Latest AHIP 2027 Final Exam verified with correct answers plus
rationales 2026/2027 instant pdf
1. Which part of Medicare primarily covers inpatient hospital services?
A. Part A
B. Part B
C. Part C
D. Part D
Answer: A. Part A
Rationale: Medicare Part A primarily covers inpatient hospital care, skilled nursing facility
care under qualifying circumstances, hospice care, and certain home health services.
2. Medicare Part B generally covers which type of service?
A. Inpatient hospital room and board
B. Physician and outpatient medical services
C. Prescription drugs purchased at a retail pharmacy
D. Long-term custodial nursing-home care
Answer: B. Physician and outpatient medical services
Rationale: Part B covers medically necessary physician services, outpatient care, preventive
services, durable medical equipment, and other covered medical services.
3. A beneficiary wants coverage through a Medicare Advantage plan. Which statement is
correct?
A. Medicare Advantage is Medicare Part D only.
B. Medicare Advantage is an alternative way to receive Medicare benefits through a Medicare-
approved private plan.
C. Medicare Advantage is available only to beneficiaries receiving Medicaid.
D. Medicare Advantage replaces Social Security.
Answer: B. Medicare Advantage is an alternative way to receive Medicare benefits through a
Medicare-approved private plan.
Rationale: Medicare Advantage, also called Part C, provides Medicare-covered Part A and
Part B benefits through private Medicare-approved plans, generally subject to the plan's rules.
,4. Which Medicare component primarily provides outpatient prescription drug coverage?
A. Part A
B. Part B
C. Part C
D. Part D
Answer: D. Part D
Rationale: Medicare Part D provides prescription drug coverage through Medicare-approved
prescription drug plans and Medicare Advantage plans that include prescription drug
coverage.
5. What is the purpose of Medicare Supplement Insurance, commonly called Medigap?
A. To replace Medicare Part A
B. To cover some Medicare cost-sharing expenses
C. To provide Medicaid benefits
D. To replace Part D for every beneficiary
Answer: B. To cover some Medicare cost-sharing expenses
Rationale: Medigap policies are private supplemental insurance designed to help pay certain
costs that Original Medicare does not fully cover.
6. Which person generally has Medicare eligibility based on age?
A. Anyone age 50 or older
B. Anyone age 55 or older
C. A person who meets Medicare's age requirement, generally beginning at age 65
D. Only people age 70 or older
Answer: C. A person who meets Medicare's age requirement, generally beginning at age 65
Rationale: Most people become eligible for Medicare at age 65 if they meet the applicable
eligibility requirements. Some people qualify earlier because of disability or certain medical
conditions.
,7. Which enrollment period occurs around a person's initial eligibility for Medicare?
A. Initial Enrollment Period
B. Annual Election Period
C. Special Enrollment Period
D. Open Enrollment Period for Medicare Advantage
Answer: A. Initial Enrollment Period
Rationale: The Initial Enrollment Period is the period surrounding a person's first eligibility
for Medicare.
8. Which period generally allows Medicare beneficiaries to review and change Medicare
Advantage and Part D coverage each year?
A. Annual Election Period
B. Initial Enrollment Period only
C. General Enrollment Period only
D. Medigap Open Enrollment Period
Answer: A. Annual Election Period
Rationale: The Annual Election Period provides an annual opportunity to make certain
Medicare Advantage and Part D elections for the following coverage year.
9. A beneficiary is enrolled in Original Medicare and wants prescription drug coverage.
Which product is generally appropriate?
A. A standalone Medicare Part D plan
B. A Medigap plan only
C. Part A only
D. Medicaid only
Answer: A. A standalone Medicare Part D plan
Rationale: A beneficiary who has Original Medicare may generally obtain prescription drug
coverage through a standalone Medicare Prescription Drug Plan, assuming eligibility and
applicable enrollment requirements.
10. Which organization administers the Medicare program at the federal level?
, A. CMS
B. FDA
C. OSHA
D. FTC
Answer: A. CMS
Rationale: The Centers for Medicare & Medicaid Services (CMS) administers Medicare and
establishes requirements governing Medicare Advantage, Part D, and related programs.
11. An agent discusses a Medicare Advantage plan with a beneficiary. Which action is most
appropriate?
A. Guarantee that the beneficiary will save money
B. Provide accurate, compliant information about the plan
C. Tell the beneficiary that all doctors accept the plan
D. Hide limitations until after enrollment
Answer: B. Provide accurate, compliant information about the plan
Rationale: Medicare marketing and enrollment activities must comply with CMS requirements
and must not mislead beneficiaries. CMS specifically requires agents and brokers to follow
Medicare marketing rules.
12. What does FWA stand for in Medicare compliance training?
A. Federal Wellness Administration
B. Fraud, Waste, and Abuse
C. Financial Welfare Assistance
D. Federal Workforce Authorization
Answer: B. Fraud, Waste, and Abuse
Rationale: Medicare compliance training addresses the prevention, detection, and reporting of
fraud, waste, and abuse. AHIP specifically provides Medicare + Fraud, Waste & Abuse
training.
