, 2026/2027 AHIP Final
Exam Questions and
Answers with
Rationale Updated
(Verified Answers)
Domain 1: Medicare Basics (Parts A & B)
Q1. Ms. Henderson believes that she will qualify for
Medicare coverage when she turns 65 without paying any
premiums because she has been working and paying
Medicare taxes for 40 quarters (10 years) in the U.S. What
should you tell her?
A) She is entirely correct; both Part A and Part B will be
premium-free.
B) She will receive premium-free Part A, but she must pay
a standard monthly premium for Part B.
C) She must pay a premium for Part A, but Part B is free.
D) She must pay premiums for both Part A and Part B.
Correct Answer: B
, Rationale: Most individuals who have worked at least 40
quarters (10 years) under Medicare-covered employment
do not pay a premium for Part A. However, almost
everyone must pay a monthly premium for Part B, which is
set annually and can adjust higher based on income
(IRMAA).
Q2. Mrs. Joy, age 65, is entitled to Part A but has not yet
enrolled in Part B. She is considering enrolling in a
Medicare Advantage plan (Part C). What should you advise
her?
A) She can enroll in Medicare Advantage as long as she
has Part A.
B) She is not eligible to enroll in a Medicare Advantage
plan until she also enrolls in Part B.
C) She must wait until she is 66 to enroll in Part B first.
D) She can skip Part B if she purchases a standalone
Prescription Drug Plan (PDP).
Correct Answer: B
Rationale: To be eligible to enroll in a Medicare
Advantage (Part C) plan, a beneficiary must be entitled to
Part A and enrolled in Part B.
Q3. Mr. Vasquez is preparing a budget for his retirement.
What should you tell him about his potential out-of-pocket
exposure for inpatient hospital services under Original
Medicare?
A) He has a flat $50 copay per hospital stay.
B) Under Original Medicare, there is a single deductible
amount due for the first 60 days of any inpatient hospital
, stay, after which a daily coinsurance amount applies for
days 61 to 90.
C) Original Medicare covers inpatient stays 100% from day
one with zero deductible.
D) Inpatient hospital care is only covered if he has a
Medigap policy.
Correct Answer: B
Rationale: Under Original Medicare Part A, inpatient
hospital stays are subject to a benefit period deductible for
the first 60 days. Days 61 through 90 require a daily
coinsurance payment, and days 91+ draw from lifetime
reserve days with a higher daily copay.
Q4. Mrs. West wears glasses and dentures, and enjoys
massage therapy for arthritis pain relief. She asks if these
are covered by Original Medicare. What should you tell her?
A) They are fully covered under Part B.
B) They are covered only if prescribed by a specialist.
C) Original Medicare does not generally cover massage
therapy, routine eyeglasses, or dentures.
D) Part A covers dentures, while Part B covers glasses.
Correct Answer: C
Rationale: Original Medicare (Parts A and B) has strict
statutory exclusions, which include routine dental care (and
dentures), routine vision care (and eyeglasses, except
following cataract surgery), and alternative therapies like
massage therapy.
Q5. Mrs. Duarte disagrees with a coverage determination on
her Medicare Summary Notice (MSN). What is the time
limit for her to file an appeal of this initial determination?
Exam Questions and
Answers with
Rationale Updated
(Verified Answers)
Domain 1: Medicare Basics (Parts A & B)
Q1. Ms. Henderson believes that she will qualify for
Medicare coverage when she turns 65 without paying any
premiums because she has been working and paying
Medicare taxes for 40 quarters (10 years) in the U.S. What
should you tell her?
A) She is entirely correct; both Part A and Part B will be
premium-free.
B) She will receive premium-free Part A, but she must pay
a standard monthly premium for Part B.
C) She must pay a premium for Part A, but Part B is free.
D) She must pay premiums for both Part A and Part B.
Correct Answer: B
, Rationale: Most individuals who have worked at least 40
quarters (10 years) under Medicare-covered employment
do not pay a premium for Part A. However, almost
everyone must pay a monthly premium for Part B, which is
set annually and can adjust higher based on income
(IRMAA).
Q2. Mrs. Joy, age 65, is entitled to Part A but has not yet
enrolled in Part B. She is considering enrolling in a
Medicare Advantage plan (Part C). What should you advise
her?
A) She can enroll in Medicare Advantage as long as she
has Part A.
B) She is not eligible to enroll in a Medicare Advantage
plan until she also enrolls in Part B.
C) She must wait until she is 66 to enroll in Part B first.
D) She can skip Part B if she purchases a standalone
Prescription Drug Plan (PDP).
Correct Answer: B
Rationale: To be eligible to enroll in a Medicare
Advantage (Part C) plan, a beneficiary must be entitled to
Part A and enrolled in Part B.
Q3. Mr. Vasquez is preparing a budget for his retirement.
What should you tell him about his potential out-of-pocket
exposure for inpatient hospital services under Original
Medicare?
A) He has a flat $50 copay per hospital stay.
B) Under Original Medicare, there is a single deductible
amount due for the first 60 days of any inpatient hospital
, stay, after which a daily coinsurance amount applies for
days 61 to 90.
C) Original Medicare covers inpatient stays 100% from day
one with zero deductible.
D) Inpatient hospital care is only covered if he has a
Medigap policy.
Correct Answer: B
Rationale: Under Original Medicare Part A, inpatient
hospital stays are subject to a benefit period deductible for
the first 60 days. Days 61 through 90 require a daily
coinsurance payment, and days 91+ draw from lifetime
reserve days with a higher daily copay.
Q4. Mrs. West wears glasses and dentures, and enjoys
massage therapy for arthritis pain relief. She asks if these
are covered by Original Medicare. What should you tell her?
A) They are fully covered under Part B.
B) They are covered only if prescribed by a specialist.
C) Original Medicare does not generally cover massage
therapy, routine eyeglasses, or dentures.
D) Part A covers dentures, while Part B covers glasses.
Correct Answer: C
Rationale: Original Medicare (Parts A and B) has strict
statutory exclusions, which include routine dental care (and
dentures), routine vision care (and eyeglasses, except
following cataract surgery), and alternative therapies like
massage therapy.
Q5. Mrs. Duarte disagrees with a coverage determination on
her Medicare Summary Notice (MSN). What is the time
limit for her to file an appeal of this initial determination?
