AHIP Final Exam – Medicare Certification |
Actual Questions and Answers + Expert
Rationales | 2026/27 Updates | 100% correct
1. Mrs. West wears glasses and dentures and has enjoyed considerable pain relief from
arthritis through acupuncture. She is concerned about whether or not Medicare will cover
these items and services. What should you tell her?
A) Medicare covers acupuncture, glasses, and dentures in full.
B) Medicare covers glasses and dentures, but not acupuncture.
C) Medicare does not cover acupuncture, or, in general, glasses or dentures.
D) Medicare covers acupuncture, but not glasses or dentures.
Correct Answer: C) Medicare does not cover acupuncture, or, in general, glasses or dentures.
Expert Rationale: Original Medicare (Parts A and B) does not cover routine dental care
(dentures), vision exams for glasses, or acupuncture for pain relief. These are considered non-
covered services unless part of a specific Medicare Advantage plan's supplemental benefits.
2. Mr. Bickford did not quite qualify for the extra help low-income subsidy under the
Medicare Part D Prescription Drug program and he is wondering if there is any other option
he has for obtaining help with his considerable drug costs. What should you tell him?
A) He should apply for Medicaid immediately.
B) He could check with the manufacturers of his medications to see if they offer an assistance
program to help people with limited means obtain the medications they need. Alternatively, he
could check to see whether his state has a pharmacy assistance program to help him with his
expenses.
C) He has no other options and must pay the full cost.
D) He can enroll in a Medicare Advantage plan to reduce drug costs.
Correct Answer: B) He could check with the manufacturers of his medications to see if they
offer an assistance program to help people with limited means obtain the medications they
need. Alternatively, he could check to see whether his state has a pharmacy assistance program
to help him with his expenses.
Expert Rationale: Many pharmaceutical companies offer patient assistance programs (PAPs) for
low-income individuals. Additionally, many states have State Pharmaceutical Assistance
Programs (SPAPs) that help with drug costs. These are viable alternatives for those who do not
qualify for the federal Extra Help program.
,3. Mr. Lombardi is interested in a Medicare Advantage (MA) PPO plan that you represent. It is
one of three plans operated by the same organization in Mr. Lombardi's area. The MA PPO
plan does not include drug coverage, but the other two plans do. Mr. Lombardi likes the PPO
plan that does not include drug coverage and intends to obtain his drug coverage through a
stand-alone Medicare prescription drug plan. What should you tell him about this situation?
A) He can enroll in the MA-only PPO plan and also enroll in a stand-alone prescription drug plan.
B) He cannot enroll in the MA-only PPO plan because it does not offer drug coverage.
C) He could enroll in one of the MA plans that include prescription drug coverage or a Medigap
plan and a stand-alone prescription drug plan, but he cannot enroll in the MA-only PPO plan
and a stand-alone prescription drug plan.
D) He should enroll in Original Medicare instead.
Correct Answer: C) He could enroll in one of the MA plans that include prescription drug
coverage or a Medigap plan and a stand-alone prescription drug plan, but he cannot enroll in
the MA-only PPO plan and a stand-alone prescription drug plan.
Expert Rationale: Federal law prohibits beneficiaries from enrolling in a Medicare Advantage
plan that does not offer drug coverage (MA-only) and a separate stand-alone Part D plan
simultaneously. If a beneficiary wants drug coverage with an MA plan, they must choose an MA-
PD plan that includes it.
4. Mr. Torres has a small savings account. He would like to pay for his monthly Part D
premiums with an automatic monthly withdrawal from his savings account until it is
exhausted, and then have his premiums withheld from his Social Security check. What should
you tell him?
A) He can switch payment methods at any time during the year.
B) In general, he must select a single Part D premium payment mechanism that will be used
throughout the year.
C) He must always pay by automatic withdrawal.
D) He can only pay via Social Security deduction.
Correct Answer: B) In general, he must select a single Part D premium payment mechanism that
will be used throughout the year.
Expert Rationale: Part D plans require enrollees to choose one payment method (e.g., auto-
debit, direct billing, or Social Security withholding) and generally do not allow mid-year changes
to the payment mechanism unless specific circumstances occur.
