2027 AHIP FINAL EXAM – MEDICARE
CERTIFICATION – ACTUAL QUESTIONS &
ANSWERS (AHIP) GUARANTEE PASS (UPDATED
PDF)
Table of Contents
1. Medicare Basics
2. Medicare Parts A, B, C, and D
3. Eligibility & Enrollment
4. Medicare Advantage
5. Prescription Drug Coverage
6. Medigap
7. Compliance & Fraud, Waste, and Abuse
8. Marketing & Communications
9. Special Enrollment Situations
10. Comprehensive Review
Part 1: Questions 1–10
Section 1: Medicare Basics
Question 1
Which part of Medicare primarily covers inpatient hospital services?
A. Medicare Part A
B. Medicare Part B
C. Medicare Part C
D. Medicare Part D
,Correct Answer: A. Medicare Part A
Rationale:
Part A is hospital insurance and generally covers inpatient hospital care, skilled nursing facility
care (under qualifying conditions), hospice, and limited home health services. Part B covers
outpatient medical services, Part C is Medicare Advantage, and Part D covers prescription drugs.
Question 2
Which Medicare part generally covers physician visits and outpatient medical services?
A. Part A
B. Part B
C. Part C
D. Part D
Correct Answer: B. Part B
Rationale:
Part B helps pay for medically necessary physician services, outpatient care, preventive services,
laboratory tests, durable medical equipment, and many other outpatient medical services.
Question 3
What is the primary purpose of Medicare Part D?
A. Cover inpatient hospital stays
B. Cover outpatient surgery
C. Provide prescription drug coverage
D. Cover long-term nursing home care
Correct Answer: C. Provide prescription drug coverage
Rationale:
Medicare Part D helps beneficiaries pay for covered prescription medications through private
plans approved by Medicare. It does not cover hospital stays or long-term custodial care.
Question 4
A beneficiary enrolled in a Medicare Advantage plan receives Medicare benefits through:
,A. A state Medicaid agency
B. A private insurance company approved by Medicare
C. Their employer
D. Social Security
Correct Answer: B. A private insurance company approved by Medicare
Rationale:
Medicare Advantage (Part C) plans are offered by private insurers that contract with Medicare to
provide Medicare-covered benefits.
Question 5
Which statement best describes Original Medicare?
A. It combines medical and prescription drug coverage into one plan.
B. It consists of Part A and Part B administered by the federal government.
C. It is available only to individuals under age 65.
D. It always includes dental and vision benefits.
Correct Answer: B. It consists of Part A and Part B administered by the federal government.
Rationale:
Original Medicare includes Part A and Part B. Most beneficiaries who want prescription drug
coverage enroll separately in a Part D plan. Dental and vision benefits are generally not included.
Question 6
Which of the following is generally considered a preventive service covered under Medicare Part
B?
A. Cosmetic surgery
B. Annual wellness visit
C. Vacation travel insurance
D. Long-term custodial nursing home care
Correct Answer: B. Annual wellness visit
, Rationale:
Part B covers many preventive services, including annual wellness visits, screenings, and certain
vaccines intended to promote early detection and preventive care.
Question 7
Which statement about Medicare eligibility is generally correct?
A. Only individuals over age 70 qualify.
B. Individuals age 65 and older may qualify if they meet Medicare eligibility requirements.
C. Only retired federal employees qualify.
D. Medicare is available only to people with employer insurance.
Correct Answer: B. Individuals age 65 and older may qualify if they meet Medicare eligibility
requirements.
Rationale:
Most people become eligible for Medicare at age 65 if they meet applicable eligibility
requirements. Some younger individuals with certain disabilities or qualifying medical
conditions may also qualify.
Question 8
Which Medicare component is optional for beneficiaries?
A. Medicare enrollment
B. Medicare Part D prescription drug coverage
C. Medicare eligibility
D. Social Security benefits
Correct Answer: B. Medicare Part D prescription drug coverage
Rationale:
Part D is optional, although delaying enrollment without other creditable prescription drug
coverage may result in a late enrollment penalty if the beneficiary enrolls later.
Question 9
Which organization administers the Medicare program at the federal level?
