HIP Final Exam Medicare Advantage Part D
A
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SECTION 1: MEDICARE BASICS & ELIGIBILITY Q1 – Q10
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Question 1 of 50
Mr. Davis is turning 65 in March. He currently has group health insurance through his
employer, where he actively works full-time. He wants to delay enrolling in Medicare Part
B without facing a penalty. Under CMS rules, what must be true regarding his employer
coverage?
. His employer must have fewer than 20 employees.
A
B. He must enroll in Medicare Part A to maintain his group coverage.
C. His employer coverage must be considered active primary coverage based on the
size of the company. ✓ CORRECT
D. He must drop his employer coverage entirely before applying for Medicare.
orrect Answer: C
C
Rationale: Active employee group health coverage allows a beneficiary to delay Part B
without penalty if the employer has 20 or more employees, making the group plan
primary. If the employer has fewer than 20 employees, Medicare is generally primary,
meaning delaying Part B could leave gaps in coverage and trigger penalties. A Special
,Enrollment Period is available as long as the beneficiary or their spouse is actively
working and covered by a group health plan.
Question 2 of 50
Sarah was diagnosed with ALS (Amyotrophic Lateral Sclerosis) last month at age 58.
She is concerned about her health insurance options and asks her agent when she will
be eligible for Medicare. What guidance should the agent provide regarding her
Medicare eligibility?
. She is eligible for Medicare the first month she receives Social Security disability
A
benefits due to ALS. ✓ CORRECT
B. She must wait the standard 24-month Social Security disability waiting period before
Medicare begins.
C. She will only become eligible for Medicare if she requires a kidney transplant or
dialysis.
D. She can buy into Medicare Part A immediately but must wait until age 65 for Part B.
orrect Answer: A
C
Rationale: Beneficiaries diagnosed with ALS are entitled to Medicare the first month
they receive Social Security Disability Insurance (SSDI) benefits, bypassing the usual
24-month waiting period. The standard 24-month waiting period applies to most other
disabilities, but ALS and ESRD have special legislative exceptions. Agents must ensure
they do not misguide ALS patients into believing they must wait two years for coverage.
Question 3 of 50
Mrs. Johnson decided not to enroll in Medicare Part D when she was first eligible
because she felt she did not take any prescriptions. Two years later, her doctor
,prescribes several expensive medications, and she now wants to enroll in a Part D plan.
How will the late enrollment penalty be calculated?
. She will pay a fixed penalty of $10 per month added to her premium indefinitely.
A
B. The penalty is 1% of her specific plan's monthly premium for each uncovered month.
C. There is no penalty because she did not take any medications during the gap period.
D. The penalty is 1% of the national base beneficiary premium multiplied by the number
of uncovered months. ✓ CORRECT
orrect Answer: D
C
Rationale: The Part D late enrollment penalty is calculated by multiplying 1% of the
national base beneficiary premium by the number of full, uncovered months the
beneficiary was eligible but did not have creditable coverage. The penalty is not based
on the specific plan's premium she chooses, but rather the base premium, which
changes annually. This penalty is added to her monthly premium for as long as she has
Part D coverage.
Question 4 of 50
An agent is explaining Medicare Savings Programs (MSPs) to a beneficiary with limited
income. The beneficiary asks which MSP pays for both Medicare Part A and Part B
premiums, as well as deductibles, coinsurance, and copayments. What is the correct
program?
. Specified Low-Income Medicare Beneficiary (SLMB) program.
A
B. Qualified Medicare Beneficiary (QMB) program. ✓ CORRECT
C. Qualifying Individual (QI) program.
D. Qualified Disabled and Working Individuals (QDWI) program.
, orrect Answer: B
C
Rationale: The Qualified Medicare Beneficiary (QMB) program is the most
comprehensive MSP, paying for Part A and Part B premiums, deductibles, coinsurance,
and copayments. The SLMB and QI programs only pay for Part B premiums, leaving the
beneficiary responsible for cost-sharing. Providers are legally prohibited from billing
QMB beneficiaries for Medicare cost-sharing, making it crucial for agents to identify
eligible individuals.
Question 5 of 50
Robert is 68 years old and has been on Original Medicare for three years. He recently
moved to a different state and lost access to his current Medicare Advantage plan
because it does not service his new area. What enrollment opportunity does he have?
. He is granted a Special Enrollment Period to enroll in a new Medicare Advantage plan
A
or Part D plan available in his new area. ✓ CORRECT
B. He must wait for the Annual Election Period to make any changes to his coverage.
C. He can only enroll in Original Medicare and cannot join a new MA plan until next year.
D. He automatically qualifies for a Special Needs Plan based on his relocation.
orrect Answer: A
C
Rationale: Losing coverage because a beneficiary moves out of a Medicare Advantage
or Part D plan's service area triggers a Special Enrollment Period (SEP). This SEP allows
the beneficiary to enroll in another MA or Part D plan that services their new location.
Waiting for the Annual Election Period is incorrect because moving triggers a
guaranteed SEP to prevent gaps in coverage.
