Verified Edition 2026 AHIP Final Exam
– 100 Questions And Answers With
Rationales
Medicare Basics (Parts A & B)
1. Mr. Thompson is 67 years old and has been covered under
his employer's group health plan since he turned 65. He is still
working full-time and his employer has more than 20
employees. He is considering enrolling in Medicare Part A.
Which of the following is correct?
A) He must enroll in Part A immediately upon turning 65 or face a
permanent late enrollment penalty.
B) He may delay enrolling in Part A without penalty because he
has coverage through a large employer group health plan.
C) He can only enroll in Part A during the Annual Election Period
each year.
D) He is not eligible for Part A until he retires.
Correct Answer: B
Rationale: Individuals who are still working and covered by a
group health plan through their own employment (or a spouse's
employment) with an employer of 20 or more employees may
delay enrolling in Part A without incurring a late enrollment
,penalty. The Special Enrollment Period (SEP) allows them to enroll
later without penalty. Choice A is incorrect because there is no
immediate enrollment requirement for those with qualifying
employer coverage. Choice C is incorrect because SEP is available
outside the Annual Election Period. Choice D is incorrect because
eligibility for Part A begins at age 65 regardless of employment
status.
2. Mrs. Kowalski is enrolled in Original Medicare (Parts A and
B). She recently received a bill for a hospital stay and is
concerned about her cost-sharing obligations. Under
Medicare Part A, what is the structure of cost-sharing for
inpatient hospital stays?
A) A flat copayment per day with no deductible
B) A deductible for the first 60 days, followed by daily coinsurance
for days 61-90, and additional costs for lifetime reserve days
C) No deductible or coinsurance for the first 90 days
D) A percentage coinsurance for the entire stay with no
deductible
Correct Answer: B
Rationale: Medicare Part A inpatient hospital coverage includes a
deductible for the first 60 days of a benefit period, daily
coinsurance for days 61-90, and additional daily coinsurance for
lifetime reserve days (up to 60 total days over a beneficiary's
lifetime). Choice A is incorrect because there is a deductible, not
just a copayment. Choice C is incorrect because there are cost-
,sharing requirements. Choice D is incorrect because the structure
is not a simple percentage coinsurance for the entire stay.
3. Mr. Patel is 72 years old and has Medicare Part B. He is
considering a new preventive service that his doctor
recommended. Under Medicare Part B, which of the following
preventive services is covered with no cost-sharing when
provided by a participating provider?
A) Annual physical exam with comprehensive lab work
B) Colonoscopy performed for diagnostic purposes after
symptoms appear
C) Annual Wellness Visit
D) Routine vision exam for eyeglasses
Correct Answer: C
Rationale: Medicare Part B covers the Annual Wellness Visit with
no deductible or coinsurance when provided by a participating
provider. Choice A is incorrect because Medicare does not cover a
comprehensive annual physical exam in the same way; the
"Welcome to Medicare" visit and Annual Wellness Visit are
covered but are not comprehensive physicals. Choice B is
incorrect because diagnostic colonoscopies (performed due to
symptoms) are subject to cost-sharing; screening colonoscopies
are covered without cost-sharing. Choice D is incorrect because
routine vision exams for eyeglasses are not covered by Original
Medicare.
, 4. Ms. Garcia is eligible for Medicare and is considering
whether to enroll in Part B. She is concerned about the late
enrollment penalty. Which of the following statements about
the Part B late enrollment penalty is correct?
A) The penalty is a one-time fee paid at the time of enrollment.
B) The penalty increases the Part B premium by 10% for each full
12-month period the individual was eligible but not enrolled.
C) The penalty applies only if the individual never had any health
insurance coverage.
D) The penalty is waived if the individual enrolls during the
General Enrollment Period.
Correct Answer: B
Rationale: The Part B late enrollment penalty is calculated as a
10% increase in the standard Part B premium for each full 12-
month period that the individual was eligible for Part B but did
not enroll. This penalty lasts for as long as the individual has Part
B. Choice A is incorrect because the penalty is not a one-time fee
but an ongoing premium increase. Choice C is incorrect because
the penalty applies even if the individual had other coverage that
was not considered creditable. Choice D is incorrect because
enrolling during the General Enrollment Period does not waive the
penalty; the penalty is based on the length of time without
coverage after initial eligibility.
