AHIP Exam 2026/2027 | 50 Verified Questions | A+ Graded UPDATED - CMS 2026/2027 Guidelines
AHIP Exam
50 Verified Questions with Correct Answers
A+ Graded - UPDATED - Aligned with 2026-2027 CMS Guidelines
Examination Overview. This 50-question certification-prep exam is structured across seven (7) sections
that mirror the AHIP (America's Health Insurance Plans) certification knowledge domains for 2026-2027.
Each question is scenario-based, recall-based, or calculation-based per AHIP cognitive-level distribution
(approximately 30% recall, 50% application, 20% analysis). Each question includes one (1) correct answer,
three (3) field-tested distractors representing the most common AHIP exam errors, and a comprehensive
rationale with the underlying CMS regulatory citation.
# Section Title Questions
1 Medicare Basics, Eligibility, and Parts A & B Coverage Q1 - Q12
2 Medicare Advantage (Part C) Plans and Benefits Q13 - Q20
3 Medicare Part D Prescription Drug Coverage Q21 - Q28
4 Medigap (Medicare Supplement) Plans and Coordination Q29 - Q34
5 Enrollment Periods and Special Enrollment Periods Q35 - Q40
6 Low-Income Assistance Programs Q41 - Q44
7 Compliance, Marketing, FWA, and Beneficiary Rights Q45 - Q50
Total Questions: 50 Cognitive Mix: ~30% Recall / 50% Application / 20% Analysis
Sections: 7 Question Style: ~70% Scenario / 25% Direct Recall / 5% Calculation
Format: 4-option MCQ Rationale Depth: 2-3 sentences with CMS citations
Instructions to Candidate: Read each question stem carefully. Select the single best answer among the
four options (A-D). The correct answer is marked [CORRECT] and followed by a detailed rationale citing the
governing CMS regulation (42 U.S.C. / 42 CFR) and 2026-2027 program figures. This document is intended
for self-study and AHIP certification preparation; it is not affiliated with or endorsed by CMS or America's
Health Insurance Plans.
AHIP Certification Exam Prep - Aligned with CMS 2026-2027 Guidelines Page 1
,AHIP Exam 2026/2027 | 50 Verified Questions | A+ Graded UPDATED - CMS 2026/2027 Guidelines
Section 1: Medicare Basics, Eligibility, and Parts A & B Coverage
Q1 - Q12 | Topics: age/disability/ESRD/ALS entitlement, Part A premium-free rules, benefit periods, inpatient &
SNF coinsurance, Lifetime Reserve Days, hospice, Part B scope, IRMAA, late enrollment penalty, preventive
services.
Q1. Maria is a 64-year-old lawful permanent resident who has lived in the United States for 4 years
and 11 months. She will turn 65 next month and wants to enroll in Medicare. Which statement best
describes her eligibility?
A. She is eligible for premium-free Part A simply because she is turning 65.
B. She is not yet eligible because she has not been a lawful permanent resident for at least 5
continuous years. [CORRECT]
C. She is eligible for Part B only, but not Part A.
D. She is eligible for both Part A and Part B immediately upon turning 65 regardless of residency
duration.
Correct Answer: B
Rationale: Age-65 Medicare entitlement requires both being 65 or older AND being a U.S. citizen or lawful
permanent resident who has lived in the U.S. continuously for at least 5 years (42 U.S.C. §426(a)). Maria is
one month short of the 5-year residency requirement, so she is not yet eligible. Options A, C, and D each
assume she meets the residency rule, which she does not; she must wait until the 5-year threshold is
satisfied.
Q2. Robert, age 58, has been receiving Social Security Disability Insurance (SSDI) benefits for 23
months due to a severe back injury. When will he become entitled to Medicare?
A. He is entitled to Medicare immediately upon SSDI approval.
B. He will be entitled in 1 month, after completing 24 months of SSDI benefits. [CORRECT]
C. He must wait until age 65 to qualify for Medicare.
D. He will be entitled to Medicare only if he also qualifies for Medicaid.
Correct Answer: B
Rationale: Under 42 U.S.C. §426(b), individuals receiving SSDI benefits become entitled to Medicare Parts
A and B starting on the first day of the 25th month of SSDI benefit entitlement. Robert has received 23
months of benefits, so he will be entitled in 1 more month. Option A is wrong because of the 24-month
waiting period. Option C is wrong because disability is an independent entitlement pathway. Option D
improperly ties Medicare to Medicaid eligibility.
AHIP Certification Exam Prep - Aligned with CMS 2026-2027 Guidelines Page 2
, AHIP Exam 2026/2027 | 50 Verified Questions | A+ Graded UPDATED - CMS 2026/2027 Guidelines
Q3. Which statement is correct regarding Medicare eligibility for individuals diagnosed with ALS
(Amyotrophic Lateral Sclerosis) versus ESRD (End-Stage Renal Disease)?
A. Both ALS and ESRD beneficiaries must wait 24 months before Medicare begins.
B. ALS beneficiaries receive Medicare the month SSDI begins; ESRD beneficiaries have a
24-month waiting period measured from the start of dialysis. [CORRECT]
C. Both ALS and ESRD beneficiaries receive Medicare immediately upon diagnosis.
D. ALS beneficiaries must wait 24 months; ESRD beneficiaries receive Medicare immediately upon
dialysis.
