2027 AHIP FINAL EXAM – MEDICARE CERTIFICATION –
COMPREHENSIVE EXAM QUESTIONS
200 QUESTIONS WITH CORRECT ANSWERS AND EXPERT
RATIONALES
1. Which part of Medicare is commonly referred to as "hospital
insurance" and covers inpatient hospital stays, skilled nursing facility
care, hospice, and some home health services?
A. Part B
B. Part C
C. Part D
D. Part A
Correct Answer: D
Expert Rationale: Medicare Part A is hospital insurance that covers
inpatient hospital care, skilled nursing facility care following a qualifying
hospital stay, hospice care, and limited home health services. Part B
covers outpatient and physician services, Part C is Medicare Advantage,
and Part D covers prescription drugs.
2. Mr. Reynolds is enrolled in Original Medicare and would like
prescription drug coverage but does not want to join a Medicare
Advantage plan. What should you tell him?
,A. He must enroll in a Medicare Advantage plan to obtain drug
coverage.
B. He can enroll in a stand-alone Prescription Drug Plan (PDP) while
keeping Original Medicare.
C. Prescription drug coverage is only available through employer-
sponsored plans.
D. He should purchase a Medigap policy that includes drug coverage.
Correct Answer: B
Expert Rationale: Medicare beneficiaries in Original Medicare can enroll
in a stand-alone Prescription Drug Plan (PDP) to obtain Part D coverage
without joining a Medicare Advantage plan. Medigap policies sold today
cannot include prescription drug coverage (this ended in 2006).
3. What is the primary purpose of Medicare Advantage (Part C)?
A. To provide prescription drug coverage only
B. To offer a private plan alternative to Original Medicare
C. To replace Medicaid for low-income beneficiaries
D. To provide supplemental coverage only
Correct Answer: B
Expert Rationale: Medicare Advantage plans are private health plan
alternatives to Original Medicare, often including additional benefits
like dental, vision, and hearing. They must provide at least the same
level of coverage as Original Medicare (except hospice, which remains
covered under Part A).
4. A beneficiary enrolls in a Medicare Advantage plan during the
Annual Election Period (AEP). When does coverage typically begin?
,A. Immediately upon enrollment
B. January 1 of the following year
C. The first day of the month after enrollment
D. The first day of the month after the plan receives the enrollment
request
Correct Answer: B
Expert Rationale: When a beneficiary enrolls in a Medicare Advantage
plan during the Annual Election Period (AEP), which runs from October
15 to December 7, coverage typically begins on January 1 of the
following year.
5. Which of the following is true regarding a beneficiary enrolled in a
Medicare Advantage plan?
A. They lose their Medicare rights and protections
B. They must still pay their Medicare Part B monthly premium
C. They no longer have coverage for emergency room care
D. They cannot be billed any copayments or deductibles
Correct Answer: B
Expert Rationale: To enroll and remain in a Medicare Advantage plan, a
beneficiary must continue to pay their Medicare Part B premium to the
federal government. MA plans can charge copayments and deductibles,
and beneficiaries retain all Medicare rights and protections.
6. Mr. Capadona would like to purchase a Medicare Advantage plan
and a Medigap plan to cover costs not covered by the MA plan. What
should you tell him?
, A. You can sell him a Medigap plan to help with costs not covered under
Medicare Advantage.
B. It is illegal to sell Mr. Capadona a Medigap plan if he is enrolled in an
MA plan, and Medigap only works with Original Medicare.
C. Medigap plans are designed to work alongside Medicare Advantage
plans.
D. He must disenroll from his MA plan before buying a Medigap plan.
Correct Answer: B
Expert Rationale: Medigap plans are supplemental policies that fill gaps
in Original Medicare (Parts A and B). Federal law prohibits the sale of a
Medigap policy to someone enrolled in a Medicare Advantage plan.
Medigap cannot pay the deductibles, copayments, or coinsurance
associated with an MA plan.
7. Under Original Medicare Part B, what percentage of the Medicare-
approved amount is the beneficiary typically responsible for after
meeting the annual deductible?
A. 10%
B. 20%
C. 30%
D. 50%
Correct Answer: B
Expert Rationale: Under Original Medicare Part B, the beneficiary is
responsible for a 20% coinsurance after the annual deductible is
satisfied. Medicare pays the remaining 80% of the Medicare-approved
amount.
