2027 AHIP FINAL EXAM – MEDICARE CERTIFICATION – ACTUAL QUESTIONS & ANSWERS (AHIP) WITH RATIONALES

2027 AHIP FINAL EXAM – MEDICARE
CERTIFICATION – ACTUAL QUESTIONS &
ANSWERS (AHIP) WITH RATIONALES



Questions 1–50: Medicare Basics (Parts A, B, C, D) & Eligibility


1. Medicare is a federal health insurance program primarily for:
A) Individuals of any age with any income level
B) Individuals aged 65 or older, certain younger people with disabilities, and
people with End-Stage Renal Disease (ESRD) or ALS
C) Only low-income individuals regardless of age
D) Only individuals over age 65 who are retired


Correct Answer: B
Rationale: Medicare eligibility includes those 65+, those under 65 who have
received Social Security Disability Insurance for 24 months, and those of any
age with ESRD requiring dialysis or transplant, or ALS.


2. Medicare Part A primarily covers:
A) Outpatient prescription drugs
B) Inpatient hospital, skilled nursing facility, hospice, and some home health
care
C) Routine dental and vision care

,D) Physician office visits


Correct Answer: B
Rationale: Part A is "hospital insurance" covering inpatient stays, skilled
nursing facility care, hospice, and some home health services.


3. Medicare Part B primarily covers:
A) Inpatient hospital services
B) Outpatient medical services, physician visits, preventive services, and
durable medical equipment
C) Long-term custodial nursing home care
D) Over-the-counter medications


Correct Answer: B
Rationale: Part B is "medical insurance" covering physician services,
outpatient care, preventive screenings, ambulance services, DME, and mental
health services.


4. Medicare Part C refers to:
A) Prescription drug coverage
B) Medigap supplemental insurance
C) Medicare Advantage plans offered by private companies approved by
Medicare
D) The Original Medicare fee-for-service program


Correct Answer: C

,Rationale: Part C (Medicare Advantage) allows private health plans to provide
all Part A and Part B benefits, often including Part D drug coverage and
additional benefits.


5. Medicare Part D covers:
A) Hospital stays
B) Prescription drugs
C) Physical therapy
D) Dental care


Correct Answer: B
Rationale: Part D is the prescription drug benefit under Medicare.


6. Which part of Medicare covers inpatient hospital services?
A) Part A
B) Part B
C) Part C
D) Part D


Correct Answer: A
Rationale: Medicare Part A (Hospital Insurance) covers inpatient hospital
stays, skilled nursing facility care, hospice, and some home health services.


7. Which of the following best describes Medicare Part A coverage for
inpatient hospital stays?
A) No deductible; full coverage for any length of stay

, B) A single deductible per benefit period for days 1–60; daily coinsurance for
days 61–90; additional lifetime reserve days; after reserve days, patient pays
all costs
C) A copayment for each day starting with day 1
D) A flat 20% coinsurance for the entire stay


Correct Answer: B
Rationale: This is the correct structure of Part A inpatient hospital benefits.
The beneficiary pays a deductible for days 1–60, then daily coinsurance for
days 61–90, then can use lifetime reserve days before paying all costs.


8. Medicare Part B covers outpatient services and preventive care. Which of
the following is an example?
A) Inpatient surgery
B) Annual wellness visit
C) Skilled nursing facility stay
D) Hospice care


Correct Answer: B
Rationale: Part B covers physician services, outpatient care, and preventive
services such as the annual wellness visit.


9. Which government program provides health coverage to low-income
individuals and families?
A) Medicare
B) Medicaid
C) TRICARE