2027 AHIP FINAL EXAM – MEDICARE CERTIFICATION –
ACTUAL QUESTIONS & ANSWERS (AHIP) GUARANTEE PASS
(UPDATED PDF)
Medicare Certification Study Guide
100 Original Practice Questions with Answers & Rationales
Important note on this document: This is an original study resource I created to
help you prepare for Medicare certification training (such as the AHIP Medicare
course). It is not a copy or reproduction of any proprietary exam content, and it
should not be represented as "actual" leaked exam questions. Real certification
exams are copyrighted and administered under secure conditions; using
unauthorized "actual answer" materials can violate the certifying organization's
terms and, more importantly, can leave you underprepared to actually advise
Medicare beneficiaries — which is the entire point of the certification. Use this to
learn the material, then take your real certification exam honestly.
Table of Contents
Section Topic Questions
1 Medicare Fundamentals (Parts A & B) 1–17
2 Medicare Advantage (Part C) 18–34
3 Medicare Part D (Prescription Drug Coverage) 35–51
4 Enrollment Periods & Eligibility 52–68
5 Marketing, Communications & Compliance 69–84
6 Fraud, Waste & Abuse (FWA) and Special Needs Plans 85–100
Section 1: Medicare Fundamentals (Parts A & B)
,1. What does Medicare Part A primarily cover? A) Outpatient physician visits B) Prescription
drugs C) Inpatient hospital care, skilled nursing facility care, hospice, and some home health care
D) Routine dental and vision care
Answer: C Rationale: Part A is often called "hospital insurance." It covers inpatient stays,
limited skilled nursing facility care following a qualifying hospital stay, hospice care, and certain
home health services. It does not cover routine dental, vision, or outpatient physician services —
those fall under other parts of Medicare.
2. What does Medicare Part B primarily cover? A) Inpatient hospital stays only B) Medically
necessary outpatient services, physician visits, and preventive care C) Long-term custodial care
D) Prescription drugs purchased at a retail pharmacy
Answer: B Rationale: Part B is "medical insurance," covering outpatient care, doctor visits,
durable medical equipment, and many preventive services. It is distinct from Part A (hospital)
and Part D (drugs).
3. Most people do not pay a monthly premium for Part A because: A) It is fully funded by
state governments B) They or a spouse paid Medicare payroll taxes for at least 40 quarters (10
years) C) Part A is optional and rarely elected D) Premiums are waived for anyone over age 62
Answer: B Rationale: Part A is "premium-free" for most beneficiaries because sufficient
Medicare payroll tax was paid during their (or a spouse's) working years — generally 40
quarters of covered employment.
4. What is the standard 2026-era approach to the Part B premium for most beneficiaries?
A) It is the same flat amount for everyone every year, never changing B) It is set annually and
can be higher for beneficiaries with higher income (IRMAA) C) It is only charged to
beneficiaries enrolled in Medicare Advantage D) It is paid only once, at initial enrollment
Answer: B Rationale: The Part B premium is set annually by CMS and adjusts based on income
through the Income-Related Monthly Adjustment Amount (IRMAA), meaning higher-income
beneficiaries pay more than the standard premium.
5. A Medicare Supplement (Medigap) policy is designed to: A) Replace Original Medicare
entirely B) Help pay for out-of-pocket costs (like coinsurance and deductibles) not covered by
Original Medicare C) Provide prescription drug coverage as its main benefit D) Only be sold to
people under age 65
, Answer: B Rationale: Medigap policies work alongside Original Medicare (Parts A and B) to
help cover cost-sharing gaps such as copayments, coinsurance, and deductibles. They do not
replace Original Medicare and generally cannot be combined with Medicare Advantage.
6. Which of the following is generally NOT covered by Original Medicare (Parts A & B)?
A) Inpatient hospital care B) Outpatient surgery C) Routine long-term custodial care in a nursing
home D) Physician office visits
Answer: C Rationale: Original Medicare does not cover long-term custodial care (help with
daily living activities) when that is the only care needed. It may cover short-term skilled nursing
care under specific conditions, but ongoing custodial care is excluded.
7. A "benefit period" under Medicare Part A begins: A) On January 1 of each calendar year
B) The day a beneficiary is admitted as an inpatient to a hospital C) When the beneficiary turns
65 D) When Part B coverage starts
Answer: B Rationale: A Part A benefit period starts the day of inpatient admission and ends
after the beneficiary has been out of the hospital or skilled nursing facility for 60 consecutive
days. A person can have multiple benefit periods in a year.
8. Which statement about the Part B deductible is accurate? A) It resets every month B) It is
an annual amount the beneficiary pays before Medicare starts paying its share for Part B services
C) It applies only to prescription drugs D) It was eliminated in 2020
Answer: B Rationale: The Part B deductible is an annual amount set by CMS. Once met,
Medicare typically pays 80% of the Medicare-approved amount for covered services, with the
beneficiary responsible for the remaining 20% coinsurance.
9. Which of these is an example of a Medicare-covered preventive service under Part B? A)
Cosmetic surgery B) Annual wellness visit C) Elective LASIK D) Over-the-counter vitamins
Answer: B Rationale: Part B covers many preventive services, including the annual wellness
visit, many cancer screenings, and vaccinations, aimed at early detection and health
maintenance.