, 5. Agent Jennings makes a presentation on Medicare advertised as an educational event.
Agent Jennings distributes materials that are solely educational in nature. However, she gives
a brief presentation that mentions plan-specific premiums. Is this a prohibited activity at an
event that has been advertised as educational?
A) No, because the materials were educational.
B) Yes, because the event was advertised as educational, so she should only provide objective
information.
C) Yes. When an event has been advertised as "educational," discussing plan-specific premiums
is impermissible.
D) No, because mentioning premiums is not considered marketing.
Correct Answer: C) Yes. When an event has been advertised as "educational," discussing plan-
specific premiums is impermissible.
Expert Rationale: CMS guidelines strictly prohibit "educational" events from containing any
plan-specific information, including premiums, benefits, or cost-sharing. These events must be
purely informational to avoid being classified as marketing/sales events.
6. Mrs. Mulcahy is concerned that she may not qualify for enrollment in a Medicare
prescription drug plan because, although she is entitled to Part A, she is not enrolled under
Medicare Part B. What should you tell her?
A) She must enroll in Part B before she can enroll in a Part D plan.
B) Everyone who is entitled to Part A or enrolled under Part B is eligible to enroll in a Medicare
prescription drug plan. As long as Mrs. Mulcahy is entitled to Part A, she does not need to enroll
under Part B before enrolling in a prescription drug plan.
C) She is not eligible for Part D until she turns 65.
D) She must wait for the Annual Enrollment Period.
Correct Answer: B) Everyone who is entitled to Part A or enrolled under Part B is eligible to
enroll in a Medicare prescription drug plan. As long as Mrs. Mulcahy is entitled to Part A, she
does not need to enroll under Part B before enrolling in a prescription drug plan.
Expert Rationale: Eligibility for Part D requires entitlement to Part A OR enrollment in Part B.
They are mutually exclusive qualifiers; a beneficiary does not need both to join a stand-alone
PDP.
7. Mr. Jacob understands that there is a standard Medicare Part D prescription drug benefit,
but when he looks at information on various plans available in his area, he sees a wide range
in what they charge for deductibles, premiums and cost sharing. How can you explain this to
Actual Questions and Answers + Expert
Rationales | 2026/27 Updates | 100% correct
1. Mrs. West wears glasses and dentures and has enjoyed considerable pain relief from
arthritis through acupuncture. She is concerned about whether or not Medicare will cover
these items and services. What should you tell her?
A) Medicare covers acupuncture, glasses, and dentures in full.
B) Medicare covers glasses and dentures, but not acupuncture.
C) Medicare does not cover acupuncture, or, in general, glasses or dentures.
D) Medicare covers acupuncture, but not glasses or dentures.
Correct Answer: C) Medicare does not cover acupuncture, or, in general, glasses or dentures.
Expert Rationale: Original Medicare (Parts A and B) does not cover routine dental care
(dentures), vision exams for glasses, or acupuncture for pain relief. These are considered non-
covered services unless part of a specific Medicare Advantage plan's supplemental benefits.
2. Mr. Bickford did not quite qualify for the extra help low-income subsidy under the
Medicare Part D Prescription Drug program and he is wondering if there is any other option
he has for obtaining help with his considerable drug costs. What should you tell him?
A) He should apply for Medicaid immediately.
B) He could check with the manufacturers of his medications to see if they offer an assistance
program to help people with limited means obtain the medications they need. Alternatively, he
could check to see whether his state has a pharmacy assistance program to help him with his
expenses.
C) He has no other options and must pay the full cost.
D) He can enroll in a Medicare Advantage plan to reduce drug costs.
Correct Answer: B) He could check with the manufacturers of his medications to see if they
offer an assistance program to help people with limited means obtain the medications they
need. Alternatively, he could check to see whether his state has a pharmacy assistance program
to help him with his expenses.
Expert Rationale: Many pharmaceutical companies offer patient assistance programs (PAPs) for
low-income individuals. Additionally, many states have State Pharmaceutical Assistance
Programs (SPAPs) that help with drug costs. These are viable alternatives for those who do not
qualify for the federal Extra Help program.
