2027 AHIP Final Exam – Medicare Certification –
Actual Questions & ANSWERs (AHIP) Guarantee
Pass (Updated Pdf)
).
SECTION 1 – MEDICARE ELIGIBILITY & ENROLLMENT (Q1–18)
1. Mrs. Alvarez turns 65 next month and has received Social Security retirement benefits since age 62.
How will she obtain Medicare?
A. She must apply in person at a Social Security office. — Incorrect: beneficiaries already drawing SS
benefits are enrolled automatically; no application is needed.
B. She will be automatically enrolled in Parts A and B. — Correct: SSA auto‑enrolls current beneficiaries;
the red‑white‑blue card arrives about 3 months before the 65th birthday.
C. Only Part A is automatic; she must elect Part B herself. — Incorrect: Part B is also automatic (she may
decline it, but no affirmative election is required).
D. She must file Form CMS‑40B to get any coverage. — Incorrect: that form is for voluntary Part B
enrollment, not for automatic enrollment.
Correct ANSWER: B
2. Mr. Chen, 66, is a lawful permanent resident who has lived in the U.S. continuously for 4 years. Is he
eligible for Medicare now?
A. Yes – all permanent residents qualify at 65. — Incorrect: lawfully admitted permanent residents need
5 continuous years of U.S. residency.
B. No – he must complete 5 continuous years of U.S. residency first. — Correct: citizens qualify at 65;
permanent residents qualify only after 5 continuous years.
C. No – only U.S. citizens may ever enroll. — Incorrect: qualifying legal residents may enroll once the
5‑year residency test is met.
D. Yes – if he agrees to pay double premiums. — Incorrect: no such provision exists in Title XVIII.
Correct ANSWER: B
3. Which individual qualifies for Medicare BEFORE age 65?
A. A retiree age 62 with a private pension. — Incorrect: early retirement alone never triggers Medicare.
B. A person who has received Social Security disability (SSDI) benefits for 24 months. — Correct:
Medicare entitlement begins after the 24‑month disability waiting period.
C. A veteran receiving VA compensation. — Incorrect: VA benefits do not confer Medicare eligibility.
,D. A person with high annual medical bills. — Incorrect: medical expense level is irrelevant to eligibility.
Correct ANSWER: B
4. Ms. Lee was just diagnosed with ALS and becomes entitled to disability benefits. When does her
Medicare begin?
A. After the usual 24‑month waiting period. — Incorrect: ALS (Lou Gehrig's disease) is exempt from the
24‑month wait.
B. The first month of disability entitlement. — Correct: Congress eliminated the waiting period for ALS;
coverage starts the first month of disability benefits.
C. Only at age 65. — Incorrect: ALS qualifies regardless of age.
D. After 6 months of dialysis. — Incorrect: that concept applies to ESRD, not ALS.
Correct ANSWER: B
5. Mr. Diaz began chronic in‑center dialysis for ESRD on March 15 (no home‑dialysis training). When
does Medicare typically begin?
A. June 1 – the first day of the 4th month of dialysis. — Correct: ESRD entitlement generally starts on
day 1 of the 4th month of dialysis treatments.
B. March 15 – the day dialysis began. — Incorrect: coverage is delayed unless the beneficiary completes
home‑dialysis training.
C. September 15 – after 6 months. — Incorrect: the rule is 4 months (3‑month waiting period), not 6.
D. Only at age 65. — Incorrect: ESRD qualifies at any age after the waiting period.
Correct ANSWER: A
6. How many quarters of Medicare‑taxed employment produce premium‑FREE Part A?
A. 20 quarters. — Incorrect: 20 quarters qualifies for nothing by itself.
B. 30 quarters. — Incorrect: 30–39 quarters only reduces the Part A premium.
C. 40 quarters. — Correct: 40 quarters (10 years) of Medicare‑taxed work = premium‑free Part A
(spouse's record may also qualify).
D. 60 quarters. — Incorrect: no such threshold exists.
Correct ANSWER: C
7. Mrs. Sanders will soon be 65, has been a U.S. citizen for 12 years, worked full‑time, and paid Medicare
taxes the entire period. She fears she won't qualify for Part A because she was not born in the United
States. What should you tell her?
A. She must have been born in the U.S. to get Part A. — Incorrect: place of birth is irrelevant; citizenship
plus work history controls.
