AHIP FINAL EXAM AND PRACTICE EXAM Medicare Certification 2026/2027 Complete Test Bank
— 300 Practice Questions with Verified Answers & Detailed Rationales
TABLE OF CONTENTS
| Section | Topic | Questions |
|---------|-------|-----------|
| Section 1 | Medicare Basics – Parts A, B, C, D | Q1–Q40 |
| Section 2 | Eligibility & Enrollment Periods (IEP, AEP, SEP, ICEP, MA OEP) | Q41–Q80 |
| Section 3 | Medicare Advantage (Part C) – Plans, SNPs, MSAs, PACE | Q81–Q120 |
| Section 4 | Medicare Part D – Prescription Drug Coverage, Formularies, Coverage Gap | Q121–
Q155 |
| Section 5 | Medigap (Medicare Supplement Insurance) | Q156–Q180 |
| Section 6 | Marketing & Communications – CMS Rules, SOA, Gifts, Telephonic Rules | Q181–
Q215 |
| Section 7 | Fraud, Waste & Abuse (FWA) – Compliance & Reporting | Q216–Q250 |
| Section 8 | Agent & Broker Responsibilities – Ethics, Scope of Appointment | Q251–Q275 |
| Section 9 | Special Populations – Dual Eligible, ESRD, Disabled, Low-Income Subsidy | Q276–
Q300 |
---
EXAM OVERVIEW
| Category | Details |
|--------------|-------------|
,| Exam Name | AHIP Final Exam – Medicare Certification |
| Certification Period | 2026/2027 |
| Total Practice Questions | 300 |
| Question Format | Multiple Choice |
| Passing Score Requirement | 90% (Actual AHIP Exam Standard) |
| Primary Focus Areas | Medicare Parts A, B, C, D; Medicare Advantage; Part D Prescription Drug
Coverage; Enrollment Periods; Compliance; Marketing Guidelines; Fraud, Waste & Abuse (FWA);
Agent Responsibilities |
| Key References | CMS Medicare Managed Care Manual; AHIP Training Modules 1–5; CMS
Marketing Guidelines (MCMG); Inflation Reduction Act Updates |
---
SECTION 1: MEDICARE BASICS – PARTS A, B, C, D
Questions 1–40
---
Q1. Which part of Medicare covers inpatient hospital services?
A) Part B
B) Part C
C) Part D
D) Part A
Correct Answer: D) Part A
,Rationale: Medicare Part A (Hospital Insurance) covers inpatient hospital stays, skilled nursing
facility care, hospice, and some home health services.
---
Q2. Which of the following best describes Medicare Part A coverage for inpatient hospital stays?
A) No deductible; full coverage for any length of stay
B) A single deductible per benefit period for days 1–60; daily coinsurance for days 61–90;
additional lifetime reserve days; after reserve days, patient pays all costs
C) A copayment for each day starting with day 1
D) A flat 20% coinsurance for the entire stay
Correct Answer: B) A single deductible per benefit period for days 1–60; daily coinsurance for
days 61–90; additional lifetime reserve days; after reserve days, patient pays all costs
Rationale: This is the correct structure of Part A inpatient hospital benefits. The beneficiary pays
a deductible for days 1–60, then a daily coinsurance for days 61–90, then can use lifetime
reserve days (up to 60 days over lifetime) before paying all costs.
---
Q3. Medicare Part B covers which of the following services?
A) Inpatient hospital stays
B) Skilled nursing facility care after a hospital stay
C) Professional services such as those provided by a doctor
, D) Prescription drugs
Correct Answer: C) Professional services such as those provided by a doctor
Rationale: Part B covers professional services including physician services, outpatient care,
preventive services, and some home health services.
---
Q4. Mr. Schmidt would like to plan for retirement and has asked you what is covered under
Original Fee-for-Service (FFS) Medicare. What could you tell him?
A) Only Part A is covered under Original Medicare
B) Only Part B is covered under Original Medicare
C) Part A (hospital, skilled nursing facility, hospice, home health) and Part B (professional
services such as those provided by a doctor) are covered under Original Medicare
D) Parts A, B, C, and D are all covered under Original Medicare
Correct Answer: C) Part A (hospital, skilled nursing facility, hospice, home health) and Part B
(professional services such as those provided by a doctor) are covered under Original Medicare
Rationale: Original Medicare consists of Part A and Part B. Part C (Medicare Advantage) and Part
D (prescription drug coverage) are offered through private insurance companies.
