AHIP Final Exam 200 ACTUAL QUESTIONS AND
CORRECT ANSWERS WITH RATIONALE
ALTEST 2026 ALREADY GRADED A+
This comprehensive collection of 200 unique, multiple-choice questions is
designed to simulate the actual AHIP Medicare + Fraud, Waste, and Abuse
(FWA) Final Exam. Each question presents a realistic beneficiary scenario
testing your knowledge of Medicare Parts A, B, C, and D, enrollment periods,
cost-sharing rules, covered services, and compliance requirements. Every
entry includes four answer choices, one clearly correct answer, and a detailed
rationale explaining the underlying Medicare regulation or guideline. The
questions are non-repetitive, covering distinct topics from ambulance services
and hospice care to Part D formularies, appeals processes, and Special
Enrollment Periods, ensuring thorough preparation for achieving the
required 90% passing score.
Question 1
Mrs. Turner is comparing her employer's retiree insurance to Original Medicare
and would like to know which of the following services Original Medicare will
cover if the appropriate criteria are met. What could you tell her?
A) Original Medicare covers ambulance services
B) Original Medicare covers routine dental care
C) Original Medicare covers eyeglasses
D) Original Medicare covers hearing aids
Correct Answer: A
Rationale: Original Medicare provides coverage for ambulance services when
transportation in any other vehicle could endanger the beneficiary's health and the
services are medically necessary. Routine dental care, eyeglasses, and hearing aids
are not covered under Original Medicare Parts A and B.
Question 2
Mrs. Shields is covered by Original Medicare. She sustained a hip fracture and is
being successfully treated. She and her physicians feel that after her lengthy
hospital stay, she will need a month or two of nursing and rehabilitative care. What
should you tell them about Original Medicare's coverage of care in a skilled
nursing facility?
,A) Medicare will cover Mrs. Shield's skilled nursing services provided during the
first 20 days of her stay, after which she would have a copay until she has been in
the facility for 100 days
B) Medicare covers all skilled nursing facility care indefinitely with no cost-
sharing
C) Medicare only covers skilled nursing facility care for 30 days total
D) Medicare does not cover any skilled nursing facility care under Original
Medicare
Correct Answer: A
Rationale: Original Medicare covers skilled nursing facility care for up to 100 days
per benefit period following a qualifying hospital stay of at least three consecutive
days. The first 20 days are covered in full with no coinsurance. Days 21 through
100 require a daily coinsurance payment. After 100 days, Medicare provides no
coverage for skilled nursing facility care, and the beneficiary is responsible for all
costs.
Question 3
Mrs. Duarte is enrolled in Original Medicare Parts A and B. She has recently
reviewed her Medicare Summary Notice (MSN) and disagrees with a decision.
What should she do?
A) File an appeal using the process outlined on the MSN
B) Call her local television station to complain
C) Ignore the decision since it cannot be changed
D) Enroll in a Medicare Advantage plan immediately
Correct Answer: A
Rationale: Beneficiaries who disagree with Medicare coverage decisions or
payment determinations have the right to appeal. The Medicare Summary Notice
provides detailed information about how to file an appeal, including timeframes
and contact information. The appeals process allows beneficiaries to challenge
decisions about coverage, services received, or amounts paid.
Question 4
Edward suffered from serious kidney disease and became eligible for Medicare due
to end-stage renal disease (ESRD). A close relative donated their kidney and
Edward successfully underwent transplant surgery 12 months ago. Edward is now
age 50 and asks if his Medicare coverage will continue. What should you say?
A) His Medicare coverage will end 12 months after transplant surgery
B) His Medicare coverage will continue as long as he receives follow-up care
C) His Medicare coverage will end 36 months after the transplant unless he
otherwise qualifies
,D) His Medicare coverage ends immediately after transplant surgery
Correct Answer: C
Rationale: For individuals who qualify for Medicare due to end-stage renal disease,
Medicare coverage ends 36 months after a successful kidney transplant unless the
individual qualifies for Medicare due to age (65 or older) or disability. Edward will
have coverage for three years post-transplant. During this period, he continues to
receive Medicare benefits for transplant-related care and other covered services.
Question 5
Ms. Henderson believes she will qualify for Medicare coverage when she turns 65
without paying any premiums because she has been working for 40 years and
paying Medicare taxes. What should you tell her?
A) She is not eligible for any Medicare coverage
B) She will receive Medicare Part A without premiums but must pay premiums for
Part B
C) She will not need to pay any premiums for Part A or Part B
D) She is only eligible for Medicare Part B
Correct Answer: B
Rationale: Medicare Part A is premium-free for individuals who have worked and
paid Medicare taxes for at least 40 quarters (10 years). Ms. Henderson qualifies for
premium-free Part A. However, Medicare Part B requires payment of a monthly
premium regardless of work history. The Part B premium is income-adjusted
through the Income-Related Monthly Adjustment Amount (IRMAA) for higher-
income beneficiaries.
Question 6
Mr. Capadona would like to purchase a Medicare Advantage (MA) plan and a
Medigap plan to pick up costs not covered by that plan. What should you tell him?