,B. She qualifies for premium‑free Part A as a citizen with 40+ quarters of taxed employment. — Correct:
naturalized citizens who meet the 40‑quarter test get premium‑free Part A at 65.
C. She can only ever receive Part B. — Incorrect: she fully satisfies Part A requirements.
D. She must purchase Part A at the full premium. — Incorrect: with 40 quarters she owes no Part A
premium.
Correct ANSWER: B
8. A 67‑year‑old applicant has only 28 quarters of Medicare‑taxed work and wants Part A. What is true?
A. He cannot enroll in Part A at all. — Incorrect: premium‑free eligibility is not the same as eligibility to
purchase.
B. He may purchase Part A by paying the full monthly premium. — Correct: at 65+, citizens/residents
with fewer than 30 quarters may buy Part A at the full premium (30–39 quarters = reduced premium).
C. He receives premium‑free Part A anyway. — Incorrect: 40 quarters are required for premium‑free
status.
D. He must enroll in Medicaid instead. — Incorrect: Medicaid is income‑based and unrelated to quarter
counts.
Correct ANSWER: B
9. Mr. Patel failed to enroll in Part B for 3 full 12‑month periods after his IEP and had no employer
coverage. His late enrollment penalty is:
A. 10% total, for life. — Incorrect: the penalty is 10% per full 12‑month period of delay, not a flat 10%.
B. 30% added to his Part B premium for as long as he has Part B. — Correct: 3 periods × 10% = 30%, and
the Part B penalty generally lasts for life.
C. 30% for only 3 years. — Incorrect: unlike some penalties, the Part B LEP does not expire after a set
term.
D. No penalty, because he eventually enrolled. — Incorrect: delayed enrollment without qualifying
coverage triggers the penalty.
Correct ANSWER: B
10. When is the Part B General Enrollment Period (GEP)?
A. October 15 – December 7. — Incorrect: that is the Annual Election Period for MA/Part D.
B. January 1 – March 31. — Correct: since 2023, Part B GEP runs Jan 1–Mar 31 each year, with coverage
starting the month after enrollment.
C. April 1 – June 30. — Incorrect: that was the old GEP schedule repealed by the 2023 changes.
D. Any time of year. — Incorrect: enrollment outside IEP/SEP/GEP is not permitted.
Correct ANSWER: B
, 11. The Initial Enrollment Period (IEP) surrounding the 65th birthday lasts:
A. 3 months. — Incorrect: that is only the "before" portion.
B. 7 months. — Correct: 3 months before + birthday month + 3 months after = 7 months.
C. 8 months. — Incorrect: 8 months describes the Part B SEP after employment ends.
D. 12 months. — Incorrect: no 12‑month IEP exists.
Correct ANSWER: B
12. Mrs. Nguyen, 65, keeps working for an employer with 25 employees and has the group health plan.
What should you tell her about Part B?
A. She must take Part B at 65 or be penalized forever. — Incorrect: with an active employer plan (20+
employees), she may delay Part B penalty‑free.
B. She may delay Part B and later use an 8‑month SEP when work or coverage ends, with no penalty. —
Correct: the employer plan (20+ employees) is primary and the 8‑month SEP protects her from the LEP.
C. Her employer may not cover her after 65. — Incorrect: employers may and often do cover active
workers 65+.
D. Medicare pays primary ahead of her employer plan. — Incorrect: with 20+ employees, the employer
plan is primary and Medicare secondary.
Correct ANSWER: B
13. For an ESRD beneficiary who also has employer group health coverage, the coordination period
during which the employer plan is primary lasts:
A. 12 months. — Incorrect: too short.
B. 18 months. — Incorrect: not a Medicare coordination period.
C. 30 months. — Correct: the ESRD coordination period is 30 months from entitlement; afterward
Medicare becomes primary.
D. 36 months. — Incorrect: the statutory period is 30 months.
Correct ANSWER: C
14. Which program typically pays the Part B premium (and cost‑sharing for QMB) for low‑income
dual‑eligible beneficiaries?
A. TRICARE. — Incorrect: TRICARE serves military members/dependents.
B. Medicaid (including Medicare Savings Programs). — Correct: Medicaid/MSPs (QMB, SLMB, QI) pay
premiums and, for QMB, Medicare cost‑sharing.
C. Veterans Affairs. — Incorrect: VA covers service‑connected care, not Medicare premiums.
D. FEHB. — Incorrect: FEHB is the federal employee program.
Actual Questions & ANSWERs (AHIP) Guarantee
Pass (Updated Pdf)
).
