AHIP Medicare Advantage (Part C) Exam
Questions with Correct Answers
(VerifiedAnswers) Plus Rationales 2026 Q&A
Instant Download PDF
Question 1
Which statement best describes Medicare Advantage (Medicare
Part C)?
A. It is supplemental insurance that pays costs not covered by
Original Medicare.
B. It is a Medicare program in which private Medicare-approved
organizations provide Medicare-covered benefits according to
plan rules.
C. It is prescription drug coverage available only to people who
have Medicare Part A.
D. It is Medicaid coverage administered exclusively by state
governments.
Correct Answer: B. It is a Medicare program in which private
Medicare-approved organizations provide Medicare-covered
benefits according to plan rules.
,Rationale: Medicare Advantage is an alternative way for
beneficiaries to receive their Medicare Part A and Part B
benefits through a Medicare-approved private health plan.
Depending on the plan, members may also receive additional
benefits and, in many cases, Part D prescription drug coverage.
Medicare Advantage plans operate under CMS rules governing
benefits, enrollment, cost sharing, networks, marketing,
appeals, and beneficiary protections.
Question 2
A beneficiary wants to enroll in a Medicare Advantage plan.
Which basic Medicare eligibility combination is generally
required?
A. Part A only
B. Part B only
C. Part A and Part B
D. Part D only
Correct Answer: C. Part A and Part B
Rationale: Generally, an individual must have both Medicare
Part A and Part B to enroll in a Medicare Advantage plan.
Medicare Advantage replaces the way the beneficiary receives
covered Part A and Part B services, although the beneficiary
remains enrolled in Medicare. There are special rules and
,exceptions for certain situations, but Part A and Part B
entitlement is the standard eligibility foundation.
Question 3
What is one of the principal differences between Original
Medicare and Medicare Advantage?
A. Original Medicare generally uses a nationwide provider
system, while Medicare Advantage plans may establish provider
networks.
B. Medicare Advantage never has provider networks.
C. Original Medicare requires beneficiaries to select a primary
care physician in every case.
D. Medicare Advantage is administered only by state Medicaid
agencies.
Correct Answer: A. Original Medicare generally uses a
nationwide provider system, while Medicare Advantage plans
may establish provider networks.
Rationale: Medicare Advantage plans may use network
structures such as HMOs and PPOs. Network rules can affect
where a member receives services and how much the member
pays. Original Medicare generally allows beneficiaries to receive
covered services from Medicare-participating providers
, nationwide, subject to Medicare rules. Understanding network
requirements is therefore essential when explaining an MA plan.
Question 4
Which Medicare Advantage plan type generally requires
members to receive care from network providers except for
emergency and urgently needed care and certain other
circumstances?
A. HMO
B. PFFS
C. MSA
D. Original Medicare
Correct Answer: A. HMO
Rationale: Medicare Advantage Health Maintenance
Organization plans generally require members to use providers
within the plan's network for covered services, subject to
important exceptions such as emergency care, urgently needed
care, and certain services for which the plan's rules provide
broader access. Members should understand the network
before obtaining routine care.
Question 5
Questions with Correct Answers
(VerifiedAnswers) Plus Rationales 2026 Q&A
Instant Download PDF
Question 1
Which statement best describes Medicare Advantage (Medicare
Part C)?
A. It is supplemental insurance that pays costs not covered by
Original Medicare.
B. It is a Medicare program in which private Medicare-approved
organizations provide Medicare-covered benefits according to
plan rules.
C. It is prescription drug coverage available only to people who
have Medicare Part A.
D. It is Medicaid coverage administered exclusively by state
governments.
Correct Answer: B. It is a Medicare program in which private
Medicare-approved organizations provide Medicare-covered
benefits according to plan rules.
,Rationale: Medicare Advantage is an alternative way for
beneficiaries to receive their Medicare Part A and Part B
benefits through a Medicare-approved private health plan.
Depending on the plan, members may also receive additional
benefits and, in many cases, Part D prescription drug coverage.
Medicare Advantage plans operate under CMS rules governing
benefits, enrollment, cost sharing, networks, marketing,
appeals, and beneficiary protections.
Question 2
A beneficiary wants to enroll in a Medicare Advantage plan.
Which basic Medicare eligibility combination is generally
required?
A. Part A only
B. Part B only
C. Part A and Part B
D. Part D only
Correct Answer: C. Part A and Part B
Rationale: Generally, an individual must have both Medicare
Part A and Part B to enroll in a Medicare Advantage plan.
Medicare Advantage replaces the way the beneficiary receives
covered Part A and Part B services, although the beneficiary
remains enrolled in Medicare. There are special rules and
,exceptions for certain situations, but Part A and Part B
entitlement is the standard eligibility foundation.
Question 3
What is one of the principal differences between Original
Medicare and Medicare Advantage?
A. Original Medicare generally uses a nationwide provider
system, while Medicare Advantage plans may establish provider
networks.
B. Medicare Advantage never has provider networks.
C. Original Medicare requires beneficiaries to select a primary
care physician in every case.
D. Medicare Advantage is administered only by state Medicaid
agencies.
Correct Answer: A. Original Medicare generally uses a
nationwide provider system, while Medicare Advantage plans
may establish provider networks.
Rationale: Medicare Advantage plans may use network
structures such as HMOs and PPOs. Network rules can affect
where a member receives services and how much the member
pays. Original Medicare generally allows beneficiaries to receive
covered services from Medicare-participating providers
, nationwide, subject to Medicare rules. Understanding network
requirements is therefore essential when explaining an MA plan.
Question 4
Which Medicare Advantage plan type generally requires
members to receive care from network providers except for
emergency and urgently needed care and certain other
circumstances?
A. HMO
B. PFFS
C. MSA
D. Original Medicare
Correct Answer: A. HMO
Rationale: Medicare Advantage Health Maintenance
Organization plans generally require members to use providers
within the plan's network for covered services, subject to
important exceptions such as emergency care, urgently needed
care, and certain services for which the plan's rules provide
broader access. Members should understand the network
before obtaining routine care.
Question 5
