AHIP Final Exam 2027| Complete 50-Question Practice Test
with 100% Verified Answers | Medicare & ACA Focused |
Updated Study Guide for Certification Success | Graded A+
Question 1
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) You can sell him a Medigap plan to help with costs not covered under Medicare
Advantage.
B) It is illegal for you to sell Mr. Capadona a Medigap plan if he is enrolled in an MA
plan, and besides, Medigap only works with Original Medicare.
C) Medigap plans are designed to work alongside Medicare Advantage plans.
D) He must disenroll from his MA plan before buying a Medigap plan.
Correct Answer: B
Rationale: Medigap plans are supplemental policies that fill gaps in Original Medicare
(Parts A and B) coverage. Federal law prohibits the sale of a Medigap policy to anyone
currently enrolled in a Medicare Advantage plan .
Question 2
Mr. Diaz continued working with his company and was insured under his employer's
group plan until he reached age 68. He has heard that there is a premium penalty for
those who did not sign up for Part B when first eligible and wants to know how much he
will have to pay. What should you tell him?
A) Mr. Diaz will pay a 10% penalty for each year he delayed enrollment.
B) Mr. Diaz will not pay any penalty because he had continuous coverage under his
employer's plan.
C) Mr. Diaz will pay a 20% penalty for each year he delayed enrollment.
D) Mr. Diaz must pay the full Part B premium with no penalty.
Correct Answer: B
,Rationale: Individuals who have continuous creditable coverage under an employer-
sponsored group health plan are not subject to the Part B late enrollment penalty when
they eventually enroll .
Question 3
Madeline Martinez was widowed several years ago. Her husband worked for many years
and contributed into the Medicare system. He also left a substantial estate which
provides Madeline with an annual income of approximately $130,000. Madeline, who
has only worked part-time for the last three years, will soon turn age 65 and hopes to
enroll in Original Medicare. What should you tell her?
A) Madeline will not qualify for Medicare because she has not worked enough.
B) Madeline will be able to enroll in Medicare Part A without paying monthly premiums
due to her husband's long work record. She will pay Part B premiums at more than the
standard lowest rate but less than the highest rate due to her substantial income.
C) Madeline will have to pay full premiums for both Part A and Part B.
D) Madeline should apply for Medicaid instead of Medicare.
Correct Answer: B
Rationale: Madeline qualifies for premium-free Part A based on her husband's work
record. Part B premiums are income-adjusted under IRMAA (Income-Related Monthly
Adjustment Amount) .
Question 4
A beneficiary who is enrolled in a Medicare Advantage plan has the right to a grievance
if:
A) They disagree with a plan's coverage decision.
B) They believe their plan is not providing quality care.
C) They are dissatisfied with the plan's service and want to file a complaint.
D) Their provider is not in the network.
Correct Answer: C
, Rationale: Grievances are complaints about the plan's services or quality of care, not about
coverage decisions. Coverage disputes are handled through the appeals process .
Question 5
During 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) Switch from one Medicare Advantage plan to another, or return to Original Medicare.
D) Set plan premiums.
Correct Answer: C
Rationale: AEP allows beneficiaries to switch from one MA plan to another, return to
Original Medicare (and optionally join a Part D plan), or join an MA plan for the first time .
Question 6
Which of the following services are NOT covered under Medicare Part A?
A) Skilled nursing facility care
B) Hospice care
C) Home health services
D) Outpatient physical therapy
Correct Answer: D
Rationale: Outpatient physical therapy is covered under Part B, not Part A, which primarily
covers inpatient and facility-based care .
Question 7
Which of the following is a prohibited marketing practice under CMS rules?
A) Hosting educational events without enrollment forms
B) Calling leads who have given prior permission
with 100% Verified Answers | Medicare & ACA Focused |
Updated Study Guide for Certification Success | Graded A+
Question 1
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) You can sell him a Medigap plan to help with costs not covered under Medicare
Advantage.
B) It is illegal for you to sell Mr. Capadona a Medigap plan if he is enrolled in an MA
plan, and besides, Medigap only works with Original Medicare.
C) Medigap plans are designed to work alongside Medicare Advantage plans.
D) He must disenroll from his MA plan before buying a Medigap plan.
Correct Answer: B
Rationale: Medigap plans are supplemental policies that fill gaps in Original Medicare
(Parts A and B) coverage. Federal law prohibits the sale of a Medigap policy to anyone
currently enrolled in a Medicare Advantage plan .
Question 2
Mr. Diaz continued working with his company and was insured under his employer's
group plan until he reached age 68. He has heard that there is a premium penalty for
those who did not sign up for Part B when first eligible and wants to know how much he
will have to pay. What should you tell him?
A) Mr. Diaz will pay a 10% penalty for each year he delayed enrollment.
B) Mr. Diaz will not pay any penalty because he had continuous coverage under his
employer's plan.
C) Mr. Diaz will pay a 20% penalty for each year he delayed enrollment.
D) Mr. Diaz must pay the full Part B premium with no penalty.
Correct Answer: B
,Rationale: Individuals who have continuous creditable coverage under an employer-
sponsored group health plan are not subject to the Part B late enrollment penalty when
they eventually enroll .
Question 3
Madeline Martinez was widowed several years ago. Her husband worked for many years
and contributed into the Medicare system. He also left a substantial estate which
provides Madeline with an annual income of approximately $130,000. Madeline, who
has only worked part-time for the last three years, will soon turn age 65 and hopes to
enroll in Original Medicare. What should you tell her?
A) Madeline will not qualify for Medicare because she has not worked enough.
B) Madeline will be able to enroll in Medicare Part A without paying monthly premiums
due to her husband's long work record. She will pay Part B premiums at more than the
standard lowest rate but less than the highest rate due to her substantial income.
C) Madeline will have to pay full premiums for both Part A and Part B.
D) Madeline should apply for Medicaid instead of Medicare.
Correct Answer: B
Rationale: Madeline qualifies for premium-free Part A based on her husband's work
record. Part B premiums are income-adjusted under IRMAA (Income-Related Monthly
Adjustment Amount) .
Question 4
A beneficiary who is enrolled in a Medicare Advantage plan has the right to a grievance
if:
A) They disagree with a plan's coverage decision.
B) They believe their plan is not providing quality care.
C) They are dissatisfied with the plan's service and want to file a complaint.
D) Their provider is not in the network.
Correct Answer: C
, Rationale: Grievances are complaints about the plan's services or quality of care, not about
coverage decisions. Coverage disputes are handled through the appeals process .
Question 5
During 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) Switch from one Medicare Advantage plan to another, or return to Original Medicare.
D) Set plan premiums.
Correct Answer: C
Rationale: AEP allows beneficiaries to switch from one MA plan to another, return to
Original Medicare (and optionally join a Part D plan), or join an MA plan for the first time .
Question 6
Which of the following services are NOT covered under Medicare Part A?
A) Skilled nursing facility care
B) Hospice care
C) Home health services
D) Outpatient physical therapy
Correct Answer: D
Rationale: Outpatient physical therapy is covered under Part B, not Part A, which primarily
covers inpatient and facility-based care .
Question 7
Which of the following is a prohibited marketing practice under CMS rules?
A) Hosting educational events without enrollment forms
B) Calling leads who have given prior permission