SECTION 1 – MEDICARE ELIGIBILITY & ENROLLMENT (Q1–18)
1. Mrs. Alvarez turns 65 next month and has received Social Security retirement benefits since age 62.
How will she obtain Medicare?
A. She must apply in person at a Social Security office. — Incorrect: beneficiaries already drawing SS
benefits are enrolled automatically; no application is needed.
B. She will be automatically enrolled in Parts A and B. — Correct: SSA auto‑enrolls current beneficiaries;
the red‑white‑blue card arrives about 3 months before the 65th birthday.
C. Only Part A is automatic; she must elect Part B herself. — Incorrect: Part B is also automatic (she may
decline it, but no affirmative election is required).
D. She must file Form CMS‑40B to get any coverage. — Incorrect: that form is for voluntary Part B
enrollment, not for automatic enrollment.
Correct ANSWER: B
2. Mr. Chen, 66, is a lawful permanent resident who has lived in the U.S. continuously for 4 years. Is he
eligible for Medicare now?
A. Yes – all permanent residents qualify at 65. — Incorrect: lawfully admitted permanent residents need
5 continuous years of U.S. residency.
B. No – he must complete 5 continuous years of U.S. residency first. — Correct: citizens qualify at 65;
permanent residents qualify only after 5 continuous years.
C. No – only U.S. citizens may ever enroll. — Incorrect: qualifying legal residents may enroll once the
5‑year residency test is met.
D. Yes – if he agrees to pay double premiums. — Incorrect: no such provision exists in Title XVIII.
Correct ANSWER: B
3. Which individual qualifies for Medicare BEFORE age 65?
A. A retiree age 62 with a private pension. — Incorrect: early retirement alone never triggers Medicare.
B. A person who has received Social Security disability (SSDI) benefits for 24 months. — Correct:
Medicare entitlement begins after the 24‑month disability waiting period.
C. A veteran receiving VA compensation. — Incorrect: VA benefits do not confer Medicare eligibility.
,D. A person with high annual medical bills. — Incorrect: medical expense level is irrelevant to eligibility.
Correct ANSWER: B
4. Ms. Lee was just diagnosed with ALS and becomes entitled to disability benefits. When does her
Medicare begin?
A. After the usual 24‑month waiting period. — Incorrect: ALS (Lou Gehrig's disease) is exempt from the
24‑month wait.
B. The first month of disability entitlement. — Correct: Congress eliminated the waiting period for ALS;
coverage starts the first month of disability benefits.
C. Only at age 65. — Incorrect: ALS qualifies regardless of age.
D. After 6 months of dialysis. — Incorrect: that concept applies to ESRD, not ALS.
Correct ANSWER: B
5. Mr. Diaz began chronic in‑center dialysis for ESRD on March 15 (no home‑dialysis training). When
does Medicare typically begin?
A. June 1 – the first day of the 4th month of dialysis. — Correct: ESRD entitlement generally starts on
day 1 of the 4th month of dialysis treatments.
B. March 15 – the day dialysis began. — Incorrect: coverage is delayed unless the beneficiary completes
home‑dialysis training.
C. September 15 – after 6 months. — Incorrect: the rule is 4 months (3‑month waiting period), not 6.
D. Only at age 65. — Incorrect: ESRD qualifies at any age after the waiting period.
Correct ANSWER: A
6. How many quarters of Medicare‑taxed employment produce premium‑FREE Part A?
A. 20 quarters. — Incorrect: 20 quarters qualifies for nothing by itself.
B. 30 quarters. — Incorrect: 30–39 quarters only reduces the Part A premium.
C. 40 quarters. — Correct: 40 quarters (10 years) of Medicare‑taxed work = premium‑free Part A
(spouse's record may also qualify).
D. 60 quarters. — Incorrect: no such threshold exists.
Correct ANSWER: C
7. Mrs. Sanders will soon be 65, has been a U.S. citizen for 12 years, worked full‑time, and paid Medicare
taxes the entire period. She fears she won't qualify for Part A because she was not born in the United
States. What should you tell her?
A. She must have been born in the U.S. to get Part A. — Incorrect: place of birth is irrelevant; citizenship
plus work history controls.
