2026 AHIP Final Exam Questions and Correct Answers |
Rated A+ With Verified Answers
Section 1: Medicare Basics, Eligibility, and Enrollment
(Questions 1–50)
1. Mrs. Kumar is concerned that her income will make her
ineligible for Medicare at age 65. What could you tell her?
A. High income makes one ineligible for Medicare
B. Only low-income individuals qualify for Medicare
C. Medicare is a program for people age 65 or older and those under age 65 with
certain disabilities, ESRD, and ALS, so she will be eligible for Medicare
D. She should apply for Medicaid instead
Answer: C
Rationale: Medicare eligibility is based on age (65+), certain disabilities, and specific
diseases such as End-Stage Renal Disease (ESRD) and ALS, not on income. While higher
income can affect Part B and Part D premiums through IRMAA (Income-Related Monthly
Adjustment Amount), it does not preclude eligibility itself. Medicaid is an income-based
program, whereas Medicare is an entitlement program .
2. Ms. Henderson believes she will qualify for Medicare coverage
at age 65 without paying any premiums because of her work
history. What should you tell her?
,A. All Medicare coverage is premium-free after working for 40 years
B. To obtain Part B coverage, she must pay a standard monthly premium, though it is
higher for individuals with higher incomes
C. Both Part A and Part B will be premium-free
D. She won't qualify for any Medicare coverage
Answer: B
Rationale: While most people do not pay a premium for Part A based on their work
history (having paid Medicare taxes for at least 40 quarters), Part B always requires a
monthly premium. The Part B premium is subject to income-related increases for
higher-income individuals. This distinction is critical for financial planning .
3. What is the primary source of funding for Medicare Part A?
A. Income taxes
B. Payroll taxes (FICA)
C. Beneficiary premiums
D. State general funds
Answer: B
Rationale: Medicare Part A (Hospital Insurance) is primarily funded by the FICA payroll
tax paid by employees, employers, and self-employed individuals. Part B is funded
through general federal revenues and beneficiary premiums .
4. How long is a Medicare beneficiary's initial enrollment period
(IEP)?
A. 3 months before their 65th birthday to 3 months after
B. 6 months before their 65th birthday to 6 months after
C. 1 month before to 1 month after
D. Only the month of their 65th birthday
Answer: A
,Rationale: The Initial Enrollment Period (IEP) is a 7-month window that begins 3 months
before the month an individual turns 65 and ends 3 months after their 65th birthday
month. Enrolling during the first 3 months ensures coverage begins on the first day of
the birthday month .
5. If a Medicare beneficiary delays enrolling in Part B and does
not have creditable coverage, they will face:
A. No penalty
B. A late enrollment penalty of 10% for each 12-month period they could have had Part
B
C. A one-time penalty fee
D. Permanent loss of Part B eligibility
Answer: B
Rationale: If a beneficiary delays Part B enrollment and does not have creditable
coverage (such as employer group health coverage), they will face a late enrollment
penalty of 10% for each full 12-month period they could have had Part B. The penalty
continues for as long as they have Part B .
6. What is the Medicare Part A deductible benefit period
structure?
A. A single deductible for the entire year
B. A deductible per benefit period, with daily coinsurance for days 61–90 and lifetime
reserve days after day 90
C. A deductible per admission only
D. No deductible for Part A
Answer: B
Rationale: Under Original Medicare, there is a single deductible amount due for the first
60 days of any inpatient hospital stay, after which it converts into a per-day coinsurance
, amount through day 90. After day 90, the beneficiary would pay a daily amount up to 60
lifetime reserve days, after which they would be responsible for all costs .
7. Which of the following is NOT covered by Original Medicare?
A. Inpatient hospital care
B. Physician services
C. Routine dental and vision care
D. Skilled nursing facility care
Answer: C
Rationale: Original Medicare does not cover routine dental care, vision care (except
certain eye exams), hearing aids, or acupuncture. Part A covers hospital and skilled
nursing care, while Part B covers physician services and certain preventive services.
These exclusions often lead beneficiaries to consider Medicare Advantage or Medigap
plans .
8. What percentage of the Medicare-approved amount does a
beneficiary typically pay for Part B services after meeting the
deductible?
A. 10%
B. 20%
C. 30%
D. 50%
Answer: B
Rationale: After meeting the Part B annual deductible, beneficiaries typically pay 20% of
the Medicare-approved amount for most covered services. This is known as the
coinsurance amount. Medicare pays the remaining 80% .