COMPREHENSIVE EXAM QUESTIONS
200 QUESTIONS WITH CORRECT ANSWERS AND EXPERT
RATIONALES
1. Which part of Medicare is commonly referred to as "hospital
insurance" and covers inpatient hospital stays, skilled nursing facility
care, hospice, and some home health services?
A. Part B
B. Part C
C. Part D
D. Part A
Correct Answer: D
Expert Rationale: Medicare Part A is hospital insurance that covers
inpatient hospital care, skilled nursing facility care following a qualifying
hospital stay, hospice care, and limited home health services. Part B
covers outpatient and physician services, Part C is Medicare Advantage,
and Part D covers prescription drugs.
2. Mr. Reynolds is enrolled in Original Medicare and would like
prescription drug coverage but does not want to join a Medicare
Advantage plan. What should you tell him?
,A. He must enroll in a Medicare Advantage plan to obtain drug
coverage.
B. He can enroll in a stand-alone Prescription Drug Plan (PDP) while
keeping Original Medicare.
C. Prescription drug coverage is only available through employer-
sponsored plans.
D. He should purchase a Medigap policy that includes drug coverage.
Correct Answer: B
Expert Rationale: Medicare beneficiaries in Original Medicare can enroll
in a stand-alone Prescription Drug Plan (PDP) to obtain Part D coverage
without joining a Medicare Advantage plan. Medigap policies sold today
cannot include prescription drug coverage (this ended in 2006).
3. What is the primary purpose of Medicare Advantage (Part C)?
A. To provide prescription drug coverage only
B. To offer a private plan alternative to Original Medicare
C. To replace Medicaid for low-income beneficiaries
D. To provide supplemental coverage only
Correct Answer: B
Expert Rationale: Medicare Advantage plans are private health plan
alternatives to Original Medicare, often including additional benefits
like dental, vision, and hearing. They must provide at least the same
level of coverage as Original Medicare (except hospice, which remains
covered under Part A).
4. A beneficiary enrolls in a Medicare Advantage plan during the
Annual Election Period (AEP). When does coverage typically begin?
,A. Immediately upon enrollment
B. January 1 of the following year
C. The first day of the month after enrollment
D. The first day of the month after the plan receives the enrollment
request
Correct Answer: B
Expert Rationale: When a beneficiary enrolls in a Medicare Advantage
plan during the Annual Election Period (AEP), which runs from October
15 to December 7, coverage typically begins on January 1 of the
following year.
5. Which of the following is true regarding a beneficiary enrolled in a
Medicare Advantage plan?
A. They lose their Medicare rights and protections
B. They must still pay their Medicare Part B monthly premium
C. They no longer have coverage for emergency room care
D. They cannot be billed any copayments or deductibles
Correct Answer: B
Expert Rationale: To enroll and remain in a Medicare Advantage plan, a
beneficiary must continue to pay their Medicare Part B premium to the
federal government. MA plans can charge copayments and deductibles,
and beneficiaries retain all Medicare rights and protections.
6. Mr. Capadona would like to purchase a Medicare Advantage plan
and a Medigap plan to cover costs not covered by the MA plan. What
should you tell him?
, A. You can sell him a Medigap plan to help with costs not covered under
Medicare Advantage.
B. It is illegal to sell Mr. Capadona a Medigap plan if he is enrolled in an
MA plan, and Medigap only works with Original Medicare.
C. Medigap plans are designed to work alongside Medicare Advantage
plans.
D. He must disenroll from his MA plan before buying a Medigap plan.
Correct Answer: B
Expert Rationale: Medigap plans are supplemental policies that fill gaps
in Original Medicare (Parts A and B). Federal law prohibits the sale of a
Medigap policy to someone enrolled in a Medicare Advantage plan.
Medigap cannot pay the deductibles, copayments, or coinsurance
associated with an MA plan.
7. Under Original Medicare Part B, what percentage of the Medicare-
approved amount is the beneficiary typically responsible for after
meeting the annual deductible?
A. 10%
B. 20%
C. 30%
D. 50%
Correct Answer: B
Expert Rationale: Under Original Medicare Part B, the beneficiary is
responsible for a 20% coinsurance after the annual deductible is
satisfied. Medicare pays the remaining 80% of the Medicare-approved
amount.