,B. She qualifies for premium‑free Part A as a citizen with 40+ quarters of taxed employment. — Correct:
naturalized citizens who meet the 40‑quarter test get premium‑free Part A at 65.
C. She can only ever receive Part B. — Incorrect: she fully satisfies Part A requirements.
D. She must purchase Part A at the full premium. — Incorrect: with 40 quarters she owes no Part A
premium.
Correct ANSWER: B
8. A 67‑year‑old applicant has only 28 quarters of Medicare‑taxed work and wants Part A. What is true?
A. He cannot enroll in Part A at all. — Incorrect: premium‑free eligibility is not the same as eligibility to
purchase.
B. He may purchase Part A by paying the full monthly premium. — Correct: at 65+, citizens/residents
with fewer than 30 quarters may buy Part A at the full premium (30–39 quarters = reduced premium).
C. He receives premium‑free Part A anyway. — Incorrect: 40 quarters are required for premium‑free
status.
D. He must enroll in Medicaid instead. — Incorrect: Medicaid is income‑based and unrelated to quarter
counts.
Correct ANSWER: B
9. Mr. Patel failed to enroll in Part B for 3 full 12‑month periods after his IEP and had no employer
coverage. His late enrollment penalty is:
A. 10% total, for life. — Incorrect: the penalty is 10% per full 12‑month period of delay, not a flat 10%.
B. 30% added to his Part B premium for as long as he has Part B. — Correct: 3 periods × 10% = 30%, and
the Part B penalty generally lasts for life.
C. 30% for only 3 years. — Incorrect: unlike some penalties, the Part B LEP does not expire after a set
term.
D. No penalty, because he eventually enrolled. — Incorrect: delayed enrollment without qualifying
coverage triggers the penalty.
Correct ANSWER: B
10. When is the Part B General Enrollment Period (GEP)?
A. October 15 – December 7. — Incorrect: that is the Annual Election Period for MA/Part D.
B. January 1 – March 31. — Correct: since 2023, Part B GEP runs Jan 1–Mar 31 each year, with coverage
starting the month after enrollment.
C. April 1 – June 30. — Incorrect: that was the old GEP schedule repealed by the 2023 changes.
D. Any time of year. — Incorrect: enrollment outside IEP/SEP/GEP is not permitted.
Correct ANSWER: B
, 11. The Initial Enrollment Period (IEP) surrounding the 65th birthday lasts:
A. 3 months. — Incorrect: that is only the "before" portion.
B. 7 months. — Correct: 3 months before + birthday month + 3 months after = 7 months.
C. 8 months. — Incorrect: 8 months describes the Part B SEP after employment ends.
D. 12 months. — Incorrect: no 12‑month IEP exists.
Correct ANSWER: B
12. Mrs. Nguyen, 65, keeps working for an employer with 25 employees and has the group health plan.
What should you tell her about Part B?
A. She must take Part B at 65 or be penalized forever. — Incorrect: with an active employer plan (20+
employees), she may delay Part B penalty‑free.
B. She may delay Part B and later use an 8‑month SEP when work or coverage ends, with no penalty. —
Correct: the employer plan (20+ employees) is primary and the 8‑month SEP protects her from the LEP.
C. Her employer may not cover her after 65. — Incorrect: employers may and often do cover active
workers 65+.
D. Medicare pays primary ahead of her employer plan. — Incorrect: with 20+ employees, the employer
plan is primary and Medicare secondary.
Correct ANSWER: B
13. For an ESRD beneficiary who also has employer group health coverage, the coordination period
during which the employer plan is primary lasts:
A. 12 months. — Incorrect: too short.
B. 18 months. — Incorrect: not a Medicare coordination period.
C. 30 months. — Correct: the ESRD coordination period is 30 months from entitlement; afterward
Medicare becomes primary.
D. 36 months. — Incorrect: the statutory period is 30 months.
Correct ANSWER: C
14. Which program typically pays the Part B premium (and cost‑sharing for QMB) for low‑income
dual‑eligible beneficiaries?
A. TRICARE. — Incorrect: TRICARE serves military members/dependents.
B. Medicaid (including Medicare Savings Programs). — Correct: Medicaid/MSPs (QMB, SLMB, QI) pay
premiums and, for QMB, Medicare cost‑sharing.
C. Veterans Affairs. — Incorrect: VA covers service‑connected care, not Medicare premiums.
D. FEHB. — Incorrect: FEHB is the federal employee program.