A) He can enroll in both MA and Medigap plans
B) Medigap can only be used with Original Medicare, not MA plans
C) Medigap will cover costs not included by MA plans
D) He does not need any plan
Correct Answer: B
Rationale: Federal law prohibits the sale of Medigap (Medicare Supplement)
policies to individuals enrolled in Medicare Advantage plans. Medigap policies are
designed to supplement Original Medicare (Parts A and B) by covering
coinsurance, copayments, and deductibles. When a beneficiary enrolls in Medicare
Advantage, they are receiving their Medicare benefits through a private insurance
company rather than Original Medicare, making Medigap coverage redundant and
legally unavailable.
, Question 7
Mr. Vasquez is in good health and preparing a budget for retirement when he turns
66. He wants to understand the health care costs he might face under Medicare if
hospitalized. In general terms, what could you tell him about his costs for inpatient
hospital services under Original Medicare?
A) There are no costs for inpatient hospitalization
B) He pays a deductible for the first 60 days, then daily coinsurance rates apply
C) He pays a flat rate regardless of length of stay
D) He pays a premium for each hospital stay
Correct Answer: B
Rationale: Under Medicare Part A, beneficiaries pay a deductible for each benefit
period. For inpatient hospital stays, the beneficiary pays the deductible for days 1
through 60. Starting on day 61, daily coinsurance charges apply. Days 61 through
90 require daily coinsurance, and days 91 and beyond require higher daily
coinsurance using lifetime reserve days. Once lifetime reserve days are exhausted,
the beneficiary pays all costs.
Question 8
Mrs. Park is an elderly retiree who has just moved to a new state and needs to find
a new primary care physician who accepts Medicare. She is enrolled in Original
Medicare and has a Medigap policy. What should you tell her about finding a
physician?
A) She must find a physician within a specific network
B) She can see any physician who accepts Medicare and takes new patients
C) She needs prior authorization before seeing any physician
D) She can only see physicians in her Medigap network
Correct Answer: B
Rationale: Original Medicare allows beneficiaries to see any physician or provider
who accepts Medicare assignment and is taking new patients. There is no network
restriction with Original Medicare. The Medigap policy follows Medicare's
coverage decisions and does not impose network restrictions for covered services.
Beneficiaries have the freedom to choose providers nationwide as long as they
participate in Medicare.
Question 9
Mr. Chen is turning 65 next month and is currently covered under his employer's
group health plan through his job. He wants to know if he must enroll in Medicare
Part B at this time. What should you tell him?
A) He must enroll in Part B immediately to avoid penalties
CORRECT ANSWERS WITH RATIONALE
ALTEST 2026 ALREADY GRADED A+
This comprehensive collection of 200 unique, multiple-choice questions is
designed to simulate the actual AHIP Medicare + Fraud, Waste, and Abuse
(FWA) Final Exam. Each question presents a realistic beneficiary scenario
testing your knowledge of Medicare Parts A, B, C, and D, enrollment periods,
cost-sharing rules, covered services, and compliance requirements. Every
entry includes four answer choices, one clearly correct answer, and a detailed
rationale explaining the underlying Medicare regulation or guideline. The
questions are non-repetitive, covering distinct topics from ambulance services
and hospice care to Part D formularies, appeals processes, and Special
Enrollment Periods, ensuring thorough preparation for achieving the
required 90% passing score.
Question 1
Mrs. Turner is comparing her employer's retiree insurance to Original Medicare
and would like to know which of the following services Original Medicare will
cover if the appropriate criteria are met. What could you tell her?
A) Original Medicare covers ambulance services
B) Original Medicare covers routine dental care
C) Original Medicare covers eyeglasses
D) Original Medicare covers hearing aids
Correct Answer: A
Rationale: Original Medicare provides coverage for ambulance services when
transportation in any other vehicle could endanger the beneficiary's health and the
services are medically necessary. Routine dental care, eyeglasses, and hearing aids
are not covered under Original Medicare Parts A and B.
Question 2
Mrs. Shields is covered by Original Medicare. She sustained a hip fracture and is
being successfully treated. She and her physicians feel that after her lengthy
hospital stay, she will need a month or two of nursing and rehabilitative care. What
should you tell them about Original Medicare's coverage of care in a skilled
nursing facility?
,A) Medicare will cover Mrs. Shield's skilled nursing services provided during the
first 20 days of her stay, after which she would have a copay until she has been in
the facility for 100 days
B) Medicare covers all skilled nursing facility care indefinitely with no cost-
sharing
C) Medicare only covers skilled nursing facility care for 30 days total
D) Medicare does not cover any skilled nursing facility care under Original
Medicare
Correct Answer: A
Rationale: Original Medicare covers skilled nursing facility care for up to 100 days
per benefit period following a qualifying hospital stay of at least three consecutive
days. The first 20 days are covered in full with no coinsurance. Days 21 through
100 require a daily coinsurance payment. After 100 days, Medicare provides no
coverage for skilled nursing facility care, and the beneficiary is responsible for all
costs.
