AHIP FINAL EXAM LATEST (2026/2027) | 200 VERIFIED QUESTIONS AND CORRECT ANSWERS | A+ GRADED

✅AHIP FINAL EXAM LATEST (2026/2027) | 200
VERIFIED QUESTIONS AND CORRECT ANSWERS | A+
GRADED




1. Which part of Medicare covers inpatient hospital services?
xz xz xz xz xz xz xz




Answer: Part A xz xz




Rationale: Medicare Part A pays for inpatient stays, skilled nursing facility care, hospice, and some
xz xz xz xz xz xz xz xz xz xz xz xz xz xz x




home health.
z xz




2. A beneficiary turning 65 and already receiving Social Security benefits is au
xz xz xz xz xz xz xz xz xz xz xz




tomatically enrolled in: xz xz




Answer: Part A and Part B
xz xz xz xz xz




Rationale: Automatic enrollment occurs when receiving SSA benefits prior to 65.
xz xz xz xz xz xz xz xz xz xz




3. The penalty for delaying Medicare Part B enrollment without creditable co
xz xz xz xz xz xz xz xz xz xz




verage is: xz




Answer: 10% for every 12 months delayed
xz xz xz xz xz xz




Rationale: CMS applies a 10% surcharge for each full uncovered year.
xz xz xz xz xz xz xz xz xz xz




4. Medicare Advantage plans must cover: xz xz xz xz




Answer: All services covered by Original Medicare
xz xz xz xz xz xz




Rationale: MA plans are required to provide equal or greater coverage than Parts A and B.
xz xz xz xz xz xz xz xz xz xz xz xz xz xz xz

,5. What is the main requirement to join a Medicare Advantage plan?
xz xz xz xz xz xz xz xz xz xz




Answer: Must have both Part A and Part B
xz xz xz xz xz xz xz xz




Rationale: Enrollment in both parts is mandatory for MA.
xz xz xz xz xz xz xz xz




6. The six protected drug classes under Part D ensure:
xz xz xz xz xz xz xz xz




Answer: Broad access to critical medications
xz xz xz xz xz




Rationale: Plans must cover all or nearly all drugs in these categories.
xz xz xz xz xz xz xz xz xz xz xz




7. An agent must obtain a Scope of Appointment (SOA):
xz xz xz xz xz xz xz xz




Answer: Before discussing specific plan benefits
xz xz xz xz xz




Rationale: CMS requires SOA to document beneficiary permission.
xz xz xz xz xz xz xz




8. LIS (Low-Income Subsidy) helps beneficiaries with:
xz xz xz xz xz




Answer: Part D premium, deductible, and cost-sharing
xz xz xz xz xz xz




Rationale: LIS reduces or eliminates drug plan costs for low-income enrollees.
xz xz xz xz xz xz xz xz xz xz




9. What is considered marketing?
xz xz xz




Answer: Materials intended to steer beneficiaries toward enrollment
xz xz xz xz xz xz xz




Rationale: CMS defines marketing by intent and content.
xz xz xz xz xz xz xz




10. Medicare Part B covers: xz xz xz




Answer: Outpatient services and preventive care
xz xz xz xz xz




Rationale: Part B includes doctor visits, screenings, DME, and outpatient services.
xz xz xz xz xz xz xz xz xz xz




11. A Special Enrollment Period (SEP) for Part B exists when:
xz xz xz xz xz xz xz xz xz

,Answer: A beneficiary has creditable employer coverage and delays enrollment
xz xz xz xz xz xz xz xz xz




Rationale: SEP avoids penalties when credible employer insurance exists.
xz xz xz xz xz xz xz xz




12. Medicare Advantage plans receive payment from CMS through:
xz xz xz xz xz xz xz




Answer: Monthly capitated payments
xz xz xz




Rationale: Plans get a fixed per-member amount regardless of service use.
xz xz xz xz xz xz xz xz xz xz




13. Upcoding by a provider is an example of:
xz xz xz xz xz xz xz




Answer: Fraud
xz




Rationale: Intentionally coding higher levels of service is deceptive and illegal.
xz xz xz xz xz xz xz xz xz xz




14. Waste refers to: xz xz




Answer: Over-utilization of services
xz xz xz




Rationale: Waste does not require intent to break rules.
xz xz xz xz xz xz xz xz




15. Which program helps pay Medicare costs for individuals with limited in
xz xz xz xz xz xz xz xz xz xz




come?

Answer: Medicare Savings Programs (MSPs)
xz xz xz xz




Rationale: MSPs cover Part A/B premiums and sometimes cost-sharing.
xz xz xz xz xz xz xz xz




16. A marketing event allows an agent to:
xz xz xz xz xz xz




Answer: Present plan-specific information
xz xz xz




Rationale: Unlike educational events, marketing events permit discussing benefits.
xz xz xz xz xz xz xz xz




17. A PPO Medicare Advantage plan allows members to:
xz xz xz xz xz xz xz




Answer: See out-of-network providers at higher cost
xz xz xz xz xz xz




Rationale: PPOs offer flexibility, but at increased OOP costs.
xz xz xz xz xz xz xz xz

, 18. Which plan type restricts members to their network for all n
xz xz xz xz xz xz xz xz xz xz




on-emergency care? xz




Answer: HMO xz




Rationale: HMOs generally require in-network providers.
xz xz xz xz xz




19. Which of the following is required for enrollment in a Special Needs Pl
xz xz xz xz xz xz xz xz xz xz xz xz




an (SNP)?
xz




Answer: Must meet the SNP’s eligibility criteria
xz xz xz xz xz xz




Rationale: SNPs require chronic conditions, institutional status, or dual eligibility.
xz xz xz xz xz xz xz xz xz




20. The Medicare Part D coverage gap (“donut hole”) occurs after:
xz xz xz xz xz xz xz xz xz




Answer: The initial coverage limit is reached
xz xz xz xz xz xz




Rationale: After the limit, members pay a percentage of drug costs until catastrophic coverage.
xz xz xz xz xz xz xz xz xz xz xz xz xz




21. A permissible activity at an educational event is:
xz xz xz xz xz xz xz




Answer: Giving out general Medicare information
xz xz xz xz xz




Rationale: No plan-specific info or enrollment forms allowed.
xz xz xz xz xz xz xz




22. Which statement is true about MA plans and emergency care?
xz xz xz xz xz xz xz xz xz




Answer: Emergency care must be covered everywhere in the U.S.
xz xz xz xz xz xz xz xz xz




Rationale: CMS requires universal emergency coverage.
xz xz xz xz xz




23. A drug formulary is:
xz xz xz




Answer: The list of drugs a Part D plan covers
xz xz xz xz xz xz xz xz xz




Rationale: Formularies categorize drugs by tiers and coverage rules.
xz xz xz xz xz xz xz xz