Correct Answer: B
Rationale: Under 42 U.S.C. §426(h), individuals with ALS are exempt from the 24-month waiting period
and become entitled to Medicare the same month their SSDI benefits begin. ESRD beneficiaries, under 42
U.S.C. §426.1, generally become entitled after a 24-month waiting period that begins with the first month of
dialysis (or the month of kidney transplant). Option A ignores the ALS exception. Option C overstates the
ESRD rule. Option D reverses the two conditions.
Q4. James worked for 30 years in jobs that paid Medicare taxes. He is now 66 and applying for
Medicare Part A. What will his 2026 Part A premium be?
A. He will pay the full 2026 premium of approximately $506 per month.
B. He will pay a reduced premium of approximately $278 per month.
C. He will pay no premium (premium-free Part A) because he has at least 40 quarters of
Medicare-covered employment. [CORRECT]
D. He will pay the standard Part B premium only.
Correct Answer: C
Rationale: Premium-free Part A is available to individuals with at least 40 quarters (10 years) of
Medicare-covered employment under 42 U.S.C. §426(a). James has 30 years (120 quarters), far exceeding
the 40-quarter threshold, so his Part A is premium-free. Option A applies to those with fewer than 30
quarters. Option B applies to those with 30 to 39 quarters. Option D confuses Part A with Part B.
Q5. A Medicare beneficiary is admitted to the hospital on March 1 and discharged on March 22 (22
inpatient days) during a single benefit period. The 2026 Part A inpatient deductible is $1,676. What is
the beneficiary's out-of-pocket cost for the inpatient stay (excluding professional fees)?
A. $0 because the stay was fewer than 60 days.
B. $1,676 deductible only, with $0 daily coinsurance for days 1-60. [CORRECT]
C. $1,676 deductible plus $419 daily coinsurance for days 21 and 22.
D. The full cost of the hospital stay because Medicare does not cover short stays.
Correct Answer: B
Rationale: In 2026, the Part A inpatient deductible is $1,676 per benefit period, and days 1-60 carry $0
coinsurance after the deductible is met (42 U.S.C. §1395w-1). For a 22-day stay, the beneficiary pays only
the $1,676 deductible. Option A ignores the deductible. Option C incorrectly applies daily coinsurance
before day 61. Option D is wrong because Medicare covers the stay after the deductible.
AHIP Certification Exam Prep - Aligned with CMS 2026-2027 Guidelines Page 3
AHIP Exam
50 Verified Questions with Correct Answers
A+ Graded - UPDATED - Aligned with 2026-2027 CMS Guidelines
Examination Overview. This 50-question certification-prep exam is structured across seven (7) sections
that mirror the AHIP (America's Health Insurance Plans) certification knowledge domains for 2026-2027.
Each question is scenario-based, recall-based, or calculation-based per AHIP cognitive-level distribution
(approximately 30% recall, 50% application, 20% analysis). Each question includes one (1) correct answer,
three (3) field-tested distractors representing the most common AHIP exam errors, and a comprehensive
rationale with the underlying CMS regulatory citation.
# Section Title Questions
1 Medicare Basics, Eligibility, and Parts A & B Coverage Q1 - Q12
2 Medicare Advantage (Part C) Plans and Benefits Q13 - Q20
3 Medicare Part D Prescription Drug Coverage Q21 - Q28
4 Medigap (Medicare Supplement) Plans and Coordination Q29 - Q34
5 Enrollment Periods and Special Enrollment Periods Q35 - Q40
6 Low-Income Assistance Programs Q41 - Q44
7 Compliance, Marketing, FWA, and Beneficiary Rights Q45 - Q50
Total Questions: 50 Cognitive Mix: ~30% Recall / 50% Application / 20% Analysis
Sections: 7 Question Style: ~70% Scenario / 25% Direct Recall / 5% Calculation
Format: 4-option MCQ Rationale Depth: 2-3 sentences with CMS citations
Instructions to Candidate: Read each question stem carefully. Select the single best answer among the
four options (A-D). The correct answer is marked [CORRECT] and followed by a detailed rationale citing the
governing CMS regulation (42 U.S.C. / 42 CFR) and 2026-2027 program figures. This document is intended
for self-study and AHIP certification preparation; it is not affiliated with or endorsed by CMS or America's
Health Insurance Plans.
AHIP Certification Exam Prep - Aligned with CMS 2026-2027 Guidelines Page 1
,AHIP Exam 2026/2027 | 50 Verified Questions | A+ Graded UPDATED - CMS 2026/2027 Guidelines
Section 1: Medicare Basics, Eligibility, and Parts A & B Coverage
Q1 - Q12 | Topics: age/disability/ESRD/ALS entitlement, Part A premium-free rules, benefit periods, inpatient &
SNF coinsurance, Lifetime Reserve Days, hospice, Part B scope, IRMAA, late enrollment penalty, preventive
services.
