1
AHIP FINAL EXAM 2026 | 50 REAL EXAM QUESTIONS
WITH VERIFIED
ANSWERS | MEDICARE TRAINING PDF
1. Which government program provides health coverage to low-income individuals and
families? A. Medicare
B.
Medicaid C.
TRICARE
D. CHIP
Answer: B. Medicaid
Rationale: Medicaid is a joint federal and state program that provides health
coverage to eligible low-income individuals and families.
2. Which part of Medicare covers outpatient services and
preventive care? A. Part A
B. Part
B C.
Part C
D. Part
D
Answer: B. Part B
Rationale: Medicare Part B covers physician services, outpatient care, preventive
services, and durable medical equipment.
3. Medicare Part D covers which type of
service? A. Hospital stays
B. Prescription
drugs C.Physical
therapy
D. Dental care
Answer: B. Prescription drugs
Rationale: Part D is the prescription drug benefit under Medicare.
4. What is the primary goal of risk adjustment in Medicare
Advantage? A. Penalize high-risk patients
B. Reward providers for sicker
enrollees C. Prevent fraud
D. Eliminate copays
Answer: B. Reward providers for sicker enrollees
Rationale: Risk adjustment adjusts payments to health plans based on the health status of
their enrollees, so plans are not penalized for enrolling sicker individuals.
5. Which law protects individuals’ health information
privacy? A. FERPA
B. ADA
, 2
messages.downloaded_by
, 3
C.
HIPAA
D. FMLA
Answer: C. HIPAA
Rationale: HIPAA (Health Insurance Portability and Accountability Act) includes
provisions for privacy and security of health information.
6. What is a formulary?
A. A plan’s benefit
package
B. A list of covered
drugs C. A provider
network
D. A claims processing system
Answer: B. A list of covered drugs
Rationale: A formulary is the list of prescription drugs a health plan covers.
7. Which type of Medicare Advantage plan restricts network providers but may
offer lower costs? A. PPO
B.
HMO
C.
PFFS D.
EPO
Answer: B. HMO
Rationale: HMOs typically require use of plan network providers and often lower
premiums/co- pays as trade-offs.
8. Which entity sets the payment rates for Medicare Part A and B
services? A. CMS
B.
AMA
C. FDA
D.
OMB
Answer: A. CMS
Rationale: The Centers for Medicare & Medicaid Services define reimbursement rules
and rates for Medicare.
9. What is “coordination of benefits” in health
insurance? A. When two providers split payment
B. Determining which plan pays first when multiple policies
exist C. When plan covers preventive care
D. Matching beneficiaries to plans
Answer: B. Determining which plan pays first when multiple policies exist
Rationale: Coordination of benefits ensures that multiple insurers work together, so
coverage is not duplicated.
10. Which election period allows individuals to enroll in or change Medicare
AHIP FINAL EXAM 2026 | 50 REAL EXAM QUESTIONS
WITH VERIFIED
ANSWERS | MEDICARE TRAINING PDF
1. Which government program provides health coverage to low-income individuals and
families? A. Medicare
B.
Medicaid C.
TRICARE
D. CHIP
Answer: B. Medicaid
Rationale: Medicaid is a joint federal and state program that provides health
coverage to eligible low-income individuals and families.
2. Which part of Medicare covers outpatient services and
preventive care? A. Part A
B. Part
B C.
Part C
D. Part
D
Answer: B. Part B
Rationale: Medicare Part B covers physician services, outpatient care, preventive
services, and durable medical equipment.
3. Medicare Part D covers which type of
service? A. Hospital stays
B. Prescription
drugs C.Physical
therapy
D. Dental care
Answer: B. Prescription drugs
Rationale: Part D is the prescription drug benefit under Medicare.
4. What is the primary goal of risk adjustment in Medicare
Advantage? A. Penalize high-risk patients
B. Reward providers for sicker
enrollees C. Prevent fraud
D. Eliminate copays
Answer: B. Reward providers for sicker enrollees
Rationale: Risk adjustment adjusts payments to health plans based on the health status of
their enrollees, so plans are not penalized for enrolling sicker individuals.
5. Which law protects individuals’ health information
privacy? A. FERPA
B. ADA
, 2
messages.downloaded_by
, 3
C.
HIPAA
D. FMLA
Answer: C. HIPAA
Rationale: HIPAA (Health Insurance Portability and Accountability Act) includes
provisions for privacy and security of health information.
6. What is a formulary?
A. A plan’s benefit
package
B. A list of covered
drugs C. A provider
network
D. A claims processing system
Answer: B. A list of covered drugs
Rationale: A formulary is the list of prescription drugs a health plan covers.
7. Which type of Medicare Advantage plan restricts network providers but may
offer lower costs? A. PPO
B.
HMO
C.
PFFS D.
EPO
Answer: B. HMO
Rationale: HMOs typically require use of plan network providers and often lower
premiums/co- pays as trade-offs.
8. Which entity sets the payment rates for Medicare Part A and B
services? A. CMS
B.
AMA
C. FDA
D.
OMB
Answer: A. CMS
Rationale: The Centers for Medicare & Medicaid Services define reimbursement rules
and rates for Medicare.
9. What is “coordination of benefits” in health
insurance? A. When two providers split payment
B. Determining which plan pays first when multiple policies
exist C. When plan covers preventive care
D. Matching beneficiaries to plans
Answer: B. Determining which plan pays first when multiple policies exist
Rationale: Coordination of benefits ensures that multiple insurers work together, so
coverage is not duplicated.
10. Which election period allows individuals to enroll in or change Medicare