Question 3
Mrs. Duarte is enrolled in Original Medicare Parts A and B. She has recently
reviewed her Medicare Summary Notice (MSN) and disagrees with a decision.
What should she do?
A) File an appeal using the process outlined on the MSN
B) Call her local television station to complain
C) Ignore the decision since it cannot be changed
D) Enroll in a Medicare Advantage plan immediately
Correct Answer: A
Rationale: Beneficiaries who disagree with Medicare coverage decisions or
payment determinations have the right to appeal. The Medicare Summary Notice
provides detailed information about how to file an appeal, including timeframes
and contact information. The appeals process allows beneficiaries to challenge
decisions about coverage, services received, or amounts paid.
Question 4
Edward suffered from serious kidney disease and became eligible for Medicare due
to end-stage renal disease (ESRD). A close relative donated their kidney and
Edward successfully underwent transplant surgery 12 months ago. Edward is now
age 50 and asks if his Medicare coverage will continue. What should you say?
A) His Medicare coverage will end 12 months after transplant surgery
B) His Medicare coverage will continue as long as he receives follow-up care
C) His Medicare coverage will end 36 months after the transplant unless he
otherwise qualifies
,D) His Medicare coverage ends immediately after transplant surgery
Correct Answer: C
Rationale: For individuals who qualify for Medicare due to end-stage renal disease,
Medicare coverage ends 36 months after a successful kidney transplant unless the
individual qualifies for Medicare due to age (65 or older) or disability. Edward will
have coverage for three years post-transplant. During this period, he continues to
receive Medicare benefits for transplant-related care and other covered services.
Question 5
Ms. Henderson believes she will qualify for Medicare coverage when she turns 65
without paying any premiums because she has been working for 40 years and
paying Medicare taxes. What should you tell her?
A) She is not eligible for any Medicare coverage
B) She will receive Medicare Part A without premiums but must pay premiums for
Part B
C) She will not need to pay any premiums for Part A or Part B
D) She is only eligible for Medicare Part B
Correct Answer: B
Rationale: Medicare Part A is premium-free for individuals who have worked and
paid Medicare taxes for at least 40 quarters (10 years). Ms. Henderson qualifies for
premium-free Part A. However, Medicare Part B requires payment of a monthly
premium regardless of work history. The Part B premium is income-adjusted
through the Income-Related Monthly Adjustment Amount (IRMAA) for higher-
income beneficiaries.
Question 6
Mr. Capadona would like to purchase a Medicare Advantage (MA) plan and a
Medigap plan to pick up costs not covered by that plan. What should you tell him?
A) He can enroll in both MA and Medigap plans
B) Medigap can only be used with Original Medicare, not MA plans
C) Medigap will cover costs not included by MA plans
D) He does not need any plan
Correct Answer: B
Rationale: Federal law prohibits the sale of Medigap (Medicare Supplement)
policies to individuals enrolled in Medicare Advantage plans. Medigap policies are
designed to supplement Original Medicare (Parts A and B) by covering
coinsurance, copayments, and deductibles. When a beneficiary enrolls in Medicare
Advantage, they are receiving their Medicare benefits through a private insurance
company rather than Original Medicare, making Medigap coverage redundant and
legally unavailable.
, Question 7
Mr. Vasquez is in good health and preparing a budget for retirement when he turns
66. He wants to understand the health care costs he might face under Medicare if
hospitalized. In general terms, what could you tell him about his costs for inpatient
hospital services under Original Medicare?
A) There are no costs for inpatient hospitalization
B) He pays a deductible for the first 60 days, then daily coinsurance rates apply
C) He pays a flat rate regardless of length of stay
D) He pays a premium for each hospital stay
Correct Answer: B
Rationale: Under Medicare Part A, beneficiaries pay a deductible for each benefit
period. For inpatient hospital stays, the beneficiary pays the deductible for days 1
through 60. Starting on day 61, daily coinsurance charges apply. Days 61 through
90 require daily coinsurance, and days 91 and beyond require higher daily
coinsurance using lifetime reserve days. Once lifetime reserve days are exhausted,
the beneficiary pays all costs.
Question 8
Mrs. Park is an elderly retiree who has just moved to a new state and needs to find
a new primary care physician who accepts Medicare. She is enrolled in Original
Medicare and has a Medigap policy. What should you tell her about finding a
physician?
A) She must find a physician within a specific network
B) She can see any physician who accepts Medicare and takes new patients
C) She needs prior authorization before seeing any physician
D) She can only see physicians in her Medigap network
Correct Answer: B
Rationale: Original Medicare allows beneficiaries to see any physician or provider
who accepts Medicare assignment and is taking new patients. There is no network
restriction with Original Medicare. The Medigap policy follows Medicare's
coverage decisions and does not impose network restrictions for covered services.
Beneficiaries have the freedom to choose providers nationwide as long as they
participate in Medicare.
Question 9
Mr. Chen is turning 65 next month and is currently covered under his employer's
group health plan through his job. He wants to know if he must enroll in Medicare
Part B at this time. What should you tell him?
A) He must enroll in Part B immediately to avoid penalties