Q1. Maria is a 64-year-old lawful permanent resident who has lived in the United States for 4 years
and 11 months. She will turn 65 next month and wants to enroll in Medicare. Which statement best
describes her eligibility?
A. She is eligible for premium-free Part A simply because she is turning 65.
B. She is not yet eligible because she has not been a lawful permanent resident for at least 5
continuous years. [CORRECT]
C. She is eligible for Part B only, but not Part A.
D. She is eligible for both Part A and Part B immediately upon turning 65 regardless of residency
duration.
Correct Answer: B
Rationale: Age-65 Medicare entitlement requires both being 65 or older AND being a U.S. citizen or lawful
permanent resident who has lived in the U.S. continuously for at least 5 years (42 U.S.C. §426(a)). Maria is
one month short of the 5-year residency requirement, so she is not yet eligible. Options A, C, and D each
assume she meets the residency rule, which she does not; she must wait until the 5-year threshold is
satisfied.
Q2. Robert, age 58, has been receiving Social Security Disability Insurance (SSDI) benefits for 23
months due to a severe back injury. When will he become entitled to Medicare?
A. He is entitled to Medicare immediately upon SSDI approval.
B. He will be entitled in 1 month, after completing 24 months of SSDI benefits. [CORRECT]
C. He must wait until age 65 to qualify for Medicare.
D. He will be entitled to Medicare only if he also qualifies for Medicaid.
Correct Answer: B
Rationale: Under 42 U.S.C. §426(b), individuals receiving SSDI benefits become entitled to Medicare Parts
A and B starting on the first day of the 25th month of SSDI benefit entitlement. Robert has received 23
months of benefits, so he will be entitled in 1 more month. Option A is wrong because of the 24-month
waiting period. Option C is wrong because disability is an independent entitlement pathway. Option D
improperly ties Medicare to Medicaid eligibility.
AHIP Certification Exam Prep - Aligned with CMS 2026-2027 Guidelines Page 2
, AHIP Exam 2026/2027 | 50 Verified Questions | A+ Graded UPDATED - CMS 2026/2027 Guidelines
Q3. Which statement is correct regarding Medicare eligibility for individuals diagnosed with ALS
(Amyotrophic Lateral Sclerosis) versus ESRD (End-Stage Renal Disease)?
A. Both ALS and ESRD beneficiaries must wait 24 months before Medicare begins.
B. ALS beneficiaries receive Medicare the month SSDI begins; ESRD beneficiaries have a
24-month waiting period measured from the start of dialysis. [CORRECT]
C. Both ALS and ESRD beneficiaries receive Medicare immediately upon diagnosis.
D. ALS beneficiaries must wait 24 months; ESRD beneficiaries receive Medicare immediately upon
dialysis.
Correct Answer: B
Rationale: Under 42 U.S.C. §426(h), individuals with ALS are exempt from the 24-month waiting period
and become entitled to Medicare the same month their SSDI benefits begin. ESRD beneficiaries, under 42
U.S.C. §426.1, generally become entitled after a 24-month waiting period that begins with the first month of
dialysis (or the month of kidney transplant). Option A ignores the ALS exception. Option C overstates the
ESRD rule. Option D reverses the two conditions.
Q4. James worked for 30 years in jobs that paid Medicare taxes. He is now 66 and applying for
Medicare Part A. What will his 2026 Part A premium be?
A. He will pay the full 2026 premium of approximately $506 per month.
B. He will pay a reduced premium of approximately $278 per month.
C. He will pay no premium (premium-free Part A) because he has at least 40 quarters of
Medicare-covered employment. [CORRECT]
D. He will pay the standard Part B premium only.
Correct Answer: C
Rationale: Premium-free Part A is available to individuals with at least 40 quarters (10 years) of
Medicare-covered employment under 42 U.S.C. §426(a). James has 30 years (120 quarters), far exceeding
the 40-quarter threshold, so his Part A is premium-free. Option A applies to those with fewer than 30
quarters. Option B applies to those with 30 to 39 quarters. Option D confuses Part A with Part B.
Q5. A Medicare beneficiary is admitted to the hospital on March 1 and discharged on March 22 (22
inpatient days) during a single benefit period. The 2026 Part A inpatient deductible is $1,676. What is
the beneficiary's out-of-pocket cost for the inpatient stay (excluding professional fees)?
A. $0 because the stay was fewer than 60 days.
B. $1,676 deductible only, with $0 daily coinsurance for days 1-60. [CORRECT]
C. $1,676 deductible plus $419 daily coinsurance for days 21 and 22.
D. The full cost of the hospital stay because Medicare does not cover short stays.
Correct Answer: B
Rationale: In 2026, the Part A inpatient deductible is $1,676 per benefit period, and days 1-60 carry $0
coinsurance after the deductible is met (42 U.S.C. §1395w-1). For a 22-day stay, the beneficiary pays only
the $1,676 deductible. Option A ignores the deductible. Option C incorrectly applies daily coinsurance
before day 61. Option D is wrong because Medicare covers the stay after the deductible.
AHIP Certification Exam Prep - Aligned with CMS 2026-2027 Guidelines Page 3
