that fill gaps in Original
Medicare (Parts A and B). Federal law prohibits issuing a Medigap policy to
anyone currently enrolled in a Medicare Advantage plan, as Medigap cannot pay
costs associated with MA .
2. Mr. Diaz continued working with his company and was insured under his
employer's group plan until he reached age 68. He has heard that there is a
premium penalty for those who did not sign up for Part B when first eligible and
wants to know how much he will have to pay. What should you tell him?
A. Mr. Diaz will pay a 10% penalty for each year he delayed enrollment.
,B. Mr. Diaz will not pay any penalty because he had continuous coverage under
his employer's plan.
C. Mr. Diaz will pay a 20% penalty for each year he delayed enrollment.
D. Mr. Diaz must pay the full Part B premium with no penalty.
Answer: B
Rationale: Individuals who have continuous creditable coverage under an
employer-sponsored group health plan are not subject to the Part B late enrollment
penalty when they eventually enroll .
3. Madeline Martinez was widowed several years ago. Her husband worked for
many years and contributed into the Medicare system. He also left a substantial
estate which provides Madeline with an annual income of approximately $130,000.
Madeline, who has only worked part-time for the last three years, will soon turn
age 65 and hopes to enroll in Original Medicare. What should you tell her?
A. Madeline will not qualify for Medicare because she has not worked enough.
B. Madeline will be able to enroll in Medicare Part A without paying monthly
premiums due to her husband's long work record. She will pay Part B premiums at
more than the standard lowest rate but less than the highest rate due to her
substantial income.
C. Madeline will have to pay full premiums for both Part A and Part B.
D. Madeline should apply for Medicaid instead of Medicare.
Answer: B
Rationale: Madeline qualifies for premium-free Part A based on her husband's
work record. Part B premiums are income-adjusted under IRMAA (Income-
Related Monthly Adjustment Amount). Her income of $130,000 exceeds the
standard threshold, so she will pay more than the base premium but less than the
highest rate .
4. Mr. Moy will soon turn age 65. He wants to understand what coverage
Medicare Supplemental Insurance (Medigap) provides. What could you tell Mr.
Moy?
A. It covers everything Original Medicare does not.
B. It provides prescription drug coverage.
C. Medicare Supplemental Insurance would help cover his Part A deductible and
Part B coinsurance or copayments in Original Fee-for-Service (FFS) Medicare as
well as possibly some services that Medicare does not cover.
D. It is only available for Medicare Advantage enrollees.
Answer: C
Rationale: Medigap policies pay many out-of-pocket costs not covered by Original
Medicare, such as deductibles, coinsurance, and copayments. Some plans also
,cover foreign travel emergency care. Medigap does not cover long-term care,
vision, dental, hearing aids, or private nursing .
5. Which of the following statements best describes the relationship between
Medicare Advantage (Part C) and Medigap?
A. Medigap plans can be used to pay Medicare Advantage copayments.
B. Beneficiaries can enroll in both a Medicare Advantage plan and a Medigap plan
simultaneously.
C. It is illegal to sell a Medigap plan to a beneficiary enrolled in a Medicare
Advantage plan.
D. Medigap plans automatically convert to Medicare Advantage plans at age 65.
Answer: C
Rationale: Federal law prohibits the sale of a Medigap policy to someone enrolled
in a Medicare Advantage plan. Medigap only works with Original Medicare .
6. Ms. Kumar is concerned that her income will make her ineligible for Medicare
at age 65. What could you tell her?
A. High income makes one ineligible for Medicare.
B. Only low-income individuals qualify for Medicare.
C. Medicare is a program for people age 65 or older and those under age 65 with
certain disabilities, ESRD, and ALS, so she will be eligible for Medicare.
D. She should apply for Medicaid instead.
Answer: C
Rationale: Eligibility for Medicare is based on age (65+), certain disabilities, and
specific diseases like ESRD and ALS, not income. Higher income can affect Part B
and D premiums through IRMAA but does not preclude eligibility itself .
7. Edward IP suffered from serious kidney disease. As a result, Edward became
eligible for Medicare coverage due to end-stage renal disease (ESRD). A close
relative donated their kidney and Edward successfully underwent transplant
surgery 12 months ago. Edward is now age 50 and asks you if his Medicare
coverage will continue. What should you tell him?
A. Edward's Medicare coverage will end immediately after the transplant.
B. Edward's Medicare coverage will continue for a period following the transplant,
typically 36 months after successful transplantation.
C. Edward's Medicare coverage will continue indefinitely.
D. Edward must reapply for Medicare after the transplant.
Answer: B
Rationale: Medicare coverage for individuals with ESRD continues for a specified
period following successful kidney transplantation, generally 36 months. After this
, period, coverage may end unless the individual qualifies for Medicare on another
basis .
8. Mr. Wu is eligible for Medicare. He has limited financial resources but failed to
qualify for the Part D low-income subsidy. Where might he turn for help with his
prescription drug costs?
A. Apply for Medicaid to cover prescription costs.
B. Seek assistance from pharmaceutical company discount programs.
C. Mr. Wu may still qualify for help in paying Part D costs through his State
Pharmaceutical Assistance Program (SPAP).
D. Try to enroll in a Medigap plan with drug coverage.
Answer: C
Rationale: States may offer State Pharmaceutical Assistance Programs (SPAPs) to
assist residents who do not qualify for the federal Low Income Subsidy but still
need help with Part D drug costs. Eligibility and benefits vary by state .
9. Mr. Vasquez is in good health and wants to understand the health care costs for
inpatient hospital services under Original Medicare. What could you tell him?
A. He pays no deductible if admitted to a hospital.
B. He is responsible for a copayment every day in the hospital.
C. Under Original Medicare, there is a single deductible amount due for the first 60
days of any inpatient hospital stay, after which it converts into a per-day
coinsurance amount through day 90. After day 90, he would pay a daily amount up
to 60 days over his lifetime, after which he would be responsible for all costs.
D. Medicare covers 100% of inpatient hospitalization with no out-of-pocket
expense.
Answer: C
Rationale: Medicare Part A has a deductible for the first 60 days of an inpatient
stay. Days 61-90 have a daily coinsurance, and days 91-150 use lifetime reserve
days with a higher daily coinsurance. After that, the beneficiary pays all costs .
10. Mrs. Paterson is concerned about the deductibles and coinsurance associated
with Original Medicare. What can she do to protect herself from such costs?
A. Enroll in a Medicare Advantage plan that offers supplemental benefits.
B. Enroll in a Medicare Supplemental Insurance (Medigap) plan that covers some
of the out-of-pocket costs not covered by Original Medicare.
C. Enroll in a Medicare prescription drug plan.
D. Enroll in a Medicare Cost Plan.
Answer: B