10. What is the purpose of a Medicare Summary Notice (MSN)? A) It is a bill that must be
paid immediately B) It is a notice summarizing claims and what Medicare paid, sent to
ACTUAL QUESTIONS & ANSWERS (AHIP) GUARANTEE PASS
(UPDATED PDF)
Medicare Certification Study Guide
100 Original Practice Questions with Answers & Rationales
Important note on this document: This is an original study resource I created to
help you prepare for Medicare certification training (such as the AHIP Medicare
course). It is not a copy or reproduction of any proprietary exam content, and it
should not be represented as "actual" leaked exam questions. Real certification
exams are copyrighted and administered under secure conditions; using
unauthorized "actual answer" materials can violate the certifying organization's
terms and, more importantly, can leave you underprepared to actually advise
Medicare beneficiaries — which is the entire point of the certification. Use this to
learn the material, then take your real certification exam honestly.
Table of Contents
Section Topic Questions
1 Medicare Fundamentals (Parts A & B) 1–17
2 Medicare Advantage (Part C) 18–34
3 Medicare Part D (Prescription Drug Coverage) 35–51
4 Enrollment Periods & Eligibility 52–68
5 Marketing, Communications & Compliance 69–84
6 Fraud, Waste & Abuse (FWA) and Special Needs Plans 85–100
Section 1: Medicare Fundamentals (Parts A & B)
,1. What does Medicare Part A primarily cover? A) Outpatient physician visits B) Prescription
drugs C) Inpatient hospital care, skilled nursing facility care, hospice, and some home health care
D) Routine dental and vision care
Answer: C Rationale: Part A is often called "hospital insurance." It covers inpatient stays,
limited skilled nursing facility care following a qualifying hospital stay, hospice care, and certain
home health services. It does not cover routine dental, vision, or outpatient physician services —
those fall under other parts of Medicare.
2. What does Medicare Part B primarily cover? A) Inpatient hospital stays only B) Medically
necessary outpatient services, physician visits, and preventive care C) Long-term custodial care
D) Prescription drugs purchased at a retail pharmacy
Answer: B Rationale: Part B is "medical insurance," covering outpatient care, doctor visits,
durable medical equipment, and many preventive services. It is distinct from Part A (hospital)
and Part D (drugs).
3. Most people do not pay a monthly premium for Part A because: A) It is fully funded by
state governments B) They or a spouse paid Medicare payroll taxes for at least 40 quarters (10
years) C) Part A is optional and rarely elected D) Premiums are waived for anyone over age 62
Answer: B Rationale: Part A is "premium-free" for most beneficiaries because sufficient
Medicare payroll tax was paid during their (or a spouse's) working years — generally 40
quarters of covered employment.
4. What is the standard 2026-era approach to the Part B premium for most beneficiaries?
A) It is the same flat amount for everyone every year, never changing B) It is set annually and
can be higher for beneficiaries with higher income (IRMAA) C) It is only charged to
beneficiaries enrolled in Medicare Advantage D) It is paid only once, at initial enrollment
Answer: B Rationale: The Part B premium is set annually by CMS and adjusts based on income
through the Income-Related Monthly Adjustment Amount (IRMAA), meaning higher-income
beneficiaries pay more than the standard premium.
5. A Medicare Supplement (Medigap) policy is designed to: A) Replace Original Medicare
entirely B) Help pay for out-of-pocket costs (like coinsurance and deductibles) not covered by
Original Medicare C) Provide prescription drug coverage as its main benefit D) Only be sold to
people under age 65
, Answer: B Rationale: Medigap policies work alongside Original Medicare (Parts A and B) to
help cover cost-sharing gaps such as copayments, coinsurance, and deductibles. They do not
replace Original Medicare and generally cannot be combined with Medicare Advantage.
6. Which of the following is generally NOT covered by Original Medicare (Parts A & B)?
A) Inpatient hospital care B) Outpatient surgery C) Routine long-term custodial care in a nursing
home D) Physician office visits
Answer: C Rationale: Original Medicare does not cover long-term custodial care (help with
daily living activities) when that is the only care needed. It may cover short-term skilled nursing
care under specific conditions, but ongoing custodial care is excluded.
7. A "benefit period" under Medicare Part A begins: A) On January 1 of each calendar year
B) The day a beneficiary is admitted as an inpatient to a hospital C) When the beneficiary turns
65 D) When Part B coverage starts
Answer: B Rationale: A Part A benefit period starts the day of inpatient admission and ends
after the beneficiary has been out of the hospital or skilled nursing facility for 60 consecutive
days. A person can have multiple benefit periods in a year.
8. Which statement about the Part B deductible is accurate? A) It resets every month B) It is
an annual amount the beneficiary pays before Medicare starts paying its share for Part B services
C) It applies only to prescription drugs D) It was eliminated in 2020
Answer: B Rationale: The Part B deductible is an annual amount set by CMS. Once met,
Medicare typically pays 80% of the Medicare-approved amount for covered services, with the
beneficiary responsible for the remaining 20% coinsurance.
9. Which of these is an example of a Medicare-covered preventive service under Part B? A)
Cosmetic surgery B) Annual wellness visit C) Elective LASIK D) Over-the-counter vitamins
Answer: B Rationale: Part B covers many preventive services, including the annual wellness
visit, many cancer screenings, and vaccinations, aimed at early detection and health
maintenance.
10. What is the purpose of a Medicare Summary Notice (MSN)? A) It is a bill that must be
paid immediately B) It is a notice summarizing claims and what Medicare paid, sent to
