AHIP Medicare Prescription Drug Coverage
Exam Questions and Verified Answers with
Rationale Latest Edition 2026/2027
Question 1
Mrs. Geisler's neighbor told her she should look at her Part D options
during the annual Medicare enrollment period because the features of
Part D might have changed. Mrs. Geisler can't remember what Part D is
so she called you to ask what her neighbor was talking about. What
could you tell her?
Choice A: Part D covers inpatient hospital stays and she should
review her deductible and coinsurance amounts.
Choice B: Part D covers prescription drugs and she should look at
her premiums, formulary, and cost-sharing among other factors to
see if they have changed.
Choice C: Part D is a supplement to Original Medicare that covers
dental and vision care.
Choice D: Part D is an alternative to Original Medicare
administered by private insurers combining hospital and medical
insurance.
Correct Answer: Choice B
Rationale: Part D is the federal program that provides prescription drug
coverage through private insurance plans. Because formularies,
premiums, and tier structures change annually, beneficiaries should
review their options every year during the annual enrollment period.
Question 2
,Mr. Alonso wants to know what costs he would generally expect when
enrolling in a standard Medicare Part D prescription drug plan. How
would you describe the typical cost structure?
Choice A: A single monthly premium that covers all prescription
costs with no deductibles or copayments.
Choice B: Free coverage for all generic medications, with costs
applying only to brand-name drugs.
Choice C: He generally would pay a monthly premium, an annual
deductible, and per-prescription cost-sharing (copayments or
coinsurance).
Choice D: No monthly premium if he enrolls early, but high
coinsurance for outpatient procedures.
Correct Answer: Choice C
Rationale: Standard Medicare Part D prescription drug plans typically
involve a monthly premium, an annual deductible up to the statutory
maximum, and cost-sharing amounts (such as copayments or
coinsurance) for filled prescriptions.
Question 3
Mr. Wu has limited financial resources but failed to qualify for the
federal Part D Low-Income Subsidy (Extra Help). Where might he turn
for help with his prescription drug costs?
Choice A: He can receive free medications directly from Medicare
headquarters.
Choice B: He may still qualify for help in paying Part D costs
through his State Pharmaceutical Assistance Program (SPAP).
Choice C: He must wait until the next calendar year to reapply for
Medicare Part A.
Choice D: He can automatically transition his drug coverage to
Medicaid without meeting state income guidelines.
,Correct Answer: Choice B
Rationale: Many states sponsor State Pharmaceutical Assistance
Programs (SPAPs) or work with pharmaceutical manufacturer assistance
programs to help residents who do not qualify for the federal Low-
Income Subsidy handle their prescription drug expenses.
Question 4
Mr. Ford enrolled in an MA-only plan in mid-November during the
Annual Election Period. On December 1, he calls you up and says that
he has changed his mind and would like to enroll in an MA-PD plan
instead. What enrollment rules would apply in this case?
Choice A: He cannot change his mind once an election form is
submitted to an insurance carrier.
Choice B: He must wait until the Open Enrollment Period in
January to make any adjustments.
Choice C: He can make as many enrollment changes as he likes
during the annual election period, and the last choice made prior to
the end of the period will be the effective one as of January 1.
Choice D: He is locked into the MA-only plan for a mandatory
trial period of 12 months.
Correct Answer: Choice C
Rationale: During the Annual Election Period (AEP), beneficiaries can
submit multiple changes. CMS processes the last transaction submitted
prior to the close of the enrollment period, which takes effect on January
1.
Question 5
Mrs. Duarte is enrolled in Original Medicare Parts A and B. She has
recently reviewed her Medicare Summary Notice (MSN) and disagrees
with a determination that partially denied one of her claims for services.
What advice would you give her?
, Choice A: She should immediately drop Original Medicare and
enroll in a Medicare Advantage plan to reverse the denial.
Choice B: She should file an appeal of this initial determination
within 120 days of the date she received the MSN in the mail.
Choice C: She has exactly 30 days to request a face-to-face review
with her local Social Security office.
Choice D: She must accept the denial because Medicare Summary
Notices cannot be contested.
Correct Answer: Choice B
Rationale: Beneficiaries who disagree with a coverage or payment
decision on their Medicare Summary Notice (MSN) have the right to
appeal. The standard timeframe to file a reconsideration or
redetermination for Part A or Part B claims is within 120 days of
receiving the notice.
Question 6
Mr. Vance is turning age 65 and is reviewing his options for obtaining
health care coverage under Medicare. He wants to know what basic
components make up the structure of Original Medicare. What should
you tell him?
Choice A: Original Medicare consists of Part A (Hospital
Insurance) and Part B (Medical Insurance).
Choice B: Original Medicare consists solely of Part C (Medicare
Advantage).
Choice C: Original Medicare combines hospital care, prescription
drugs, and supplemental dental into a single government-managed
fee structure.
Choice D: Original Medicare is entirely optional and is only
available to individuals who do not qualify for employer-sponsored
retirement plans.
