2027 AHIP MEDICARE CERTIFICATION FINAL
EXAM — 100 ORIGINAL PRACTICE
QUESTIONS & ANSWERS | UPDATED 2027
STUDY GUIDE
SECTION 1 — MEDICARE FUNDAMENTALS
1. Which Medicare part primarily provides hospital insurance coverage?
A. Part A
B. Part B
C. Part C
D. Part D
Correct Answer: A. Part A
Part A is Medicare Hospital Insurance and generally covers inpatient hospital services, skilled
nursing facility care under qualifying circumstances, hospice care, and certain home health
services. Part B primarily covers medical services. Part C is Medicare Advantage, while Part D
provides prescription drug coverage.
2. Medicare Part B primarily covers which category?
A. Inpatient hospital stays
B. Physician and outpatient medical services
C. Prescription drugs only
D. Long-term custodial nursing-home care
Correct Answer: B. Physician and outpatient medical services
Part B provides medical insurance for physician services, outpatient care, preventive services,
durable medical equipment, and other medically necessary services. Part A is primarily
hospital insurance. Medicare generally does not cover long-term custodial care simply
because an individual needs assistance with daily activities.
3. What is Medicare Part C commonly called?
,A. Medigap
B. Medicaid
C. Medicare Advantage
D. Medicare Supplement Part C
Correct Answer: C. Medicare Advantage
Medicare Part C is the Medicare Advantage program. Private Medicare Advantage
organizations contract with Medicare to provide covered Medicare benefits through
approved plan structures. Beneficiaries generally must have both Part A and Part B to enroll
in Medicare Advantage.
4. Which Medicare component provides outpatient prescription drug coverage?
A. Part A
B. Part B
C. Part C only
D. Part D
Correct Answer: D. Part D
Medicare Part D provides prescription drug coverage through private Medicare-approved
plans. Beneficiaries can obtain Part D through stand-alone Prescription Drug Plans or
through many Medicare Advantage plans that include drug coverage. Eligibility and
enrollment rules apply.
5. An individual wants to understand the distinction between Original Medicare and
Medicare Advantage. Which statement is most accurate?
A. Original Medicare is administered exclusively by private Medicare Advantage insurers.
B. Medicare Advantage is another name for Medigap.
C. Original Medicare consists primarily of Part A and Part B, while Medicare Advantage is an
alternative way to receive Medicare benefits through a private plan.
D. Medicare Advantage replaces Medicare Part D for every beneficiary.
Correct Answer: C. Original Medicare consists primarily of Part A and Part B, while
Medicare Advantage is an alternative way to receive Medicare benefits through a private
plan.
Original Medicare consists of Part A and Part B and is administered through the federal
Medicare program. Medicare Advantage plans are offered by private organizations approved
by Medicare. A Medicare Advantage plan may include prescription drug coverage and
additional benefits.
,6. Which statement about Medicare eligibility is generally correct?
A. Medicare is available only to individuals younger than 50.
B. Medicare eligibility can result from age or certain qualifying disabilities or medical
conditions.
C. Medicare automatically covers every U.S. resident regardless of eligibility.
D. Medicare is available only to individuals receiving Medicaid.
Correct Answer: B. Medicare eligibility can result from age or certain qualifying disabilities
or medical conditions.
Medicare primarily serves people age 65 and older but also covers certain younger
individuals who meet disability-related requirements. Certain individuals with specific
conditions can also qualify. Medicare eligibility should be evaluated using the applicable
federal eligibility rules.
7. Which statement best describes Medicaid in relation to Medicare?
A. Medicaid is a private Medicare Advantage plan.
B. Medicaid and Medicare are identical programs.
C. Medicaid is a joint federal-state program that can provide assistance to eligible low-
income individuals.
D. Medicaid is Medicare Part D.
Correct Answer: C. Medicaid is a joint federal-state program that can provide assistance to
eligible low-income individuals.
Medicaid is administered jointly by the federal government and states, subject to federal
requirements and state-specific rules. Medicare is a federal health insurance program. Some
individuals qualify for both programs and are referred to as dual-eligible beneficiaries.
8. What is the primary purpose of Medicare Supplement Insurance, commonly called
Medigap?
