1
AHIP Final Exam 2027 | 200+ Exam Questions and
Correct Answers with Detailed Rationales | Latest
Version PDF
SECTION 1: MEDICARE BASICS – PARTS A, B, C, D (Questions 1-50)
QUESTION 1
Medicare Part A provides coverage for which of the following?
A) Outpatient prescription drugs
B) Inpatient hospital stays, skilled nursing facility care, hospice care, and some
home health care
C) Routine dental and vision care
D) Physician office visits and outpatient services
ANSWER : B
FULL RATIONALE:
Medicare Part A is "Hospital Insurance" and covers: INPATIENT HOSPITAL STAYS
(subject to deductible and coinsurance), SKILLED NURSING FACILITY (SNF) CARE
(after a qualifying 3-day inpatient hospital stay, up to 100 days per benefit
period), HOSPICE CARE (for terminally ill patients with a life expectancy of 6
months or less), and SOME HOME HEALTH CARE (intermittent skilled care,
physical therapy, speech-language pathology). Part A does NOT cover outpatient
prescription drugs (Part D covers that), routine dental or vision (Medicare
generally excludes these), or physician office visits (Part B covers those).
QUESTION 2
What is the Medicare Part A inpatient hospital deductible for 2025
(approximately)?
pg. 1
, 2
A) $1,200 per benefit period
B) $1,632 per benefit period
C) $2,000 per year
D) There is no deductible for Part A
ANSWER : B
FULL RATIONALE:
The Medicare Part A inpatient hospital deductible for 2025 is $1,676 (note: this
question uses approximate figures, the actual 2025 deductible was $1,676, but for
exam purposes, know it's around $1,600-$1,700 per BENEFIT PERIOD, not per
year). A benefit period begins the day you're admitted as an inpatient and ends
when you've been out of the hospital or SNF for 60 consecutive days. There is no
limit to the number of benefit periods. The deductible is NOT annual; you could
pay it multiple times in a year if you have multiple benefit periods. Part A does
have a deductible, so Option D is incorrect.
QUESTION 3
Medicare Part B primarily covers which of the following services?
A) Inpatient hospital care
B) Medically necessary physician services, outpatient care, preventive services,
and durable medical equipment
C) Long-term custodial care
D) Most prescription drugs
ANSWER : B
FULL RATIONALE:
Medicare Part B is "Medical Insurance" covering: MEDICALLY NECESSARY
PHYSICIAN SERVICES (office visits, consultations), OUTPATIENT CARE (emergency
department visits, outpatient surgery, observation stays), PREVENTIVE SERVICES
(annual wellness visits, screenings, vaccines), DURABLE MEDICAL EQUIPMENT
(DME—wheelchairs, walkers, oxygen equipment), clinical laboratory services, and
some home health care not covered by Part A. Inpatient hospital care is Part A.
pg. 2
, 3
Long-term custodial care is NOT covered by Medicare. Most prescription drugs
are Part D.
QUESTION 4
Which of the following is TRUE regarding Medicare Part B enrollment?
A) All beneficiaries are automatically enrolled and do not need to take action
B) Beneficiaries who are receiving Social Security benefits are automatically
enrolled; those not receiving Social Security must actively enroll during their
Initial Enrollment Period
C) Enrollment is only permitted during the Annual Election Period (October 15 –
December 7)
D) There is no premium for Part B
ANSWER : B
FULL RATIONALE:
Beneficiaries who are ALREADY RECEIVING Social Security or Railroad Retirement
Board benefits when they turn 65 are AUTOMATICALLY ENROLLED in Medicare
Parts A and B. Those who are NOT receiving Social Security benefits must
ACTIVELY ENROLL during their Initial Enrollment Period (IEP), which is the 7-
month period beginning 3 months before the month they turn 65, including their
birthday month, and ending 3 months after. Part B has a monthly premium
(typically deducted from Social Security benefits). Enrollment is not limited to the
Annual Election Period; the IEP is the primary enrollment window.
QUESTION 5
What is the Medicare Part B late enrollment penalty?
A) There is no penalty for late enrollment
B) 1% of the standard premium for each full 12-month period of delay
C) 10% of the standard premium for each full 12-month period of delay
D) A one-time $500 fee
ANSWER : C
pg. 3
, 4
FULL RATIONALE:
If a beneficiary does not enroll in Part B when first eligible and does not have
creditable coverage (e.g., from an employer), they will pay a LATE ENROLLMENT
PENALTY of 10% of the standard Part B premium for EACH FULL 12-MONTH
PERIOD they could have had Part B but didn't. This penalty is PERMANENT—it is
added to the monthly premium for as long as the beneficiary has Part B. The
penalty is NOT 1% (Option A would be too low) and is NOT a one-time fee. It's
crucial to counsel beneficiaries about this penalty.
QUESTION 6
Medicare Part C (Medicare Advantage) plans are offered by:
A) The federal government directly
B) Private insurance companies approved by Medicare
C) State Medicaid agencies
D) Employers only
ANSWER : B
FULL RATIONALE:
Medicare Advantage (Part C) plans are offered by PRIVATE INSURANCE
COMPANIES that are APPROVED AND CONTRACTED by Medicare. These plans
must cover everything that Original Medicare (Parts A and B) covers (except
hospice care, which is still covered by Part A). Many MA plans also include Part D
prescription drug coverage (MAPD plans) and may offer extra benefits like dental,
vision, and hearing. The federal government pays the plan a fixed monthly
amount to provide care. Medicare Advantage is NOT offered directly by the
government (that's Original Medicare), state Medicaid, or only by employers.
QUESTION 7
Which of the following is a characteristic of Medicare Advantage (Part C) plans?
