AHIP Final Exam 2026–2027 | 75 Questions & Correct Answers
AHIP MEDICARE ADVANTAGE AND
PRESCRIPTION DRUG CERTIFICATION EXAM
2026–2027 FINAL EXAM
75 Questions and Correct Answers | Graded A+ | 100% Verified
Key Domains: Medicare Basics, Medicare Advantage (MA) Plans, Prescription Drug Plans (PDP),
Enrollment and Disenrollment Rules, Cost-Sharing, CMS Regulations, and Beneficiary Rights
INSTRUCTIONS
Each question is followed by four options (A–D). The correct answer is highlighted in
bold cyan along with a concise rationale explaining regulatory and operational
reasoning, code adherence, and why alternative options are less appropriate.
DOMAIN 1: Medicare Basics – Parts A, B, C, and D
Questions 1–15
1. What is Medicare Part A primarily responsible for covering?
A. Outpatient physician services and preventive care
B. Inpatient hospital stays, skilled nursing facility care, hospice care, and some home health services
C. Prescription drug coverage for all medications
D. Dental and vision services for Medicare beneficiaries
Answer: B
Rationale: Medicare Part A is hospital insurance that covers inpatient hospital stays, skilled nursing facility (SNF)
care, hospice care, and limited home health services. Most beneficiaries receive premium-free Part A based on their
work history or that of a spouse.
2. Which Medicare Part covers physician services, outpatient care, preventive services, and medical
equipment?
A. Medicare Part A B. Medicare Part B
C. Medicare Part C D. Medicare Part D
Answer: B
Rationale: Medicare Part B is medical insurance that covers services from doctors and other health care providers,
outpatient care, medical equipment, preventive services, and some home health services. Part B requires a monthly
premium that most beneficiaries pay.
3. Who is eligible for premium-free Medicare Part A?
A. All U.S. citizens age 65 and older regardless of work history
B. Individuals who have worked at least 40 quarters (10 years) in Medicare-covered employment, or those who
qualify through a spouse's work history
C. Only individuals who are currently employed full-time
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, AHIP Final Exam 2026–2027 | 75 Questions & Correct Answers
D. Only individuals receiving Social Security disability benefits
Answer: B
Rationale: Premium-free Part A is available to individuals aged 65 or older who have accumulated at least 40 quarters
of Medicare-covered employment. Eligibility can also be established through a current or divorced spouse's work
history, or through disability after a 24-month waiting period.
4. What is the General Enrollment Period (GEP) for Medicare Part B, and when does it occur?
A. January 1 through March 31 each year, with coverage effective July 1
B. November 15 through December 31 each year
C. Only during the beneficiary's birthday month
D. Anytime during the calendar year with immediate effect
Answer: A
Rationale: The General Enrollment Period for Medicare Part B runs from January 1 through March 31 of each year.
Coverage for enrollees during the GEP begins on July 1 of that year. Beneficiaries who miss their Initial Enrollment
Period may enroll during the GEP.
5. What is the Initial Enrollment Period (IEP) for Medicare, and how long does it last?
A. A 30-day window around the beneficiary's 65th birthday
B. A 7-month period that includes the 3 months before, the month of, and the 3 months after the beneficiary's
65th birthday (or 25th month of disability)
C. A 12-month period beginning on January 1 of each year
D. The month the beneficiary retires from employment
Answer: B
Rationale: The IEP is a 7-month window centered on the month the beneficiary turns 65 (or the 25th month of
receiving Social Security disability benefits). It includes the 3 months before, the month of, and the 3 months after the
qualifying event.
6. What is Medicare Part C, and how does it differ from traditional Medicare?
A. Part C is Medicare's prescription drug program
B. Part C is the Medicare Advantage program that allows private companies to offer Medicare benefits as an
alternative to Original Medicare (Parts A and B)
C. Part C provides supplemental insurance coverage only
D. Part C is a Medigap policy sold by private insurers
Answer: B
Rationale: Medicare Part C (Medicare Advantage) allows beneficiaries to receive their Medicare benefits through
private health plans approved by Medicare. These plans must cover all Part A and Part B services and typically offer
additional benefits beyond Original Medicare.
7. What is the penalty for late enrollment in Medicare Part B if the beneficiary did not have qualifying
creditable coverage?
A. No penalty is assessed for late enrollment
B. A 10% premium penalty for each 12-month period the beneficiary could have had Part B but did not enroll
C. A flat $500 one-time penalty
D. The penalty is 5% per year of delayed enrollment
Answer: B
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, AHIP Final Exam 2026–2027 | 75 Questions & Correct Answers
Rationale: Beneficiaries who do not enroll in Part B during their IEP and do not have other creditable coverage face a
late enrollment penalty of 10% of the standard Part B premium for each full 12-month period they were eligible but did
not enroll. This penalty applies for as long as the beneficiary has Part B.
