AHIP Medicare Certification 2025–2026 – Updated AHIP Exam Study Guide
& Practice Material
MODULE 1 – MEDICARE PROGRAM BASICS (Q1–Q10)
Q1: Which individual is automatically eligible for premium-free Medicare Part A in 2026?
A) A 62-year-old who has 20 quarters of Social Security credits
B) A 65-year-old who has 40 quarters of Medicare-only employment
C) A 65-year-old who has 40 quarters of Social Security or Railroad Retirement credits
D) A 66-year-old who is still working and has group health coverage
Answer: C
Explanation: 40 quarters (10 years) of Social Security–covered employment or
equivalent Railroad Retirement work automatically confers premium-free Part A. The
other choices either lack enough quarters or confuse plan types.
Q2: Mrs. Lewis, age 68, is admitted to the hospital for three days and then discharged to
a skilled-nursing facility (SNF). Which cost applies for the SNF stay under Original
Medicare?
A) $0 for the first 20 days; daily coinsurance applies after
B) 20 % coinsurance from day 1
C) Full daily rate until she has paid the Part A deductible again
D) Nothing; SNF is never covered under Part A
Answer: A
,Explanation: Original Medicare covers days 1–20 in an SNF at $0 coinsurance after a
qualifying 3-day hospital stay. Days 21–100 require a daily coinsurance; after 100 days
the patient pays all costs.
Q3: Which service is NOT covered under Original Medicare Part B?
A) Annual wellness visit
B) Routine dental cleanings
C) Ambulance transport when medically necessary
D) Diabetes self-management training
Answer: B
Explanation: Part B excludes routine dental care. The other listed services are explicit
Part B benefits.
Q4: Mr. Gomez did not enroll in Part B at age 65 because he had employer coverage. He
retires at 68. How long does he have to enroll without penalty?
A) 60 days before retirement
B) 8 months after the month employment ends
C) 63 days after losing group coverage
D) Until the next General Enrollment Period only
Answer: B
Explanation: The Part B Special Enrollment Period lasts 8 months after the month
employer coverage ends, preventing late-enrollment penalties if elected timely.
, Q5: The 2026 Part A inpatient hospital deductible is:
A) $1,676
B) $1,864
C) $2,064
D) $2,800
Answer: A
Explanation: CMS announced the 2026 Part A deductible as $1,676. The other figures
are close but incorrect.
Q6: Which statement about Medicare Part B premiums in 2026 is correct?
A) Everyone pays the same amount regardless of income
B) Higher-income beneficiaries pay a surcharge called IRMAA
C) Premiums are deducted only from Social Security checks
D) Part B premiums cover 100 % of program costs
Answer: B
Explanation: The Income-Related Monthly Adjustment Amount (IRMAA) raises Part B
premiums for individuals above set MAGI thresholds. Payments can also come from
bank drafts, and premiums cover roughly 25 % of costs.
Q7: Under Original Medicare, which cost-sharing applies to outpatient mental-health
services?
A) 50 % coinsurance with no deductible
& Practice Material
MODULE 1 – MEDICARE PROGRAM BASICS (Q1–Q10)
Q1: Which individual is automatically eligible for premium-free Medicare Part A in 2026?
A) A 62-year-old who has 20 quarters of Social Security credits
B) A 65-year-old who has 40 quarters of Medicare-only employment
C) A 65-year-old who has 40 quarters of Social Security or Railroad Retirement credits
D) A 66-year-old who is still working and has group health coverage
Answer: C
Explanation: 40 quarters (10 years) of Social Security–covered employment or
equivalent Railroad Retirement work automatically confers premium-free Part A. The
other choices either lack enough quarters or confuse plan types.
Q2: Mrs. Lewis, age 68, is admitted to the hospital for three days and then discharged to
a skilled-nursing facility (SNF). Which cost applies for the SNF stay under Original
Medicare?
A) $0 for the first 20 days; daily coinsurance applies after
B) 20 % coinsurance from day 1
C) Full daily rate until she has paid the Part A deductible again
D) Nothing; SNF is never covered under Part A
Answer: A
,Explanation: Original Medicare covers days 1–20 in an SNF at $0 coinsurance after a
qualifying 3-day hospital stay. Days 21–100 require a daily coinsurance; after 100 days
the patient pays all costs.
Q3: Which service is NOT covered under Original Medicare Part B?
A) Annual wellness visit
B) Routine dental cleanings
C) Ambulance transport when medically necessary
D) Diabetes self-management training
Answer: B
Explanation: Part B excludes routine dental care. The other listed services are explicit
Part B benefits.
Q4: Mr. Gomez did not enroll in Part B at age 65 because he had employer coverage. He
retires at 68. How long does he have to enroll without penalty?
A) 60 days before retirement
B) 8 months after the month employment ends
C) 63 days after losing group coverage
D) Until the next General Enrollment Period only
Answer: B
Explanation: The Part B Special Enrollment Period lasts 8 months after the month
employer coverage ends, preventing late-enrollment penalties if elected timely.
, Q5: The 2026 Part A inpatient hospital deductible is:
A) $1,676
B) $1,864
C) $2,064
D) $2,800
Answer: A
Explanation: CMS announced the 2026 Part A deductible as $1,676. The other figures
are close but incorrect.
Q6: Which statement about Medicare Part B premiums in 2026 is correct?
A) Everyone pays the same amount regardless of income
B) Higher-income beneficiaries pay a surcharge called IRMAA
C) Premiums are deducted only from Social Security checks
D) Part B premiums cover 100 % of program costs
Answer: B
Explanation: The Income-Related Monthly Adjustment Amount (IRMAA) raises Part B
premiums for individuals above set MAGI thresholds. Payments can also come from
bank drafts, and premiums cover roughly 25 % of costs.
Q7: Under Original Medicare, which cost-sharing applies to outpatient mental-health
services?
A) 50 % coinsurance with no deductible
