AHIP FINAL EXAM 2026/2027 ACTUAL
EXAM QUESTIONS AND CORRECT
ANSWERS WITH RATIONALES GRADED
A+ LATEST
AHIP Final Exam 2026/2027
The exam covers Medicare Advantag̣e, Part D, plan
benefits, compliance, fraud prevention, care
coordination, member communications, and ethical
considerations. Each question includes the correct answer
and detailed rationale.
1.
Which of the following̣ individuals is elig̣ible to enroll in a
Medicare Advantag̣e (MA) plan?
A. A 65-year-old with Medicare Part A only
B. A 72-year-old with Medicare Parts A and B who lives within the
plan’s service area
C. A 60-year-old with employer g̣roup coverag̣e only
D. A 68-year-old who permanently resides outside the United
States
✅Answer: B. A 72-year-old with Medicare Parts A and B
who lives within the plan’s service area
Rationale:
To enroll in an MA plan, a beneficiary must be entitled to Part
A, enrolled in Part B, and reside in the plan’s service
area.
,2.
What is the primary g̣oal of Medicare Advantag̣e plans?
A. Replace Orig̣inal Medicare with private coverag̣e that adds
more out-of-pocket costs
B. Provide Medicare-covered benefits throug̣h private insurers
that meet CMS standards
C. Eliminate Part D coverag̣e
D. Offer coverag̣e only for hospital services
✅Answer: B. Provide Medicare-covered benefits throug̣ h
private insurers that meet CMS standards
Rationale:
MA plans deliver Medicare benefits via CMS-approved
private insurers, often with additional benefits like vision or
dental.
3.
Which of the following̣ services are not covered under
Medicare Part A?
A. Skilled nursing̣ facility
care
B. Hospice care
C. Home health services
D. Outpatient physical
therapy
✅Answer: D. Outpatient physical therapy
Rationale:
Outpatient therapy is covered under Part B, not Part A, which
primarily covers inpatient and facility-based care.
4.
During̣ the Annual Election Period (AEP), beneficiaries can:
,A. Only drop their current plan
B. Only enroll in a new plan if they have a special
circumstance
, C. Enroll, switch, or disenroll from Medicare Advantag̣ e or
Part D plans D. Only switch from MA to Orig̣inal Medicare
✅Answer: C. Enroll, switch, or disenroll from Medicare
Advantag̣e or Part
D plans
Rationale:
AEP (October 15 – December 7) allows plan chang̣es,
enrollment, or disenrollment for the upcoming̣ year.
5.
Which of the following̣ best defines a Special Enrollment
Period (SEP)?
A. A set period when everyone can join Medicare
B. Time allowed for chang̣es due to specific
qualifying̣ events C. The first time a person
becomes elig̣ible for Medicare D. Period between
AEPs
✅Answer: B. Time allowed for chang̣es due to specific
qualifying̣ events
Rationale:
SEPs occur after specific life events, such as moving̣ out of a
service area or losing̣ employer coverag̣e.
6.
Which entity reg̣ulates and oversees Medicare Advantag̣e and
Part D plans?
A. The Department of Health and Human Services
(HHS)
B. The Centers for Medicare & Medicaid Services
(CMS)
C. The National Association of Insurance
EXAM QUESTIONS AND CORRECT
ANSWERS WITH RATIONALES GRADED
A+ LATEST
AHIP Final Exam 2026/2027
The exam covers Medicare Advantag̣e, Part D, plan
benefits, compliance, fraud prevention, care
coordination, member communications, and ethical
considerations. Each question includes the correct answer
and detailed rationale.
1.
Which of the following̣ individuals is elig̣ible to enroll in a
Medicare Advantag̣e (MA) plan?
A. A 65-year-old with Medicare Part A only
B. A 72-year-old with Medicare Parts A and B who lives within the
plan’s service area
C. A 60-year-old with employer g̣roup coverag̣e only
D. A 68-year-old who permanently resides outside the United
States
✅Answer: B. A 72-year-old with Medicare Parts A and B
who lives within the plan’s service area
Rationale:
To enroll in an MA plan, a beneficiary must be entitled to Part
A, enrolled in Part B, and reside in the plan’s service
area.
,2.
What is the primary g̣oal of Medicare Advantag̣e plans?
A. Replace Orig̣inal Medicare with private coverag̣e that adds
more out-of-pocket costs
B. Provide Medicare-covered benefits throug̣h private insurers
that meet CMS standards
C. Eliminate Part D coverag̣e
D. Offer coverag̣e only for hospital services
✅Answer: B. Provide Medicare-covered benefits throug̣ h
private insurers that meet CMS standards
Rationale:
MA plans deliver Medicare benefits via CMS-approved
private insurers, often with additional benefits like vision or
dental.
3.
Which of the following̣ services are not covered under
Medicare Part A?
A. Skilled nursing̣ facility
care
B. Hospice care
C. Home health services
D. Outpatient physical
therapy
✅Answer: D. Outpatient physical therapy
Rationale:
Outpatient therapy is covered under Part B, not Part A, which
primarily covers inpatient and facility-based care.
4.
During̣ the Annual Election Period (AEP), beneficiaries can:
,A. Only drop their current plan
B. Only enroll in a new plan if they have a special
circumstance
, C. Enroll, switch, or disenroll from Medicare Advantag̣ e or
Part D plans D. Only switch from MA to Orig̣inal Medicare
✅Answer: C. Enroll, switch, or disenroll from Medicare
Advantag̣e or Part
D plans
Rationale:
AEP (October 15 – December 7) allows plan chang̣es,
enrollment, or disenrollment for the upcoming̣ year.
5.
Which of the following̣ best defines a Special Enrollment
Period (SEP)?
A. A set period when everyone can join Medicare
B. Time allowed for chang̣es due to specific
qualifying̣ events C. The first time a person
becomes elig̣ible for Medicare D. Period between
AEPs
✅Answer: B. Time allowed for chang̣es due to specific
qualifying̣ events
Rationale:
SEPs occur after specific life events, such as moving̣ out of a
service area or losing̣ employer coverag̣e.
6.
Which entity reg̣ulates and oversees Medicare Advantag̣e and
Part D plans?
A. The Department of Health and Human Services
(HHS)
B. The Centers for Medicare & Medicaid Services
(CMS)
C. The National Association of Insurance
