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AHIP MEDICARE CERTIFICATION Organized by Module – Original EXAM
Questions with Answers & Rationales
MODULES 1 & 2: MEDICARE BASICS & PLAN TYPES
Medicare Part A & B, Medicare Advantage (Part C),
Prescription Drug Coverage (Part D)
SECTION 1.1: MEDICARE PART A
1. Medicare Part A provides coverage for all of the following
EXCEPT:
A) Inpatient hospital stays
B) Skilled nursing facility care
C) Routine physical examinations
D) Hospice care
Answer: C
Rationale: Part A covers inpatient hospital, skilled nursing
facility, hospice, and some home health services. Routine
physical exams are covered under Part B (as part of the Annual
Wellness Visit or Welcome to Medicare visit).
2. The Medicare Part A benefit period begins:
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A) On January 1 each year
B) When the beneficiary is admitted to a hospital or SNF and
ends 60 days after discharge
C) On the beneficiary's birthday
D) It never begins
Answer: B
Rationale: A benefit period begins at hospital/SNF admission
and ends when the beneficiary has been out of the facility for
60 consecutive days. There is no limit to the number of benefit
periods.
3. A Medicare beneficiary is admitted to the hospital. In 2025,
the Part A deductible is approximately:
A) $250
B) $500
C) $1,632
D) $3,000
Answer: C
Rationale: The 2025 Part A deductible is approximately $1,632
per benefit period. This is adjusted annually by CMS.
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4. For hospital days 61–90 in a benefit period, the beneficiary
pays:
A) Nothing
B) A daily copayment (approximately $408/day in 2025)
C) The full cost
D) Only the deductible
Answer: B
Rationale: After the deductible, days 1–60 are covered in full.
Days 61–90 require a daily copayment (approximately $408/day
in 2025).
5. For hospital days 91 and beyond (lifetime reserve days), the
beneficiary pays:
A) Nothing
B) A higher daily copayment (approximately $816/day in 2025)
C) Only the deductible
D) 20% coinsurance
Answer: B
Rationale: Lifetime reserve days (60 nonrenewable days)
require a daily copayment of approximately $816/day in 2025.
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6. A beneficiary who has used all 60 lifetime reserve days and
needs additional hospital care:
A) Has unlimited coverage
B) Pays the full cost of additional hospital days
C) Only pays the deductible
D) Cannot receive care
Answer: B
Rationale: After exhausting lifetime reserve days, the
beneficiary is responsible for all costs of additional inpatient
days.
7. Skilled nursing facility (SNF) care is covered by Part A when:
A) The beneficiary needs only custodial care
B) The beneficiary had a qualifying 3-day inpatient hospital stay
and needs skilled care
C) The beneficiary has any doctor's order
D) SNF care is never covered
Answer: B
Rationale: Medicare covers SNF care after a qualifying 3-day
inpatient hospital stay for skilled nursing/rehabilitation needs,
not custodial care.
AHIP MEDICARE CERTIFICATION Organized by Module – Original EXAM
Questions with Answers & Rationales
MODULES 1 & 2: MEDICARE BASICS & PLAN TYPES
Medicare Part A & B, Medicare Advantage (Part C),
Prescription Drug Coverage (Part D)
SECTION 1.1: MEDICARE PART A
1. Medicare Part A provides coverage for all of the following
EXCEPT:
A) Inpatient hospital stays
B) Skilled nursing facility care
C) Routine physical examinations
D) Hospice care
Answer: C
Rationale: Part A covers inpatient hospital, skilled nursing
facility, hospice, and some home health services. Routine
physical exams are covered under Part B (as part of the Annual
Wellness Visit or Welcome to Medicare visit).
2. The Medicare Part A benefit period begins:
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A) On January 1 each year
B) When the beneficiary is admitted to a hospital or SNF and
ends 60 days after discharge
C) On the beneficiary's birthday
D) It never begins
Answer: B
Rationale: A benefit period begins at hospital/SNF admission
and ends when the beneficiary has been out of the facility for
60 consecutive days. There is no limit to the number of benefit
periods.
3. A Medicare beneficiary is admitted to the hospital. In 2025,
the Part A deductible is approximately:
A) $250
B) $500
C) $1,632
D) $3,000
Answer: C
Rationale: The 2025 Part A deductible is approximately $1,632
per benefit period. This is adjusted annually by CMS.
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4. For hospital days 61–90 in a benefit period, the beneficiary
pays:
A) Nothing
B) A daily copayment (approximately $408/day in 2025)
C) The full cost
D) Only the deductible
Answer: B
Rationale: After the deductible, days 1–60 are covered in full.
Days 61–90 require a daily copayment (approximately $408/day
in 2025).
5. For hospital days 91 and beyond (lifetime reserve days), the
beneficiary pays:
A) Nothing
B) A higher daily copayment (approximately $816/day in 2025)
C) Only the deductible
D) 20% coinsurance
Answer: B
Rationale: Lifetime reserve days (60 nonrenewable days)
require a daily copayment of approximately $816/day in 2025.
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6. A beneficiary who has used all 60 lifetime reserve days and
needs additional hospital care:
A) Has unlimited coverage
B) Pays the full cost of additional hospital days
C) Only pays the deductible
D) Cannot receive care
Answer: B
Rationale: After exhausting lifetime reserve days, the
beneficiary is responsible for all costs of additional inpatient
days.
7. Skilled nursing facility (SNF) care is covered by Part A when:
A) The beneficiary needs only custodial care
B) The beneficiary had a qualifying 3-day inpatient hospital stay
and needs skilled care
C) The beneficiary has any doctor's order
D) SNF care is never covered
Answer: B
Rationale: Medicare covers SNF care after a qualifying 3-day
inpatient hospital stay for skilled nursing/rehabilitation needs,
not custodial care.