8. What is the standard Medicare Part B monthly premium for 2026, and who sets this amount?
A. The premium is set by each state individually
B. CMS sets the standard Part B premium annually; for 2026, the standard amount is approximately $185.00
(subject to annual adjustment)
C. There is no monthly premium for Medicare Part B
D. Congress sets the premium at a fixed amount that never changes
Answer: B
Rationale: CMS sets the standard Medicare Part B premium annually based on statutory requirements. The premium
amount can change each year and higher-income beneficiaries may pay an income-related monthly adjustment amount
(IRMAA) in addition to the standard premium.
9. What is the purpose of Medicare Supplement Insurance (Medigap) policies?
A. To replace Original Medicare coverage entirely
B. To help pay some of the out-of-pocket costs that Original Medicare does not cover, such as copayments,
coinsurance, and deductibles
C. To provide prescription drug coverage to Medicare beneficiaries
D. To serve as Medicare Advantage plans for dual-eligible beneficiaries
Answer: B
Rationale: Medigap policies are sold by private insurance companies and work alongside Original Medicare to help fill
gaps in coverage by paying certain cost-sharing amounts such as copayments, coinsurance, and deductibles. Medigap
policies cannot be used with Medicare Advantage plans.
10. What is the Medicare Part A deductible for 2026, and how does it apply to inpatient hospital stays?
A. There is no deductible for Medicare Part A
B. The Part A deductible is a benefit period amount (approximately $1,632 for 2026) that the beneficiary pays
for each new hospital benefit period
C. The deductible is a lifetime maximum that must be paid only once
D. The deductible is shared equally between Part A and Part B
Answer: B
Rationale: The Medicare Part A hospital deductible is charged per benefit period (not per calendar year) and covers the
first 60 days of inpatient hospital care. Each new benefit period resets the deductible. CMS adjusts this amount
annually.
11. What does the term 'creditable coverage' mean in the context of Medicare enrollment?
A. Coverage that is provided free of charge by the government
B. Health coverage that is at least as good as Medicare Part D prescription drug coverage, used to determine if
a beneficiary will owe a late enrollment penalty
C. Coverage provided only by Medicare Advantage plans
D. Coverage that automatically enrolls beneficiaries in all Medicare parts
Answer: B
Rationale: Creditable prescription drug coverage is coverage that is expected to pay, on average, at least as much as the
standard Medicare Part D plan. Beneficiaries who maintain creditable coverage and later enroll in Part D will not face
the late enrollment penalty.
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AHIP MEDICARE ADVANTAGE AND
PRESCRIPTION DRUG CERTIFICATION EXAM
2026–2027 FINAL EXAM
75 Questions and Correct Answers | Graded A+ | 100% Verified
Key Domains: Medicare Basics, Medicare Advantage (MA) Plans, Prescription Drug Plans (PDP),
Enrollment and Disenrollment Rules, Cost-Sharing, CMS Regulations, and Beneficiary Rights
INSTRUCTIONS
Each question is followed by four options (A–D). The correct answer is highlighted in
bold cyan along with a concise rationale explaining regulatory and operational
reasoning, code adherence, and why alternative options are less appropriate.
DOMAIN 1: Medicare Basics – Parts A, B, C, and D
Questions 1–15
1. What is Medicare Part A primarily responsible for covering?
A. Outpatient physician services and preventive care
B. Inpatient hospital stays, skilled nursing facility care, hospice care, and some home health services
C. Prescription drug coverage for all medications
D. Dental and vision services for Medicare beneficiaries
Answer: B
Rationale: Medicare Part A is hospital insurance that covers inpatient hospital stays, skilled nursing facility (SNF)
care, hospice care, and limited home health services. Most beneficiaries receive premium-free Part A based on their
work history or that of a spouse.
2. Which Medicare Part covers physician services, outpatient care, preventive services, and medical
equipment?
A. Medicare Part A B. Medicare Part B
C. Medicare Part C D. Medicare Part D
Answer: B
Rationale: Medicare Part B is medical insurance that covers services from doctors and other health care providers,
outpatient care, medical equipment, preventive services, and some home health services. Part B requires a monthly
premium that most beneficiaries pay.
3. Who is eligible for premium-free Medicare Part A?
A. All U.S. citizens age 65 and older regardless of work history
B. Individuals who have worked at least 40 quarters (10 years) in Medicare-covered employment, or those who
qualify through a spouse's work history
C. Only individuals who are currently employed full-time
1
, AHIP Final Exam 2026–2027 | 75 Questions & Correct Answers
D. Only individuals receiving Social Security disability benefits
Answer: B
Rationale: Premium-free Part A is available to individuals aged 65 or older who have accumulated at least 40 quarters
of Medicare-covered employment. Eligibility can also be established through a current or divorced spouse's work
history, or through disability after a 24-month waiting period.
