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2026 AHIP FINAL EXAM ACTUAL EXAM | Verified Edition
with Rationales | Updated Questions & Detailed Answers |
Pass Guaranteed - A+ Graded
Section 1: Medicare Eligibility, Enrollment & SEPs (Q1-14)
Q1. A U.S. citizen or permanent legal resident first becomes eligible for Medicare
based on age. How long does the Initial Enrollment Period (IEP) last?
A. Only during the month they turn 65
B. 3 months before their 65th birthday month, the birthday month, and 3 months
after (7 months total)
C. January 1 through March 31 of the year they turn 65
D. 6 months before and 6 months after their 65th birthday month
Correct Answer: B. 3 months before their 65th birthday month, the birthday
month, and 3 months after (7 months total) [CORRECT]
Rationale: CMS establishes a 7-month IEP for Medicare Parts A and B based on age,
running from 3 months before through 3 months after the month an individual turns
65; coverage start dates vary depending on when within the IEP the individual
enrolls.
Correct Answer: B
Q2. A beneficiary misses their IEP and does not qualify for a Special Enrollment
Period. When can they sign up for Medicare Part A and/or Part B, and when does
coverage begin?
A. October 15 through December 7; coverage begins January 1 with no late penalty
B. January 1 through March 31; coverage begins July 1 and they may face a late
enrollment penalty for Part B
C. April 1 through June 30; coverage begins October 1
D. Anytime during the year; coverage begins the first of the next month
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Correct Answer: B. January 1 through March 31; coverage begins July 1 and they
may face a late enrollment penalty for Part B [CORRECT]
Rationale: The General Enrollment Period (GEP) runs January 1 through March 31
annually for those who missed IEP; coverage begins July 1, and Part B late enrollment
penalties of 10% per full 12-month delay apply unless the individual had creditable
coverage or meets SEP criteria.
Correct Answer: B
Q3. A Medicare beneficiary moves permanently from Florida to Oregon on April 10,
2026, leaving their Medicare Advantage plan's service area. Which Special Enrollment
Period (SEP) applies, and what is the timeframe?
A. They must wait until the next Annual Election Period (AEP)
B. They have an SEP that runs from the month before the move through the month
of the move only
C. They can enroll in a new plan from the month before the month they move
through 2 full months after the month they move
D. They lose Medicare eligibility entirely and must reapply in the new state
Correct Answer: C. They can enroll in a new plan from the month before the
month they move through 2 full months after the month they move [CORRECT]
Rationale: CMS grants an SEP for individuals who move outside their plan's service
area, allowing enrollment from the month before the move through 2 full months
after the move month; this ensures continuous coverage without requiring the
beneficiary to wait for AEP.
Correct Answer: C
Q4. A beneficiary turns 65 in June 2026 and remains actively employed with
employer group health coverage through a company with 120 employees. Their
spouse and children are covered under the employee's family plan. The beneficiary
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plans to retire and lose active employment coverage on September 30, 2026. They
did not enroll in Medicare Part B during their IEP. Which sequence prevents a late
enrollment penalty and avoids a coverage gap?
A. Enroll in Part B during IEP (March–September 2026) because family coverage does
not protect against the Part B penalty
B. Wait until GEP 2027 because active employer coverage with 100+ employees
allows unlimited delay without penalty
C. Enroll in Part A during IEP, delay Part B while actively employed, and use the
employer group SEP to enroll in Part B before September 30 so coverage begins
when employer coverage ends
D. They are automatically enrolled in Part B when they retire regardless of application
timing
Correct Answer: C. Enroll in Part A during IEP, delay Part B while actively
employed, and use the employer group SEP to enroll in Part B before September
30 so coverage begins when employer coverage ends [CORRECT]
Rationale: Individuals covered under active employer group health plans with 20+
employees may delay Part B without penalty using the SEP that begins the month
after employment or coverage ends; enrolling before the loss of coverage ensures
seamless transition, whereas waiting until after coverage ends creates a gap and risks
missing the SEP window.
Correct Answer: C
Q5. A beneficiary learns that a 5-star Medicare Advantage plan is available in their
service area. Under CMS rules, which statement about the 5-star Special Enrollment
Period is correct?
