AHIP Final latest Exam Prep 2026 - 2027 Study
Guide Questions Answers Verified Master Key
Updated
1. A beneficiary enrolled in Original Medicare (Part A and Part B) wants to switch to a Medicare
Advantage (MA) plan during the Annual Election Period (AEP). Which statement about the
transition is correct?
A. They must disenroll from Part B before enrolling in an MA plan.
B. They can enroll in an MA plan and will be automatically disenrolled from Original Medicare.
C. They must first enroll in a Part D plan separately.
D. They can only switch to an MA plan during the Medicare Advantage Open Enrollment Period (MA OEP).
Answer: B
Rationale: When a beneficiary enrolls in an MA plan during AEP, they are automatically disenrolled from
Original Medicare. Part B remains active as it is included in the MA plan. Option A is incorrect because
Part B is required for MA enrollment. Option C is incorrect because MA plans often include Part D.
Option D is incorrect because AEP is the correct period.
2. Which of the following best describes the 'donut hole' (coverage gap) in Medicare Part D for
2026?
A. Beneficiaries pay 25% of drug costs until they reach the catastrophic threshold.
B. There is no coverage gap; the donut hole has been eliminated.
C. Beneficiaries pay 5% of drug costs after initial coverage limit.
D. Manufacturer discounts apply only to brand-name drugs during the gap.
Answer: A
Rationale: Under the Inflation Reduction Act, the coverage gap was restructured but not eliminated. In
2026, beneficiaries pay 25% of costs for both brand and generic drugs in the gap until reaching the
catastrophic threshold. Option B is false; the gap still exists. Option C describes catastrophic coverage.
Option D is incomplete; discounts apply to both brand and generic.
3. A Medicare Advantage plan must cover all Medicare Part A and Part B services. However,
which of the following is true regarding cost-sharing for these services?
A. Cost-sharing for Part B services cannot exceed Original Medicare amounts.
B. Plans may charge different copayments for the same service based on provider type.
C. Out-of-pocket maximums are optional for MA plans.
D. Plans must use the same deductible as Original Medicare.
Answer: B
Rationale: MA plans can vary cost-sharing by provider type (e.g., higher copay for specialists vs. PCP).
Option A is false; MA plans can have lower or higher cost-sharing. Option C is false; MA plans must
have a maximum out-of-pocket limit. Option D is false; plans can set their own deductibles.
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Guide Questions Answers Verified Master Key
Updated
1. A beneficiary enrolled in Original Medicare (Part A and Part B) wants to switch to a Medicare
Advantage (MA) plan during the Annual Election Period (AEP). Which statement about the
transition is correct?
A. They must disenroll from Part B before enrolling in an MA plan.
B. They can enroll in an MA plan and will be automatically disenrolled from Original Medicare.
C. They must first enroll in a Part D plan separately.
D. They can only switch to an MA plan during the Medicare Advantage Open Enrollment Period (MA OEP).
Answer: B
Rationale: When a beneficiary enrolls in an MA plan during AEP, they are automatically disenrolled from
Original Medicare. Part B remains active as it is included in the MA plan. Option A is incorrect because
Part B is required for MA enrollment. Option C is incorrect because MA plans often include Part D.
Option D is incorrect because AEP is the correct period.
2. Which of the following best describes the 'donut hole' (coverage gap) in Medicare Part D for
2026?
A. Beneficiaries pay 25% of drug costs until they reach the catastrophic threshold.
B. There is no coverage gap; the donut hole has been eliminated.
C. Beneficiaries pay 5% of drug costs after initial coverage limit.
D. Manufacturer discounts apply only to brand-name drugs during the gap.
Answer: A
Rationale: Under the Inflation Reduction Act, the coverage gap was restructured but not eliminated. In
2026, beneficiaries pay 25% of costs for both brand and generic drugs in the gap until reaching the
catastrophic threshold. Option B is false; the gap still exists. Option C describes catastrophic coverage.
Option D is incomplete; discounts apply to both brand and generic.
3. A Medicare Advantage plan must cover all Medicare Part A and Part B services. However,
which of the following is true regarding cost-sharing for these services?
A. Cost-sharing for Part B services cannot exceed Original Medicare amounts.
B. Plans may charge different copayments for the same service based on provider type.
C. Out-of-pocket maximums are optional for MA plans.
D. Plans must use the same deductible as Original Medicare.
Answer: B
Rationale: MA plans can vary cost-sharing by provider type (e.g., higher copay for specialists vs. PCP).
Option A is false; MA plans can have lower or higher cost-sharing. Option C is false; MA plans must
have a maximum out-of-pocket limit. Option D is false; plans can set their own deductibles.
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