Correct Answer: Choice A
Exam Questions and Verified Answers with
Rationale Latest Edition 2026/2027
Question 1
Mrs. Geisler's neighbor told her she should look at her Part D options
during the annual Medicare enrollment period because the features of
Part D might have changed. Mrs. Geisler can't remember what Part D is
so she called you to ask what her neighbor was talking about. What
could you tell her?
Choice A: Part D covers inpatient hospital stays and she should
review her deductible and coinsurance amounts.
Choice B: Part D covers prescription drugs and she should look at
her premiums, formulary, and cost-sharing among other factors to
see if they have changed.
Choice C: Part D is a supplement to Original Medicare that covers
dental and vision care.
Choice D: Part D is an alternative to Original Medicare
administered by private insurers combining hospital and medical
insurance.
Correct Answer: Choice B
Rationale: Part D is the federal program that provides prescription drug
coverage through private insurance plans. Because formularies,
premiums, and tier structures change annually, beneficiaries should
review their options every year during the annual enrollment period.
Question 2
,Mr. Alonso wants to know what costs he would generally expect when
enrolling in a standard Medicare Part D prescription drug plan. How
would you describe the typical cost structure?
Choice A: A single monthly premium that covers all prescription
costs with no deductibles or copayments.
Choice B: Free coverage for all generic medications, with costs
applying only to brand-name drugs.
Choice C: He generally would pay a monthly premium, an annual
deductible, and per-prescription cost-sharing (copayments or
coinsurance).
Choice D: No monthly premium if he enrolls early, but high
coinsurance for outpatient procedures.
Correct Answer: Choice C
Rationale: Standard Medicare Part D prescription drug plans typically
involve a monthly premium, an annual deductible up to the statutory
maximum, and cost-sharing amounts (such as copayments or
coinsurance) for filled prescriptions.
Question 3
Mr. Wu has limited financial resources but failed to qualify for the
federal Part D Low-Income Subsidy (Extra Help). Where might he turn
for help with his prescription drug costs?
Choice A: He can receive free medications directly from Medicare
headquarters.
Choice B: He may still qualify for help in paying Part D costs
through his State Pharmaceutical Assistance Program (SPAP).
Choice C: He must wait until the next calendar year to reapply for
Medicare Part A.
Choice D: He can automatically transition his drug coverage to
Medicaid without meeting state income guidelines.
,Correct Answer: Choice B
Rationale: Many states sponsor State Pharmaceutical Assistance
Programs (SPAPs) or work with pharmaceutical manufacturer assistance
programs to help residents who do not qualify for the federal Low-
Income Subsidy handle their prescription drug expenses.
Question 4
Mr. Ford enrolled in an MA-only plan in mid-November during the
Annual Election Period. On December 1, he calls you up and says that
he has changed his mind and would like to enroll in an MA-PD plan
instead. What enrollment rules would apply in this case?
Choice A: He cannot change his mind once an election form is
submitted to an insurance carrier.
Choice B: He must wait until the Open Enrollment Period in
January to make any adjustments.
Choice C: He can make as many enrollment changes as he likes
during the annual election period, and the last choice made prior to
the end of the period will be the effective one as of January 1.
Choice D: He is locked into the MA-only plan for a mandatory
trial period of 12 months.
Correct Answer: Choice C
Rationale: During the Annual Election Period (AEP), beneficiaries can
submit multiple changes. CMS processes the last transaction submitted
prior to the close of the enrollment period, which takes effect on January
1.
Question 5
Mrs. Duarte is enrolled in Original Medicare Parts A and B. She has
recently reviewed her Medicare Summary Notice (MSN) and disagrees
with a determination that partially denied one of her claims for services.
What advice would you give her?
, Choice A: She should immediately drop Original Medicare and
enroll in a Medicare Advantage plan to reverse the denial.
Choice B: She should file an appeal of this initial determination
within 120 days of the date she received the MSN in the mail.
Choice C: She has exactly 30 days to request a face-to-face review
with her local Social Security office.
Choice D: She must accept the denial because Medicare Summary
Notices cannot be contested.
Correct Answer: Choice B
Rationale: Beneficiaries who disagree with a coverage or payment
decision on their Medicare Summary Notice (MSN) have the right to
appeal. The standard timeframe to file a reconsideration or
redetermination for Part A or Part B claims is within 120 days of
receiving the notice.
Question 6
Mr. Vance is turning age 65 and is reviewing his options for obtaining
health care coverage under Medicare. He wants to know what basic
components make up the structure of Original Medicare. What should
you tell him?
Choice A: Original Medicare consists of Part A (Hospital
Insurance) and Part B (Medical Insurance).
Choice B: Original Medicare consists solely of Part C (Medicare
Advantage).
Choice C: Original Medicare combines hospital care, prescription
drugs, and supplemental dental into a single government-managed
fee structure.
Choice D: Original Medicare is entirely optional and is only
available to individuals who do not qualify for employer-sponsored
retirement plans.
Correct Answer: Choice A