A. The 5-star SEP can only be used during AEP
B. A beneficiary may use the 5-star SEP once per calendar year from December 8
through November 30 to enroll in a 5-star plan
C. The 5-star SEP is only available to beneficiaries whose current plan has a rating
below 3 stars
D. The 5-star SEP requires the beneficiary to be dual-eligible
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Correct Answer: B. A beneficiary may use the 5-star SEP once per calendar year
from December 8 through November 30 to enroll in a 5-star plan [CORRECT]
Rationale: CMS allows Medicare beneficiaries to use a one-time-per-year 5-star SEP
to switch to or enroll in a 5-star Medicare Advantage or Part D plan from December
8 through November 30, regardless of their current plan's star rating.
Correct Answer: B
Q6. A beneficiary qualifies for both Medicare and full Medicaid benefits beginning
April 2026. Which enrollment flexibility applies under CMS dual-eligible SEP rules?
A. They can change plans only during AEP and OEP
B. They have an SEP to enroll in an integrated D-SNP when first eligible and may
change Medicare Advantage or Part D plans once per quarter during the first three
quarters of the year
C. They must remain in Original Medicare and cannot enroll in any Medicare
Advantage plan
D. They can change plans daily without any CMS restrictions
Correct Answer: B. They have an SEP to enroll in an integrated D-SNP when first
eligible and may change Medicare Advantage or Part D plans once per quarter
during the first three quarters of the year [CORRECT]
Rationale: Dually eligible individuals receive an SEP upon initial dual eligibility and
can make one plan change per quarter during January–March, April–June, and July–
September, providing flexibility to align Medicare and Medicaid coverage.
Correct Answer: B
Q7. Which statement accurately distinguishes the Initial Enrollment Period (IEP) from
the Initial Coverage Election Period (ICEP)?
A. IEP is for Part D only; ICEP is for Medicare Advantage only
B. IEP enrolls individuals in Original Medicare (Parts A and B); ICEP is the same 7-
2026 AHIP FINAL EXAM ACTUAL EXAM | Verified Edition
with Rationales | Updated Questions & Detailed Answers |
Pass Guaranteed - A+ Graded
Section 1: Medicare Eligibility, Enrollment & SEPs (Q1-14)
Q1. A U.S. citizen or permanent legal resident first becomes eligible for Medicare
based on age. How long does the Initial Enrollment Period (IEP) last?
A. Only during the month they turn 65
B. 3 months before their 65th birthday month, the birthday month, and 3 months
after (7 months total)
C. January 1 through March 31 of the year they turn 65
D. 6 months before and 6 months after their 65th birthday month
Correct Answer: B. 3 months before their 65th birthday month, the birthday
month, and 3 months after (7 months total) [CORRECT]
Rationale: CMS establishes a 7-month IEP for Medicare Parts A and B based on age,
running from 3 months before through 3 months after the month an individual turns
65; coverage start dates vary depending on when within the IEP the individual
enrolls.
Correct Answer: B
Q2. A beneficiary misses their IEP and does not qualify for a Special Enrollment
Period. When can they sign up for Medicare Part A and/or Part B, and when does
coverage begin?
A. October 15 through December 7; coverage begins January 1 with no late penalty
B. January 1 through March 31; coverage begins July 1 and they may face a late
enrollment penalty for Part B
C. April 1 through June 30; coverage begins October 1
D. Anytime during the year; coverage begins the first of the next month
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Correct Answer: B. January 1 through March 31; coverage begins July 1 and they
may face a late enrollment penalty for Part B [CORRECT]
Rationale: The General Enrollment Period (GEP) runs January 1 through March 31
annually for those who missed IEP; coverage begins July 1, and Part B late enrollment
penalties of 10% per full 12-month delay apply unless the individual had creditable
coverage or meets SEP criteria.
Correct Answer: B
Q3. A Medicare beneficiary moves permanently from Florida to Oregon on April 10,
2026, leaving their Medicare Advantage plan's service area. Which Special Enrollment
Period (SEP) applies, and what is the timeframe?