13. Which is an example of potential Medicare fraud?
rationales 2026/2027 instant pdf
1. Which part of Medicare primarily covers inpatient hospital services?
A. Part A
B. Part B
C. Part C
D. Part D
Answer: A. Part A
Rationale: Medicare Part A primarily covers inpatient hospital care, skilled nursing facility
care under qualifying circumstances, hospice care, and certain home health services.
2. Medicare Part B generally covers which type of service?
A. Inpatient hospital room and board
B. Physician and outpatient medical services
C. Prescription drugs purchased at a retail pharmacy
D. Long-term custodial nursing-home care
Answer: B. Physician and outpatient medical services
Rationale: Part B covers medically necessary physician services, outpatient care, preventive
services, durable medical equipment, and other covered medical services.
3. A beneficiary wants coverage through a Medicare Advantage plan. Which statement is
correct?
A. Medicare Advantage is Medicare Part D only.
B. Medicare Advantage is an alternative way to receive Medicare benefits through a Medicare-
approved private plan.
C. Medicare Advantage is available only to beneficiaries receiving Medicaid.
D. Medicare Advantage replaces Social Security.
Answer: B. Medicare Advantage is an alternative way to receive Medicare benefits through a
Medicare-approved private plan.
Rationale: Medicare Advantage, also called Part C, provides Medicare-covered Part A and
Part B benefits through private Medicare-approved plans, generally subject to the plan's rules.
,4. Which Medicare component primarily provides outpatient prescription drug coverage?
A. Part A
B. Part B
C. Part C
D. Part D
Answer: D. Part D
Rationale: Medicare Part D provides prescription drug coverage through Medicare-approved
prescription drug plans and Medicare Advantage plans that include prescription drug
coverage.
5. What is the purpose of Medicare Supplement Insurance, commonly called Medigap?
A. To replace Medicare Part A
B. To cover some Medicare cost-sharing expenses
C. To provide Medicaid benefits
D. To replace Part D for every beneficiary
Answer: B. To cover some Medicare cost-sharing expenses
Rationale: Medigap policies are private supplemental insurance designed to help pay certain
costs that Original Medicare does not fully cover.
6. Which person generally has Medicare eligibility based on age?
A. Anyone age 50 or older
B. Anyone age 55 or older
C. A person who meets Medicare's age requirement, generally beginning at age 65
D. Only people age 70 or older
Answer: C. A person who meets Medicare's age requirement, generally beginning at age 65
Rationale: Most people become eligible for Medicare at age 65 if they meet the applicable
eligibility requirements. Some people qualify earlier because of disability or certain medical
conditions.
,7. Which enrollment period occurs around a person's initial eligibility for Medicare?
A. Initial Enrollment Period
B. Annual Election Period
C. Special Enrollment Period
D. Open Enrollment Period for Medicare Advantage
Answer: A. Initial Enrollment Period
Rationale: The Initial Enrollment Period is the period surrounding a person's first eligibility
for Medicare.
8. Which period generally allows Medicare beneficiaries to review and change Medicare
Advantage and Part D coverage each year?
A. Annual Election Period
B. Initial Enrollment Period only
C. General Enrollment Period only
D. Medigap Open Enrollment Period
Answer: A. Annual Election Period
Rationale: The Annual Election Period provides an annual opportunity to make certain
Medicare Advantage and Part D elections for the following coverage year.
9. A beneficiary is enrolled in Original Medicare and wants prescription drug coverage.
Which product is generally appropriate?
A. A standalone Medicare Part D plan
B. A Medigap plan only
C. Part A only
D. Medicaid only
Answer: A. A standalone Medicare Part D plan
Rationale: A beneficiary who has Original Medicare may generally obtain prescription drug
coverage through a standalone Medicare Prescription Drug Plan, assuming eligibility and
applicable enrollment requirements.
10. Which organization administers the Medicare program at the federal level?
, A. CMS
B. FDA
C. OSHA
D. FTC
Answer: A. CMS
Rationale: The Centers for Medicare & Medicaid Services (CMS) administers Medicare and
establishes requirements governing Medicare Advantage, Part D, and related programs.
11. An agent discusses a Medicare Advantage plan with a beneficiary. Which action is most
appropriate?
A. Guarantee that the beneficiary will save money
B. Provide accurate, compliant information about the plan
C. Tell the beneficiary that all doctors accept the plan
D. Hide limitations until after enrollment
Answer: B. Provide accurate, compliant information about the plan
Rationale: Medicare marketing and enrollment activities must comply with CMS requirements
and must not mislead beneficiaries. CMS specifically requires agents and brokers to follow
Medicare marketing rules.
12. What does FWA stand for in Medicare compliance training?
A. Federal Wellness Administration
B. Fraud, Waste, and Abuse
C. Financial Welfare Assistance
D. Federal Workforce Authorization
Answer: B. Fraud, Waste, and Abuse
Rationale: Medicare compliance training addresses the prevention, detection, and reporting of
fraud, waste, and abuse. AHIP specifically provides Medicare + Fraud, Waste & Abuse
training.
13. Which is an example of potential Medicare fraud?
