AHIP Medicare Certification Exam – AHIP Practice Exam with Answers, Medicare
Advantage & Part D Preparation – (2026-2027)
Section 1 – Medicare Basics & Eligibility (Questions 1-10)
1. Maria turns 65 on July 18, 2025. She is receiving Social Security retirement
benefits. When does her Initial Enrollment Period (IEP) end?
A. October 31, 2025
B. January 31, 2026
C. July 31, 2025
D. December 31, 2025
Correct Answer: B
Explainer: IEP ends 3 months after the birth month. July birth ⇒ IEP ends 3 full months
later (Jan 31, 2026). CMS IEP chart 2025 unchanged.
2. Which of the following individuals is automatically enrolled in both Part A & Part
B?
A. Age 62, receiving Social Security disability for 12 months
B. Age 65, still working and covered by large-group employer plan
C. Age 66, receiving Railroad Retirement survivor benefits
D. Age 65, already receiving Social Security retirement benefits
Correct Answer: D
Explainer: Social Security retirement beneficiaries are auto-enrolled in A & B at 65.
Others must actively enroll or meet separate disability criteria.
3. Mr. Lee is 68 and missed his IEP. He currently has employer coverage through a
company with 25 employees. Which statement is correct?
A. He must wait until the next General Enrollment Period (GEP).
B. He qualifies for a Special Enrollment Period (SEP) that lasts 8 months after
employer coverage ends.
C. He can enroll anytime while employer coverage remains active.
D. He will pay Part B premium with no penalty because the employer has <100
employees.
,Correct Answer: B
Explainer: SEP applies when employer coverage (regardless of size) ends; 8-month
window to enroll in Part B without penalty. CMS SEP rules 2025.
4. The 2025 Part A inpatient hospital deductible is:
A. $1,632 per benefit period
B. $1,676 per benefit period
C. $1,556 per calendar year
D. $1,600 per admission
Correct Answer: A
Explainer: CMS announced 2025 deductible = $1,632 per benefit period (not per year or
per admission).
5. Which service is NOT covered under Original Medicare Part B?
A. Annual wellness visit
B. Routine dental cleanings
C. Ambulance to nearest appropriate facility
D. Diabetes self-management training
Correct Answer: B
Explainer: Routine dental is excluded; Medicare may cover certain dental services when
integral to covered procedures, but cleanings alone are not.
6. Mrs. Duncan is 72, has Part A only, and wants to add Part B. When can she first
enroll?
A. During MA Open Enrollment (Jan 1-Mar 31)
B. During General Enrollment Period (Jan 1-Mar 31) with coverage starting July 1
C. During Open Enrollment Period for Institutional Individuals (OI-OEP)
D. Anytime through her State Health Insurance Assistance Program (SHIP)
Correct Answer: B
, Explainer: GEP (Jan 1-Mar 31) is the vehicle for adding Part B after IEP; coverage starts
July 1 unless SEP applies.
7. For 2025, the standard Part B premium is:
A. $174.70/month
B. $185.00/month
C. $170.10/month
D. $164.90/month
Correct Answer: A
Explainer: CMS set 2025 standard premium at $174.70; higher for IRMAA beneficiaries.
8. Which condition qualifies for Medicare before age 65?
A. End-Stage Renal Disease (ESRD) requiring dialysis
B. Amyotrophic Lateral Sclerosis (ALS)
C. Both A and B
D. Neither A nor B
Correct Answer: C
Explainer: ALS qualifies immediately upon disability entitlement; ESRD qualifies
generally after 3-month waiting period of dialysis or transplant.
9. Which of the following is considered “creditable coverage” for Part D purposes?
A. VA drug coverage
B. Indian Health Service (IHS)
C. Employer group health plan that expects to pay on average at least as much as
standard Part D
D. State pharmaceutical assistance program that wraps around Part D
Correct Answer: C
Explainer: Only employer/union coverage that actuarially equals or exceeds standard
Part D is creditable; VA & IHS are not creditable for Part D late-enrollment penalty rules.