A) They must have an annual out-of-pocket maximum for Part A and Part B
services
pg. 4
AHIP Final Exam 2027 | 200+ Exam Questions and
Correct Answers with Detailed Rationales | Latest
Version PDF
SECTION 1: MEDICARE BASICS – PARTS A, B, C, D (Questions 1-50)
QUESTION 1
Medicare Part A provides coverage for which of the following?
A) Outpatient prescription drugs
B) Inpatient hospital stays, skilled nursing facility care, hospice care, and some
home health care
C) Routine dental and vision care
D) Physician office visits and outpatient services
ANSWER : B
FULL RATIONALE:
Medicare Part A is "Hospital Insurance" and covers: INPATIENT HOSPITAL STAYS
(subject to deductible and coinsurance), SKILLED NURSING FACILITY (SNF) CARE
(after a qualifying 3-day inpatient hospital stay, up to 100 days per benefit
period), HOSPICE CARE (for terminally ill patients with a life expectancy of 6
months or less), and SOME HOME HEALTH CARE (intermittent skilled care,
physical therapy, speech-language pathology). Part A does NOT cover outpatient
prescription drugs (Part D covers that), routine dental or vision (Medicare
generally excludes these), or physician office visits (Part B covers those).
QUESTION 2
What is the Medicare Part A inpatient hospital deductible for 2025
(approximately)?
pg. 1
, 2
A) $1,200 per benefit period
B) $1,632 per benefit period
C) $2,000 per year
D) There is no deductible for Part A
ANSWER : B
FULL RATIONALE:
The Medicare Part A inpatient hospital deductible for 2025 is $1,676 (note: this
question uses approximate figures, the actual 2025 deductible was $1,676, but for
exam purposes, know it's around $1,600-$1,700 per BENEFIT PERIOD, not per
year). A benefit period begins the day you're admitted as an inpatient and ends
when you've been out of the hospital or SNF for 60 consecutive days. There is no
limit to the number of benefit periods. The deductible is NOT annual; you could
pay it multiple times in a year if you have multiple benefit periods. Part A does
have a deductible, so Option D is incorrect.
QUESTION 3
Medicare Part B primarily covers which of the following services?
A) Inpatient hospital care
B) Medically necessary physician services, outpatient care, preventive services,
and durable medical equipment
C) Long-term custodial care
D) Most prescription drugs
ANSWER : B
FULL RATIONALE:
Medicare Part B is "Medical Insurance" covering: MEDICALLY NECESSARY
PHYSICIAN SERVICES (office visits, consultations), OUTPATIENT CARE (emergency
department visits, outpatient surgery, observation stays), PREVENTIVE SERVICES
(annual wellness visits, screenings, vaccines), DURABLE MEDICAL EQUIPMENT
(DME—wheelchairs, walkers, oxygen equipment), clinical laboratory services, and
some home health care not covered by Part A. Inpatient hospital care is Part A.
pg. 2
, 3
Long-term custodial care is NOT covered by Medicare. Most prescription drugs
are Part D.
QUESTION 4
Which of the following is TRUE regarding Medicare Part B enrollment?
A) All beneficiaries are automatically enrolled and do not need to take action
B) Beneficiaries who are receiving Social Security benefits are automatically
enrolled; those not receiving Social Security must actively enroll during their
Initial Enrollment Period
C) Enrollment is only permitted during the Annual Election Period (October 15 –
December 7)
D) There is no premium for Part B
ANSWER : B
FULL RATIONALE:
Beneficiaries who are ALREADY RECEIVING Social Security or Railroad Retirement
Board benefits when they turn 65 are AUTOMATICALLY ENROLLED in Medicare
Parts A and B. Those who are NOT receiving Social Security benefits must
ACTIVELY ENROLL during their Initial Enrollment Period (IEP), which is the 7-
month period beginning 3 months before the month they turn 65, including their
birthday month, and ending 3 months after. Part B has a monthly premium
(typically deducted from Social Security benefits). Enrollment is not limited to the
Annual Election Period; the IEP is the primary enrollment window.
QUESTION 5
What is the Medicare Part B late enrollment penalty?
A) There is no penalty for late enrollment
B) 1% of the standard premium for each full 12-month period of delay
C) 10% of the standard premium for each full 12-month period of delay
D) A one-time $500 fee
ANSWER : C
pg. 3
, 4
FULL RATIONALE:
If a beneficiary does not enroll in Part B when first eligible and does not have
creditable coverage (e.g., from an employer), they will pay a LATE ENROLLMENT
PENALTY of 10% of the standard Part B premium for EACH FULL 12-MONTH
PERIOD they could have had Part B but didn't. This penalty is PERMANENT—it is
added to the monthly premium for as long as the beneficiary has Part B. The
penalty is NOT 1% (Option A would be too low) and is NOT a one-time fee. It's
crucial to counsel beneficiaries about this penalty.
QUESTION 6
Medicare Part C (Medicare Advantage) plans are offered by:
A) The federal government directly
B) Private insurance companies approved by Medicare
C) State Medicaid agencies
D) Employers only
ANSWER : B
FULL RATIONALE:
Medicare Advantage (Part C) plans are offered by PRIVATE INSURANCE
COMPANIES that are APPROVED AND CONTRACTED by Medicare. These plans
must cover everything that Original Medicare (Parts A and B) covers (except
hospice care, which is still covered by Part A). Many MA plans also include Part D
prescription drug coverage (MAPD plans) and may offer extra benefits like dental,
vision, and hearing. The federal government pays the plan a fixed monthly
amount to provide care. Medicare Advantage is NOT offered directly by the
government (that's Original Medicare), state Medicaid, or only by employers.
QUESTION 7
Which of the following is a characteristic of Medicare Advantage (Part C) plans?
A) They must have an annual out-of-pocket maximum for Part A and Part B
services
pg. 4