– 100 Questions And Answers With
Rationales
Medicare Basics (Parts A & B)
1. Mr. Thompson is 67 years old and has been covered under
his employer's group health plan since he turned 65. He is still
working full-time and his employer has more than 20
employees. He is considering enrolling in Medicare Part A.
Which of the following is correct?
A) He must enroll in Part A immediately upon turning 65 or face a
permanent late enrollment penalty.
B) He may delay enrolling in Part A without penalty because he
has coverage through a large employer group health plan.
C) He can only enroll in Part A during the Annual Election Period
each year.
D) He is not eligible for Part A until he retires.
Correct Answer: B
Rationale: Individuals who are still working and covered by a
group health plan through their own employment (or a spouse's
employment) with an employer of 20 or more employees may
delay enrolling in Part A without incurring a late enrollment
,penalty. The Special Enrollment Period (SEP) allows them to enroll
later without penalty. Choice A is incorrect because there is no
immediate enrollment requirement for those with qualifying
employer coverage. Choice C is incorrect because SEP is available
outside the Annual Election Period. Choice D is incorrect because
eligibility for Part A begins at age 65 regardless of employment
status.
2. Mrs. Kowalski is enrolled in Original Medicare (Parts A and
B). She recently received a bill for a hospital stay and is
concerned about her cost-sharing obligations. Under
Medicare Part A, what is the structure of cost-sharing for
inpatient hospital stays?
A) A flat copayment per day with no deductible
B) A deductible for the first 60 days, followed by daily coinsurance
for days 61-90, and additional costs for lifetime reserve days
C) No deductible or coinsurance for the first 90 days
D) A percentage coinsurance for the entire stay with no
deductible
Correct Answer: B
Rationale: Medicare Part A inpatient hospital coverage includes a
deductible for the first 60 days of a benefit period, daily
coinsurance for days 61-90, and additional daily coinsurance for
lifetime reserve days (up to 60 total days over a beneficiary's
lifetime). Choice A is incorrect because there is a deductible, not
just a copayment. Choice C is incorrect because there are cost-
,sharing requirements. Choice D is incorrect because the structure
is not a simple percentage coinsurance for the entire stay.
3. Mr. Patel is 72 years old and has Medicare Part B. He is
considering a new preventive service that his doctor
recommended. Under Medicare Part B, which of the following
preventive services is covered with no cost-sharing when
provided by a participating provider?
A) Annual physical exam with comprehensive lab work
B) Colonoscopy performed for diagnostic purposes after
symptoms appear
C) Annual Wellness Visit
D) Routine vision exam for eyeglasses
Correct Answer: C
Rationale: Medicare Part B covers the Annual Wellness Visit with
no deductible or coinsurance when provided by a participating
provider. Choice A is incorrect because Medicare does not cover a
comprehensive annual physical exam in the same way; the
"Welcome to Medicare" visit and Annual Wellness Visit are
covered but are not comprehensive physicals. Choice B is
incorrect because diagnostic colonoscopies (performed due to
symptoms) are subject to cost-sharing; screening colonoscopies
are covered without cost-sharing. Choice D is incorrect because
routine vision exams for eyeglasses are not covered by Original
Medicare.
, 4. Ms. Garcia is eligible for Medicare and is considering
whether to enroll in Part B. She is concerned about the late
enrollment penalty. Which of the following statements about
the Part B late enrollment penalty is correct?
A) The penalty is a one-time fee paid at the time of enrollment.
B) The penalty increases the Part B premium by 10% for each full
12-month period the individual was eligible but not enrolled.
C) The penalty applies only if the individual never had any health
insurance coverage.
D) The penalty is waived if the individual enrolls during the
General Enrollment Period.
Correct Answer: B
Rationale: The Part B late enrollment penalty is calculated as a
10% increase in the standard Part B premium for each full 12-
month period that the individual was eligible for Part B but did
not enroll. This penalty lasts for as long as the individual has Part
B. Choice A is incorrect because the penalty is not a one-time fee
but an ongoing premium increase. Choice C is incorrect because
the penalty applies even if the individual had other coverage that
was not considered creditable. Choice D is incorrect because
enrolling during the General Enrollment Period does not waive the
penalty; the penalty is based on the length of time without
coverage after initial eligibility.