Question 6 of 50
A
Compliance FWA Certification Official Practice
Exam Actual Exam 2026/2027 with Detailed
Rationales | Complete Exam-Style Questions |
Pass Guaranteed – A+ Graded
═════════════════════════════════════
═
SECTION 1: MEDICARE BASICS & ELIGIBILITY Q1 – Q10
══════════════════════════════════════
Question 1 of 50
Mr. Davis is turning 65 in March. He currently has group health insurance through his
employer, where he actively works full-time. He wants to delay enrolling in Medicare Part
B without facing a penalty. Under CMS rules, what must be true regarding his employer
coverage?
. His employer must have fewer than 20 employees.
A
B. He must enroll in Medicare Part A to maintain his group coverage.
C. His employer coverage must be considered active primary coverage based on the
size of the company. ✓ CORRECT
D. He must drop his employer coverage entirely before applying for Medicare.
orrect Answer: C
C
Rationale: Active employee group health coverage allows a beneficiary to delay Part B
without penalty if the employer has 20 or more employees, making the group plan
primary. If the employer has fewer than 20 employees, Medicare is generally primary,
meaning delaying Part B could leave gaps in coverage and trigger penalties. A Special
,Enrollment Period is available as long as the beneficiary or their spouse is actively
working and covered by a group health plan.
Question 2 of 50
Sarah was diagnosed with ALS (Amyotrophic Lateral Sclerosis) last month at age 58.
She is concerned about her health insurance options and asks her agent when she will
be eligible for Medicare. What guidance should the agent provide regarding her
Medicare eligibility?
. She is eligible for Medicare the first month she receives Social Security disability
A
benefits due to ALS. ✓ CORRECT
B. She must wait the standard 24-month Social Security disability waiting period before
Medicare begins.
C. She will only become eligible for Medicare if she requires a kidney transplant or
dialysis.
D. She can buy into Medicare Part A immediately but must wait until age 65 for Part B.
orrect Answer: A
C
Rationale: Beneficiaries diagnosed with ALS are entitled to Medicare the first month
they receive Social Security Disability Insurance (SSDI) benefits, bypassing the usual
24-month waiting period. The standard 24-month waiting period applies to most other
disabilities, but ALS and ESRD have special legislative exceptions. Agents must ensure
they do not misguide ALS patients into believing they must wait two years for coverage.
Question 3 of 50
Mrs. Johnson decided not to enroll in Medicare Part D when she was first eligible
because she felt she did not take any prescriptions. Two years later, her doctor
,prescribes several expensive medications, and she now wants to enroll in a Part D plan.
How will the late enrollment penalty be calculated?
. She will pay a fixed penalty of $10 per month added to her premium indefinitely.
A
B. The penalty is 1% of her specific plan's monthly premium for each uncovered month.
C. There is no penalty because she did not take any medications during the gap period.
D. The penalty is 1% of the national base beneficiary premium multiplied by the number
of uncovered months. ✓ CORRECT
orrect Answer: D
C
Rationale: The Part D late enrollment penalty is calculated by multiplying 1% of the
national base beneficiary premium by the number of full, uncovered months the
beneficiary was eligible but did not have creditable coverage. The penalty is not based
on the specific plan's premium she chooses, but rather the base premium, which
changes annually. This penalty is added to her monthly premium for as long as she has
Part D coverage.
Question 4 of 50
An agent is explaining Medicare Savings Programs (MSPs) to a beneficiary with limited
income. The beneficiary asks which MSP pays for both Medicare Part A and Part B
premiums, as well as deductibles, coinsurance, and copayments. What is the correct
program?
. Specified Low-Income Medicare Beneficiary (SLMB) program.
A
B. Qualified Medicare Beneficiary (QMB) program. ✓ CORRECT
C. Qualifying Individual (QI) program.
D. Qualified Disabled and Working Individuals (QDWI) program.
, orrect Answer: B
C
Rationale: The Qualified Medicare Beneficiary (QMB) program is the most
comprehensive MSP, paying for Part A and Part B premiums, deductibles, coinsurance,
and copayments. The SLMB and QI programs only pay for Part B premiums, leaving the
beneficiary responsible for cost-sharing. Providers are legally prohibited from billing
QMB beneficiaries for Medicare cost-sharing, making it crucial for agents to identify
eligible individuals.
Question 5 of 50
Robert is 68 years old and has been on Original Medicare for three years. He recently
moved to a different state and lost access to his current Medicare Advantage plan
because it does not service his new area. What enrollment opportunity does he have?
. He is granted a Special Enrollment Period to enroll in a new Medicare Advantage plan
A
or Part D plan available in his new area. ✓ CORRECT
B. He must wait for the Annual Election Period to make any changes to his coverage.
C. He can only enroll in Original Medicare and cannot join a new MA plan until next year.
D. He automatically qualifies for a Special Needs Plan based on his relocation.
orrect Answer: A
C
Rationale: Losing coverage because a beneficiary moves out of a Medicare Advantage
or Part D plan's service area triggers a Special Enrollment Period (SEP). This SEP allows
the beneficiary to enroll in another MA or Part D plan that services their new location.
Waiting for the Annual Election Period is incorrect because moving triggers a
guaranteed SEP to prevent gaps in coverage.
Question 6 of 50