Advantage & Part D Preparation – (2026-2027)
Section 1 – Medicare Basics & Eligibility (Questions 1-10)
1. Maria turns 65 on July 18, 2025. She is receiving Social Security retirement
benefits. When does her Initial Enrollment Period (IEP) end?
A. October 31, 2025
B. January 31, 2026
C. July 31, 2025
D. December 31, 2025
Correct Answer: B
Explainer: IEP ends 3 months after the birth month. July birth ⇒ IEP ends 3 full months
later (Jan 31, 2026). CMS IEP chart 2025 unchanged.
2. Which of the following individuals is automatically enrolled in both Part A & Part
B?
A. Age 62, receiving Social Security disability for 12 months
B. Age 65, still working and covered by large-group employer plan
C. Age 66, receiving Railroad Retirement survivor benefits
D. Age 65, already receiving Social Security retirement benefits
Correct Answer: D
Explainer: Social Security retirement beneficiaries are auto-enrolled in A & B at 65.
Others must actively enroll or meet separate disability criteria.
3. Mr. Lee is 68 and missed his IEP. He currently has employer coverage through a
company with 25 employees. Which statement is correct?
A. He must wait until the next General Enrollment Period (GEP).
B. He qualifies for a Special Enrollment Period (SEP) that lasts 8 months after
employer coverage ends.
C. He can enroll anytime while employer coverage remains active.
D. He will pay Part B premium with no penalty because the employer has <100
employees.
,Correct Answer: B
Explainer: SEP applies when employer coverage (regardless of size) ends; 8-month
window to enroll in Part B without penalty. CMS SEP rules 2025.
4. The 2025 Part A inpatient hospital deductible is:
A. $1,632 per benefit period
B. $1,676 per benefit period
C. $1,556 per calendar year
D. $1,600 per admission
Correct Answer: A
Explainer: CMS announced 2025 deductible = $1,632 per benefit period (not per year or
per admission).
5. Which service is NOT covered under Original Medicare Part B?
A. Annual wellness visit
B. Routine dental cleanings
C. Ambulance to nearest appropriate facility
D. Diabetes self-management training
Correct Answer: B
Explainer: Routine dental is excluded; Medicare may cover certain dental services when
integral to covered procedures, but cleanings alone are not.
6. Mrs. Duncan is 72, has Part A only, and wants to add Part B. When can she first
enroll?
A. During MA Open Enrollment (Jan 1-Mar 31)
B. During General Enrollment Period (Jan 1-Mar 31) with coverage starting July 1
C. During Open Enrollment Period for Institutional Individuals (OI-OEP)
D. Anytime through her State Health Insurance Assistance Program (SHIP)
Correct Answer: B
, Explainer: GEP (Jan 1-Mar 31) is the vehicle for adding Part B after IEP; coverage starts
July 1 unless SEP applies.
7. For 2025, the standard Part B premium is:
A. $174.70/month
B. $185.00/month
C. $170.10/month
D. $164.90/month
Correct Answer: A
Explainer: CMS set 2025 standard premium at $174.70; higher for IRMAA beneficiaries.
8. Which condition qualifies for Medicare before age 65?
A. End-Stage Renal Disease (ESRD) requiring dialysis
B. Amyotrophic Lateral Sclerosis (ALS)
C. Both A and B
D. Neither A nor B
Correct Answer: C
Explainer: ALS qualifies immediately upon disability entitlement; ESRD qualifies
generally after 3-month waiting period of dialysis or transplant.
9. Which of the following is considered “creditable coverage” for Part D purposes?
A. VA drug coverage
B. Indian Health Service (IHS)
C. Employer group health plan that expects to pay on average at least as much as
standard Part D
D. State pharmaceutical assistance program that wraps around Part D
Correct Answer: C
Explainer: Only employer/union coverage that actuarially equals or exceeds standard
Part D is creditable; VA & IHS are not creditable for Part D late-enrollment penalty rules.