Rated A+ With Verified Answers
Section 1: Medicare Basics, Eligibility, and Enrollment
(Questions 1–50)
1. Mrs. Kumar is concerned that her income will make her
ineligible for Medicare at age 65. What could you tell her?
A. High income makes one ineligible for Medicare
B. Only low-income individuals qualify for Medicare
C. Medicare is a program for people age 65 or older and those under age 65 with
certain disabilities, ESRD, and ALS, so she will be eligible for Medicare
D. She should apply for Medicaid instead
Answer: C
Rationale: Medicare eligibility is based on age (65+), certain disabilities, and specific
diseases such as End-Stage Renal Disease (ESRD) and ALS, not on income. While higher
income can affect Part B and Part D premiums through IRMAA (Income-Related Monthly
Adjustment Amount), it does not preclude eligibility itself. Medicaid is an income-based
program, whereas Medicare is an entitlement program .
2. Ms. Henderson believes she will qualify for Medicare coverage
at age 65 without paying any premiums because of her work
history. What should you tell her?
,A. All Medicare coverage is premium-free after working for 40 years
B. To obtain Part B coverage, she must pay a standard monthly premium, though it is
higher for individuals with higher incomes
C. Both Part A and Part B will be premium-free
D. She won't qualify for any Medicare coverage
Answer: B
Rationale: While most people do not pay a premium for Part A based on their work
history (having paid Medicare taxes for at least 40 quarters), Part B always requires a
monthly premium. The Part B premium is subject to income-related increases for
higher-income individuals. This distinction is critical for financial planning .
3. What is the primary source of funding for Medicare Part A?
A. Income taxes
B. Payroll taxes (FICA)
C. Beneficiary premiums
D. State general funds
Answer: B
Rationale: Medicare Part A (Hospital Insurance) is primarily funded by the FICA payroll
tax paid by employees, employers, and self-employed individuals. Part B is funded
through general federal revenues and beneficiary premiums .
4. How long is a Medicare beneficiary's initial enrollment period
(IEP)?
A. 3 months before their 65th birthday to 3 months after
B. 6 months before their 65th birthday to 6 months after
C. 1 month before to 1 month after
D. Only the month of their 65th birthday
Answer: A
,Rationale: The Initial Enrollment Period (IEP) is a 7-month window that begins 3 months
before the month an individual turns 65 and ends 3 months after their 65th birthday
month. Enrolling during the first 3 months ensures coverage begins on the first day of
the birthday month .
5. If a Medicare beneficiary delays enrolling in Part B and does
not have creditable coverage, they will face:
A. No penalty
B. A late enrollment penalty of 10% for each 12-month period they could have had Part
B
C. A one-time penalty fee
D. Permanent loss of Part B eligibility
Answer: B
Rationale: If a beneficiary delays Part B enrollment and does not have creditable
coverage (such as employer group health coverage), they will face a late enrollment
penalty of 10% for each full 12-month period they could have had Part B. The penalty
continues for as long as they have Part B .
6. What is the Medicare Part A deductible benefit period
structure?
A. A single deductible for the entire year
B. A deductible per benefit period, with daily coinsurance for days 61–90 and lifetime
reserve days after day 90
C. A deductible per admission only
D. No deductible for Part A
Answer: B
Rationale: Under Original Medicare, there is a single deductible amount due for the first
60 days of any inpatient hospital stay, after which it converts into a per-day coinsurance
, amount through day 90. After day 90, the beneficiary would pay a daily amount up to 60
lifetime reserve days, after which they would be responsible for all costs .
7. Which of the following is NOT covered by Original Medicare?
A. Inpatient hospital care
B. Physician services
C. Routine dental and vision care
D. Skilled nursing facility care
Answer: C
Rationale: Original Medicare does not cover routine dental care, vision care (except
certain eye exams), hearing aids, or acupuncture. Part A covers hospital and skilled
nursing care, while Part B covers physician services and certain preventive services.
These exclusions often lead beneficiaries to consider Medicare Advantage or Medigap
plans .
8. What percentage of the Medicare-approved amount does a
beneficiary typically pay for Part B services after meeting the
deductible?
A. 10%
B. 20%
C. 30%
D. 50%
Answer: B
Rationale: After meeting the Part B annual deductible, beneficiaries typically pay 20% of
the Medicare-approved amount for most covered services. This is known as the
coinsurance amount. Medicare pays the remaining 80% .