A. They must wait until the next Annual Election Period (AEP)
B. They have an SEP that runs from the month before the move through the month
of the move only
C. They can enroll in a new plan from the month before the month they move
through 2 full months after the month they move
D. They lose Medicare eligibility entirely and must reapply in the new state
Correct Answer: C. They can enroll in a new plan from the month before the
month they move through 2 full months after the month they move [CORRECT]
Rationale: CMS grants an SEP for individuals who move outside their plan's service
area, allowing enrollment from the month before the move through 2 full months
after the move month; this ensures continuous coverage without requiring the
beneficiary to wait for AEP.
Correct Answer: C
Q4. A beneficiary turns 65 in June 2026 and remains actively employed with
employer group health coverage through a company with 120 employees. Their
spouse and children are covered under the employee's family plan. The beneficiary
,3
plans to retire and lose active employment coverage on September 30, 2026. They
did not enroll in Medicare Part B during their IEP. Which sequence prevents a late
enrollment penalty and avoids a coverage gap?
A. Enroll in Part B during IEP (March–September 2026) because family coverage does
not protect against the Part B penalty
B. Wait until GEP 2027 because active employer coverage with 100+ employees
allows unlimited delay without penalty
C. Enroll in Part A during IEP, delay Part B while actively employed, and use the
employer group SEP to enroll in Part B before September 30 so coverage begins
when employer coverage ends
D. They are automatically enrolled in Part B when they retire regardless of application
timing
Correct Answer: C. Enroll in Part A during IEP, delay Part B while actively
employed, and use the employer group SEP to enroll in Part B before September
30 so coverage begins when employer coverage ends [CORRECT]
Rationale: Individuals covered under active employer group health plans with 20+
employees may delay Part B without penalty using the SEP that begins the month
after employment or coverage ends; enrolling before the loss of coverage ensures
seamless transition, whereas waiting until after coverage ends creates a gap and risks
missing the SEP window.
Correct Answer: C
Q5. A beneficiary learns that a 5-star Medicare Advantage plan is available in their
service area. Under CMS rules, which statement about the 5-star Special Enrollment
Period is correct?
A. The 5-star SEP can only be used during AEP
B. A beneficiary may use the 5-star SEP once per calendar year from December 8
through November 30 to enroll in a 5-star plan
C. The 5-star SEP is only available to beneficiaries whose current plan has a rating
below 3 stars
D. The 5-star SEP requires the beneficiary to be dual-eligible
, 4
Correct Answer: B. A beneficiary may use the 5-star SEP once per calendar year
from December 8 through November 30 to enroll in a 5-star plan [CORRECT]
Rationale: CMS allows Medicare beneficiaries to use a one-time-per-year 5-star SEP
to switch to or enroll in a 5-star Medicare Advantage or Part D plan from December
8 through November 30, regardless of their current plan's star rating.
Correct Answer: B
Q6. A beneficiary qualifies for both Medicare and full Medicaid benefits beginning
April 2026. Which enrollment flexibility applies under CMS dual-eligible SEP rules?
A. They can change plans only during AEP and OEP
B. They have an SEP to enroll in an integrated D-SNP when first eligible and may
change Medicare Advantage or Part D plans once per quarter during the first three
quarters of the year
C. They must remain in Original Medicare and cannot enroll in any Medicare
Advantage plan
D. They can change plans daily without any CMS restrictions
Correct Answer: B. They have an SEP to enroll in an integrated D-SNP when first
eligible and may change Medicare Advantage or Part D plans once per quarter
during the first three quarters of the year [CORRECT]
Rationale: Dually eligible individuals receive an SEP upon initial dual eligibility and
can make one plan change per quarter during January–March, April–June, and July–
September, providing flexibility to align Medicare and Medicaid coverage.
Correct Answer: B
Q7. Which statement accurately distinguishes the Initial Enrollment Period (IEP) from
the Initial Coverage Election Period (ICEP)?
A. IEP is for Part D only; ICEP is for Medicare Advantage only
B. IEP enrolls individuals in Original Medicare (Parts A and B); ICEP is the same 7-