CERTIFICATION – ACTUAL QUESTIONS &
ANSWERS (AHIP) GUARANTEE PASS (UPDATED
PDF)
Table of Contents
1. Medicare Basics
2. Medicare Parts A, B, C, and D
3. Eligibility & Enrollment
4. Medicare Advantage
5. Prescription Drug Coverage
6. Medigap
7. Compliance & Fraud, Waste, and Abuse
8. Marketing & Communications
9. Special Enrollment Situations
10. Comprehensive Review
Part 1: Questions 1–10
Section 1: Medicare Basics
Question 1
Which part of Medicare primarily covers inpatient hospital services?
A. Medicare Part A
B. Medicare Part B
C. Medicare Part C
D. Medicare Part D
,Correct Answer: A. Medicare Part A
Rationale:
Part A is hospital insurance and generally covers inpatient hospital care, skilled nursing facility
care (under qualifying conditions), hospice, and limited home health services. Part B covers
outpatient medical services, Part C is Medicare Advantage, and Part D covers prescription drugs.
Question 2
Which Medicare part generally covers physician visits and outpatient medical services?
A. Part A
B. Part B
C. Part C
D. Part D
Correct Answer: B. Part B
Rationale:
Part B helps pay for medically necessary physician services, outpatient care, preventive services,
laboratory tests, durable medical equipment, and many other outpatient medical services.
Question 3
What is the primary purpose of Medicare Part D?
A. Cover inpatient hospital stays
B. Cover outpatient surgery
C. Provide prescription drug coverage
D. Cover long-term nursing home care
Correct Answer: C. Provide prescription drug coverage
Rationale:
Medicare Part D helps beneficiaries pay for covered prescription medications through private
plans approved by Medicare. It does not cover hospital stays or long-term custodial care.
Question 4
A beneficiary enrolled in a Medicare Advantage plan receives Medicare benefits through:
,A. A state Medicaid agency
B. A private insurance company approved by Medicare
C. Their employer
D. Social Security
Correct Answer: B. A private insurance company approved by Medicare
Rationale:
Medicare Advantage (Part C) plans are offered by private insurers that contract with Medicare to
provide Medicare-covered benefits.
Question 5
Which statement best describes Original Medicare?
A. It combines medical and prescription drug coverage into one plan.
B. It consists of Part A and Part B administered by the federal government.
C. It is available only to individuals under age 65.
D. It always includes dental and vision benefits.
Correct Answer: B. It consists of Part A and Part B administered by the federal government.
Rationale:
Original Medicare includes Part A and Part B. Most beneficiaries who want prescription drug
coverage enroll separately in a Part D plan. Dental and vision benefits are generally not included.
Question 6
Which of the following is generally considered a preventive service covered under Medicare Part
B?
A. Cosmetic surgery
B. Annual wellness visit
C. Vacation travel insurance
D. Long-term custodial nursing home care
Correct Answer: B. Annual wellness visit
, Rationale:
Part B covers many preventive services, including annual wellness visits, screenings, and certain
vaccines intended to promote early detection and preventive care.
Question 7
Which statement about Medicare eligibility is generally correct?
A. Only individuals over age 70 qualify.
B. Individuals age 65 and older may qualify if they meet Medicare eligibility requirements.
C. Only retired federal employees qualify.
D. Medicare is available only to people with employer insurance.
Correct Answer: B. Individuals age 65 and older may qualify if they meet Medicare eligibility
requirements.
Rationale:
Most people become eligible for Medicare at age 65 if they meet applicable eligibility
requirements. Some younger individuals with certain disabilities or qualifying medical
conditions may also qualify.
Question 8
Which Medicare component is optional for beneficiaries?
A. Medicare enrollment
B. Medicare Part D prescription drug coverage
C. Medicare eligibility
D. Social Security benefits
Correct Answer: B. Medicare Part D prescription drug coverage
Rationale:
Part D is optional, although delaying enrollment without other creditable prescription drug
coverage may result in a late enrollment penalty if the beneficiary enrolls later.
Question 9
Which organization administers the Medicare program at the federal level?