---
— 300 Practice Questions with Verified Answers & Detailed Rationales
TABLE OF CONTENTS
| Section | Topic | Questions |
|---------|-------|-----------|
| Section 1 | Medicare Basics – Parts A, B, C, D | Q1–Q40 |
| Section 2 | Eligibility & Enrollment Periods (IEP, AEP, SEP, ICEP, MA OEP) | Q41–Q80 |
| Section 3 | Medicare Advantage (Part C) – Plans, SNPs, MSAs, PACE | Q81–Q120 |
| Section 4 | Medicare Part D – Prescription Drug Coverage, Formularies, Coverage Gap | Q121–
Q155 |
| Section 5 | Medigap (Medicare Supplement Insurance) | Q156–Q180 |
| Section 6 | Marketing & Communications – CMS Rules, SOA, Gifts, Telephonic Rules | Q181–
Q215 |
| Section 7 | Fraud, Waste & Abuse (FWA) – Compliance & Reporting | Q216–Q250 |
| Section 8 | Agent & Broker Responsibilities – Ethics, Scope of Appointment | Q251–Q275 |
| Section 9 | Special Populations – Dual Eligible, ESRD, Disabled, Low-Income Subsidy | Q276–
Q300 |
---
EXAM OVERVIEW
| Category | Details |
|--------------|-------------|
,| Exam Name | AHIP Final Exam – Medicare Certification |
| Certification Period | 2026/2027 |
| Total Practice Questions | 300 |
| Question Format | Multiple Choice |
| Passing Score Requirement | 90% (Actual AHIP Exam Standard) |
| Primary Focus Areas | Medicare Parts A, B, C, D; Medicare Advantage; Part D Prescription Drug
Coverage; Enrollment Periods; Compliance; Marketing Guidelines; Fraud, Waste & Abuse (FWA);
Agent Responsibilities |
| Key References | CMS Medicare Managed Care Manual; AHIP Training Modules 1–5; CMS
Marketing Guidelines (MCMG); Inflation Reduction Act Updates |
---
SECTION 1: MEDICARE BASICS – PARTS A, B, C, D
Questions 1–40
---
Q1. Which part of Medicare covers inpatient hospital services?
A) Part B
B) Part C
C) Part D
D) Part A
Correct Answer: D) Part A
,Rationale: Medicare Part A (Hospital Insurance) covers inpatient hospital stays, skilled nursing
facility care, hospice, and some home health services.
---
Q2. Which of the following best describes Medicare Part A coverage for inpatient hospital stays?
A) No deductible; full coverage for any length of stay
B) A single deductible per benefit period for days 1–60; daily coinsurance for days 61–90;
additional lifetime reserve days; after reserve days, patient pays all costs
C) A copayment for each day starting with day 1
D) A flat 20% coinsurance for the entire stay
Correct Answer: B) A single deductible per benefit period for days 1–60; daily coinsurance for
days 61–90; additional lifetime reserve days; after reserve days, patient pays all costs
Rationale: This is the correct structure of Part A inpatient hospital benefits. The beneficiary pays
a deductible for days 1–60, then a daily coinsurance for days 61–90, then can use lifetime
reserve days (up to 60 days over lifetime) before paying all costs.
---
Q3. Medicare Part B covers which of the following services?
A) Inpatient hospital stays
B) Skilled nursing facility care after a hospital stay
C) Professional services such as those provided by a doctor
, D) Prescription drugs
Correct Answer: C) Professional services such as those provided by a doctor
Rationale: Part B covers professional services including physician services, outpatient care,
preventive services, and some home health services.
---
Q4. Mr. Schmidt would like to plan for retirement and has asked you what is covered under
Original Fee-for-Service (FFS) Medicare. What could you tell him?
A) Only Part A is covered under Original Medicare
B) Only Part B is covered under Original Medicare
C) Part A (hospital, skilled nursing facility, hospice, home health) and Part B (professional
services such as those provided by a doctor) are covered under Original Medicare
D) Parts A, B, C, and D are all covered under Original Medicare
Correct Answer: C) Part A (hospital, skilled nursing facility, hospice, home health) and Part B
(professional services such as those provided by a doctor) are covered under Original Medicare
Rationale: Original Medicare consists of Part A and Part B. Part C (Medicare Advantage) and Part
D (prescription drug coverage) are offered through private insurance companies.
---