,3. Mr. Lombardi is interested in a Medicare Advantage (MA) PPO plan that you represent. It is
one of three plans operated by the same organization in Mr. Lombardi's area. The MA PPO
plan does not include drug coverage, but the other two plans do. Mr. Lombardi likes the PPO
plan that does not include drug coverage and intends to obtain his drug coverage through a
stand-alone Medicare prescription drug plan. What should you tell him about this situation?
A) He can enroll in the MA-only PPO plan and also enroll in a stand-alone prescription drug plan.
B) He cannot enroll in the MA-only PPO plan because it does not offer drug coverage.
C) He could enroll in one of the MA plans that include prescription drug coverage or a Medigap
plan and a stand-alone prescription drug plan, but he cannot enroll in the MA-only PPO plan
and a stand-alone prescription drug plan.
D) He should enroll in Original Medicare instead.
Correct Answer: C) He could enroll in one of the MA plans that include prescription drug
coverage or a Medigap plan and a stand-alone prescription drug plan, but he cannot enroll in
the MA-only PPO plan and a stand-alone prescription drug plan.
Expert Rationale: Federal law prohibits beneficiaries from enrolling in a Medicare Advantage
plan that does not offer drug coverage (MA-only) and a separate stand-alone Part D plan
simultaneously. If a beneficiary wants drug coverage with an MA plan, they must choose an MA-
PD plan that includes it.
4. Mr. Torres has a small savings account. He would like to pay for his monthly Part D
premiums with an automatic monthly withdrawal from his savings account until it is
exhausted, and then have his premiums withheld from his Social Security check. What should
you tell him?
A) He can switch payment methods at any time during the year.
B) In general, he must select a single Part D premium payment mechanism that will be used
throughout the year.
C) He must always pay by automatic withdrawal.
D) He can only pay via Social Security deduction.
Correct Answer: B) In general, he must select a single Part D premium payment mechanism that
will be used throughout the year.
Expert Rationale: Part D plans require enrollees to choose one payment method (e.g., auto-
debit, direct billing, or Social Security withholding) and generally do not allow mid-year changes
to the payment mechanism unless specific circumstances occur.
, 5. Agent Jennings makes a presentation on Medicare advertised as an educational event.
Agent Jennings distributes materials that are solely educational in nature. However, she gives
a brief presentation that mentions plan-specific premiums. Is this a prohibited activity at an
event that has been advertised as educational?
A) No, because the materials were educational.
B) Yes, because the event was advertised as educational, so she should only provide objective
information.
C) Yes. When an event has been advertised as "educational," discussing plan-specific premiums
is impermissible.
D) No, because mentioning premiums is not considered marketing.
Correct Answer: C) Yes. When an event has been advertised as "educational," discussing plan-
specific premiums is impermissible.
Expert Rationale: CMS guidelines strictly prohibit "educational" events from containing any
plan-specific information, including premiums, benefits, or cost-sharing. These events must be
purely informational to avoid being classified as marketing/sales events.
6. Mrs. Mulcahy is concerned that she may not qualify for enrollment in a Medicare
prescription drug plan because, although she is entitled to Part A, she is not enrolled under
Medicare Part B. What should you tell her?
A) She must enroll in Part B before she can enroll in a Part D plan.
B) Everyone who is entitled to Part A or enrolled under Part B is eligible to enroll in a Medicare
prescription drug plan. As long as Mrs. Mulcahy is entitled to Part A, she does not need to enroll
under Part B before enrolling in a prescription drug plan.
C) She is not eligible for Part D until she turns 65.
D) She must wait for the Annual Enrollment Period.
Correct Answer: B) Everyone who is entitled to Part A or enrolled under Part B is eligible to
enroll in a Medicare prescription drug plan. As long as Mrs. Mulcahy is entitled to Part A, she
does not need to enroll under Part B before enrolling in a prescription drug plan.
Expert Rationale: Eligibility for Part D requires entitlement to Part A OR enrollment in Part B.
They are mutually exclusive qualifiers; a beneficiary does not need both to join a stand-alone
PDP.
7. Mr. Jacob understands that there is a standard Medicare Part D prescription drug benefit,
but when he looks at information on various plans available in his area, he sees a wide range
in what they charge for deductibles, premiums and cost sharing. How can you explain this to
