AHIP FINAL EXAM 80 KEY QUESTIONS
& ANSWERS (2026/2027)
MEDICARE BASICS
Q1: What are the four main parts of Medicare?
A: Medicare Part A (Hospital Insurance), Part B (Medical
Insurance), Part C (Medicare Advantage), and Part D
(Prescription Drug Coverage)
Q2: Who is eligible for Medicare?
A: Individuals who are:
Age 65 or older
Under 65 with certain disabilities (receiving SSDI for 24
months)
Any age with End-Stage Renal Disease (ESRD)
Any age with Amyotrophic Lateral Sclerosis (ALS)
Q3: What is the difference between Medicare Part A
and Part B?
A:
Part A covers inpatient hospital care, skilled nursing
facility care, hospice, and some home health care
Part B covers doctor visits, outpatient care, medical
supplies, and preventive services
Q4: What is the Initial Enrollment Period (IEP)?
A: A 7-month period that begins 3 months before your 65th
birthday month, includes your birthday month, and ends 3
months after. Missing this may result in coverage delays
and late enrollment penalties.
Q5: What is Medicare General Enrollment Period?
A: January 1 – March 31 each year for individuals who didn't
enroll during their IEP. Coverage begins July 1. Late
enrollment penalties may apply.
Q6: What is the Medicare Part A deductible for 2025?
A: $1,600 per benefit period (Note: amounts change
annually)
Dr. Wise
, Q7: What percentage does Medicare Part B typically
cover after deductible?
A: 80% of approved amounts for most services. The
beneficiary pays 20%.
Q8: What is the Medicare Part B standard monthly
premium for 2025?
A: Approximately $174.70 (varies by income; higher-income
beneficiaries pay more)
MEDICARE ADVANTAGE PLANS (PART C)
Q9: What is Medicare Advantage?
A: Medicare Part C, an alternative to Traditional Medicare
offered by private companies approved by Medicare.
Includes all Part A and Part B benefits, often includes Part D,
and may offer extra benefits.
Q10: What are the main types of Medicare Advantage
plans?
A:
HMO: Requires choosing primary care physician,
referrals for specialists, services mostly in-network
PPO: Can use out-of-network at higher cost, no
referrals needed typically
PFFS: Private Fee-for-Service with set pricing structure
MSA: Medical Savings Account with high deductible +
savings account
Cost Plans: Mix of HMO and traditional Medicare
features
Q11: What benefits must all Medicare Advantage
plans cover?
A: All MA plans must cover everything Traditional Medicare
covers (Part A and Part B services), except end-stage renal
disease in some cases.
Q12: What are common extra benefits in Medicare
Advantage plans?
A:
Prescription drug coverage (Part D)
Dental, vision, and hearing services
Dr. Wise
& ANSWERS (2026/2027)
MEDICARE BASICS
Q1: What are the four main parts of Medicare?
A: Medicare Part A (Hospital Insurance), Part B (Medical
Insurance), Part C (Medicare Advantage), and Part D
(Prescription Drug Coverage)
Q2: Who is eligible for Medicare?
A: Individuals who are:
Age 65 or older
Under 65 with certain disabilities (receiving SSDI for 24
months)
Any age with End-Stage Renal Disease (ESRD)
Any age with Amyotrophic Lateral Sclerosis (ALS)
Q3: What is the difference between Medicare Part A
and Part B?
A:
Part A covers inpatient hospital care, skilled nursing
facility care, hospice, and some home health care
Part B covers doctor visits, outpatient care, medical
supplies, and preventive services
Q4: What is the Initial Enrollment Period (IEP)?
A: A 7-month period that begins 3 months before your 65th
birthday month, includes your birthday month, and ends 3
months after. Missing this may result in coverage delays
and late enrollment penalties.
Q5: What is Medicare General Enrollment Period?
A: January 1 – March 31 each year for individuals who didn't
enroll during their IEP. Coverage begins July 1. Late
enrollment penalties may apply.
Q6: What is the Medicare Part A deductible for 2025?
A: $1,600 per benefit period (Note: amounts change
annually)
Dr. Wise
, Q7: What percentage does Medicare Part B typically
cover after deductible?
A: 80% of approved amounts for most services. The
beneficiary pays 20%.
Q8: What is the Medicare Part B standard monthly
premium for 2025?
A: Approximately $174.70 (varies by income; higher-income
beneficiaries pay more)
MEDICARE ADVANTAGE PLANS (PART C)
Q9: What is Medicare Advantage?
A: Medicare Part C, an alternative to Traditional Medicare
offered by private companies approved by Medicare.
Includes all Part A and Part B benefits, often includes Part D,
and may offer extra benefits.
Q10: What are the main types of Medicare Advantage
plans?
A:
HMO: Requires choosing primary care physician,
referrals for specialists, services mostly in-network
PPO: Can use out-of-network at higher cost, no
referrals needed typically
PFFS: Private Fee-for-Service with set pricing structure
MSA: Medical Savings Account with high deductible +
savings account
Cost Plans: Mix of HMO and traditional Medicare
features
Q11: What benefits must all Medicare Advantage
plans cover?
A: All MA plans must cover everything Traditional Medicare
covers (Part A and Part B services), except end-stage renal
disease in some cases.
Q12: What are common extra benefits in Medicare
Advantage plans?
A:
Prescription drug coverage (Part D)
Dental, vision, and hearing services
Dr. Wise