4. What is the General Enrollment Period (GEP) for Medicare Part B, and when does it occur?
A. January 1 through March 31 each year, with coverage effective July 1
B. November 15 through December 31 each year
C. Only during the beneficiary's birthday month
D. Anytime during the calendar year with immediate effect
Answer: A
Rationale: The General Enrollment Period for Medicare Part B runs from January 1 through March 31 of each year.
Coverage for enrollees during the GEP begins on July 1 of that year. Beneficiaries who miss their Initial Enrollment
Period may enroll during the GEP.
5. What is the Initial Enrollment Period (IEP) for Medicare, and how long does it last?
A. A 30-day window around the beneficiary's 65th birthday
B. A 7-month period that includes the 3 months before, the month of, and the 3 months after the beneficiary's
65th birthday (or 25th month of disability)
C. A 12-month period beginning on January 1 of each year
D. The month the beneficiary retires from employment
Answer: B
Rationale: The IEP is a 7-month window centered on the month the beneficiary turns 65 (or the 25th month of
receiving Social Security disability benefits). It includes the 3 months before, the month of, and the 3 months after the
qualifying event.
6. What is Medicare Part C, and how does it differ from traditional Medicare?
A. Part C is Medicare's prescription drug program
B. Part C is the Medicare Advantage program that allows private companies to offer Medicare benefits as an
alternative to Original Medicare (Parts A and B)
C. Part C provides supplemental insurance coverage only
D. Part C is a Medigap policy sold by private insurers
Answer: B
Rationale: Medicare Part C (Medicare Advantage) allows beneficiaries to receive their Medicare benefits through
private health plans approved by Medicare. These plans must cover all Part A and Part B services and typically offer
additional benefits beyond Original Medicare.
7. What is the penalty for late enrollment in Medicare Part B if the beneficiary did not have qualifying
creditable coverage?
A. No penalty is assessed for late enrollment
B. A 10% premium penalty for each 12-month period the beneficiary could have had Part B but did not enroll
C. A flat $500 one-time penalty
D. The penalty is 5% per year of delayed enrollment
Answer: B
2
, AHIP Final Exam 2026–2027 | 75 Questions & Correct Answers
Rationale: Beneficiaries who do not enroll in Part B during their IEP and do not have other creditable coverage face a
late enrollment penalty of 10% of the standard Part B premium for each full 12-month period they were eligible but did
not enroll. This penalty applies for as long as the beneficiary has Part B.
8. What is the standard Medicare Part B monthly premium for 2026, and who sets this amount?
A. The premium is set by each state individually
B. CMS sets the standard Part B premium annually; for 2026, the standard amount is approximately $185.00
(subject to annual adjustment)
C. There is no monthly premium for Medicare Part B
D. Congress sets the premium at a fixed amount that never changes
Answer: B
Rationale: CMS sets the standard Medicare Part B premium annually based on statutory requirements. The premium
amount can change each year and higher-income beneficiaries may pay an income-related monthly adjustment amount
(IRMAA) in addition to the standard premium.
9. What is the purpose of Medicare Supplement Insurance (Medigap) policies?
A. To replace Original Medicare coverage entirely
B. To help pay some of the out-of-pocket costs that Original Medicare does not cover, such as copayments,
coinsurance, and deductibles
C. To provide prescription drug coverage to Medicare beneficiaries
D. To serve as Medicare Advantage plans for dual-eligible beneficiaries
Answer: B
Rationale: Medigap policies are sold by private insurance companies and work alongside Original Medicare to help fill
gaps in coverage by paying certain cost-sharing amounts such as copayments, coinsurance, and deductibles. Medigap
policies cannot be used with Medicare Advantage plans.
10. What is the Medicare Part A deductible for 2026, and how does it apply to inpatient hospital stays?
A. There is no deductible for Medicare Part A
B. The Part A deductible is a benefit period amount (approximately $1,632 for 2026) that the beneficiary pays
for each new hospital benefit period
C. The deductible is a lifetime maximum that must be paid only once
D. The deductible is shared equally between Part A and Part B
Answer: B
Rationale: The Medicare Part A hospital deductible is charged per benefit period (not per calendar year) and covers the
first 60 days of inpatient hospital care. Each new benefit period resets the deductible. CMS adjusts this amount
annually.
11. What does the term 'creditable coverage' mean in the context of Medicare enrollment?
A. Coverage that is provided free of charge by the government
B. Health coverage that is at least as good as Medicare Part D prescription drug coverage, used to determine if
a beneficiary will owe a late enrollment penalty
C. Coverage provided only by Medicare Advantage plans
D. Coverage that automatically enrolls beneficiaries in all Medicare parts
Answer: B
Rationale: Creditable prescription drug coverage is coverage that is expected to pay, on average, at least as much as the
standard Medicare Part D plan. Beneficiaries who maintain creditable coverage and later enroll in Part D will not face
the late enrollment penalty.
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