Page 1 of 197
AHIP FINAL EXAM LATEST UPDATE THIS YEAR
(2026-2027) ALL 300 QUESTIONS AND CORRECT
ANSWERS WITH RATIONALES
AHIP FINAL EXAM – MEDICARE CERTIFICATION
300 RANDOMIZED SCENARIO-BASED PRACTICE QUESTIONS
1. Mrs. Chen, age 67, is new to Medicare and asks if she must enroll in a Medicare
prescription drug plan when she enrolls in Medicare Part A and Part B. What should you tell
her?
A) Yes, prescription drug coverage is mandatory for all Medicare beneficiaries
B) No, she can decline coverage but may face a late enrollment penalty if she enrolls later
without creditable coverage
C) No, prescription drug coverage is optional with no penalty for late enrollment
D) Yes, but only if she has a chronic medical condition requiring medications
Answer: B. Medicare Part D coverage is optional, but beneficiaries who do not enroll when first
eligible and go 63+ consecutive days without creditable prescription drug coverage will incur a
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late enrollment penalty (1% of the national base beneficiary premium per month) that lasts as
long as they have Part D coverage.
2. Mr. Rodriguez, age 68, has Original Medicare and a Medigap policy. He wants to switch to a
Medicare Advantage plan. What should he know about his Medigap policy?
A) He can keep his Medigap policy and use it with Medicare Advantage
B) He must drop his Medigap policy before enrolling in Medicare Advantage
C) He can keep his Medigap policy, but it cannot pay his Medicare Advantage copayments,
deductibles, or premiums
D) His Medigap policy will automatically convert to a Medicare Advantage plan
Answer: C. Beneficiaries cannot use a Medigap policy to pay Medicare Advantage cost-sharing.
If a beneficiary enrolls in Medicare Advantage, they should consider dropping their Medigap
policy because it cannot pay MA copayments, deductibles, or premiums.
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3. Mrs. Thompson, age 72, has Medicare Advantage and wants to switch to Original Medicare
with a Medigap policy during the Medicare Advantage Open Enrollment Period (MA OEP).
What is her guaranteed issue right?
A) She has a guaranteed issue right to any Medigap policy in her state
B) She has a guaranteed issue right to Medigap Plan A, B, C, F, K, or L in most states
C) She has no guaranteed issue right and must undergo medical underwriting
D) She has a guaranteed issue right only if she is moving out of her plan's service area
Answer: C. During the MA OEP (January 1 – March 31), beneficiaries can switch from Medicare
Advantage to Original Medicare and enroll in a Part D plan, but they do not have guaranteed
issue rights for Medigap. They may be subject to medical underwriting unless they qualify for a
specific trial right period.
4. Mr. Davis, age 65, is retiring and losing his employer-sponsored health coverage. He wants
to enroll in Medicare Part A and Part B. When should he enroll to avoid a late enrollment
penalty for Part B?
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A) Within 8 months of losing employer coverage
B) Within 6 months of losing employer coverage
C) Within 3 months of losing employer coverage
D) Within 12 months of losing employer coverage
Answer: A. Individuals who lose employer-sponsored coverage have a Special Enrollment Period
(SEP) of 8 months to enroll in Part B without penalty. The SEP begins the month after
employment ends or coverage ends, whichever comes first.
5. Mrs. Garcia, age 70, has Original Medicare and a stand-alone Part D plan. She is admitted
to a skilled nursing facility (SNF) after a 3-day inpatient hospital stay. How much of her SNF
care will Medicare Part A cover?
A) Days 1-20: full coverage; Days 21-100: partial coverage with a daily coinsurance
B) Days 1-30: full coverage; Days 31-100: partial coverage
C) Days 1-50: full coverage; Days 51-100: partial coverage
D) Days 1-100: full coverage with no coinsurance
4
AHIP FINAL EXAM LATEST UPDATE THIS YEAR
(2026-2027) ALL 300 QUESTIONS AND CORRECT
ANSWERS WITH RATIONALES
AHIP FINAL EXAM – MEDICARE CERTIFICATION
300 RANDOMIZED SCENARIO-BASED PRACTICE QUESTIONS
1. Mrs. Chen, age 67, is new to Medicare and asks if she must enroll in a Medicare
prescription drug plan when she enrolls in Medicare Part A and Part B. What should you tell
her?
A) Yes, prescription drug coverage is mandatory for all Medicare beneficiaries
B) No, she can decline coverage but may face a late enrollment penalty if she enrolls later
without creditable coverage
C) No, prescription drug coverage is optional with no penalty for late enrollment
D) Yes, but only if she has a chronic medical condition requiring medications
Answer: B. Medicare Part D coverage is optional, but beneficiaries who do not enroll when first
eligible and go 63+ consecutive days without creditable prescription drug coverage will incur a
1
, Page 2 of 197
late enrollment penalty (1% of the national base beneficiary premium per month) that lasts as
long as they have Part D coverage.
2. Mr. Rodriguez, age 68, has Original Medicare and a Medigap policy. He wants to switch to a
Medicare Advantage plan. What should he know about his Medigap policy?
A) He can keep his Medigap policy and use it with Medicare Advantage
B) He must drop his Medigap policy before enrolling in Medicare Advantage
C) He can keep his Medigap policy, but it cannot pay his Medicare Advantage copayments,
deductibles, or premiums
D) His Medigap policy will automatically convert to a Medicare Advantage plan
Answer: C. Beneficiaries cannot use a Medigap policy to pay Medicare Advantage cost-sharing.
If a beneficiary enrolls in Medicare Advantage, they should consider dropping their Medigap
policy because it cannot pay MA copayments, deductibles, or premiums.
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3. Mrs. Thompson, age 72, has Medicare Advantage and wants to switch to Original Medicare
with a Medigap policy during the Medicare Advantage Open Enrollment Period (MA OEP).
What is her guaranteed issue right?
A) She has a guaranteed issue right to any Medigap policy in her state
B) She has a guaranteed issue right to Medigap Plan A, B, C, F, K, or L in most states
C) She has no guaranteed issue right and must undergo medical underwriting
D) She has a guaranteed issue right only if she is moving out of her plan's service area
Answer: C. During the MA OEP (January 1 – March 31), beneficiaries can switch from Medicare
Advantage to Original Medicare and enroll in a Part D plan, but they do not have guaranteed
issue rights for Medigap. They may be subject to medical underwriting unless they qualify for a
specific trial right period.
4. Mr. Davis, age 65, is retiring and losing his employer-sponsored health coverage. He wants
to enroll in Medicare Part A and Part B. When should he enroll to avoid a late enrollment
penalty for Part B?
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A) Within 8 months of losing employer coverage
B) Within 6 months of losing employer coverage
C) Within 3 months of losing employer coverage
D) Within 12 months of losing employer coverage
Answer: A. Individuals who lose employer-sponsored coverage have a Special Enrollment Period
(SEP) of 8 months to enroll in Part B without penalty. The SEP begins the month after
employment ends or coverage ends, whichever comes first.
5. Mrs. Garcia, age 70, has Original Medicare and a stand-alone Part D plan. She is admitted
to a skilled nursing facility (SNF) after a 3-day inpatient hospital stay. How much of her SNF
care will Medicare Part A cover?
A) Days 1-20: full coverage; Days 21-100: partial coverage with a daily coinsurance
B) Days 1-30: full coverage; Days 31-100: partial coverage
C) Days 1-50: full coverage; Days 51-100: partial coverage
D) Days 1-100: full coverage with no coinsurance
4