A. To replace Medicaid
B. To help pay certain Medicare cost-sharing amounts under Original Medicare
C. To provide employer-sponsored insurance
D. To provide only prescription drug coverage
Correct Answer: B. To help pay certain Medicare cost-sharing amounts under Original
Medicare
, Medigap policies are designed to supplement Original Medicare by helping with certain
deductibles, coinsurance, and other eligible cost-sharing amounts depending on the policy.
Medigap is not the same as Medicare Advantage. A beneficiary generally cannot have a
Medigap policy and Medicare Advantage plan simultaneously.
9. Which individual would generally need to evaluate whether enrollment in Part B is
appropriate when first eligible?
A. Someone who already has Medicare Part A only
B. Someone who has no healthcare needs
C. Someone who wants to avoid all insurance decisions
D. Someone who is automatically enrolled in every Medicare component
Correct Answer: A. Someone who already has Medicare Part A only
Part A and Part B are separate Medicare components. Eligibility for Part A does not mean
that an individual must automatically choose Part B in every circumstance. Employment
coverage, retirement coverage, and other circumstances can affect the timing and
consequences of Part B enrollment.
10. Which statement best describes Medicare Advantage?
A. It is administered only by state Medicaid agencies.
B. It is a private insurance alternative through which beneficiaries receive Medicare-covered
benefits.
C. It provides only dental coverage.
D. It is identical to a Medigap policy.
Correct Answer: B. It is a private insurance alternative through which beneficiaries receive
Medicare-covered benefits.
Medicare Advantage organizations contract with Medicare to provide Medicare-covered
benefits. Plans may use networks, cost-sharing structures, and additional benefits permitted
under program rules. Beneficiaries should compare plan benefits, provider access, pharmacy
arrangements, and costs before enrolling.
SECTION 2 — ELIGIBILITY AND ENROLLMENT
11. Which requirement generally applies to an individual enrolling in a Medicare Part D
plan?
EXAM — 100 ORIGINAL PRACTICE
QUESTIONS & ANSWERS | UPDATED 2027
STUDY GUIDE
SECTION 1 — MEDICARE FUNDAMENTALS
1. Which Medicare part primarily provides hospital insurance coverage?
A. Part A
B. Part B
C. Part C
D. Part D
Correct Answer: A. Part A
Part A is Medicare Hospital Insurance and generally covers inpatient hospital services, skilled
nursing facility care under qualifying circumstances, hospice care, and certain home health
services. Part B primarily covers medical services. Part C is Medicare Advantage, while Part D
provides prescription drug coverage.
2. Medicare Part B primarily covers which category?
A. Inpatient hospital stays
B. Physician and outpatient medical services
C. Prescription drugs only
D. Long-term custodial nursing-home care
Correct Answer: B. Physician and outpatient medical services
Part B provides medical insurance for physician services, outpatient care, preventive services,
durable medical equipment, and other medically necessary services. Part A is primarily
hospital insurance. Medicare generally does not cover long-term custodial care simply
because an individual needs assistance with daily activities.
3. What is Medicare Part C commonly called?
,A. Medigap
B. Medicaid
C. Medicare Advantage
D. Medicare Supplement Part C
Correct Answer: C. Medicare Advantage
Medicare Part C is the Medicare Advantage program. Private Medicare Advantage
organizations contract with Medicare to provide covered Medicare benefits through
approved plan structures. Beneficiaries generally must have both Part A and Part B to enroll
in Medicare Advantage.
4. Which Medicare component provides outpatient prescription drug coverage?
A. Part A
B. Part B
C. Part C only
D. Part D
Correct Answer: D. Part D
Medicare Part D provides prescription drug coverage through private Medicare-approved
plans. Beneficiaries can obtain Part D through stand-alone Prescription Drug Plans or
through many Medicare Advantage plans that include drug coverage. Eligibility and
enrollment rules apply.
5. An individual wants to understand the distinction between Original Medicare and
Medicare Advantage. Which statement is most accurate?
A. Original Medicare is administered exclusively by private Medicare Advantage insurers.
B. Medicare Advantage is another name for Medigap.
C. Original Medicare consists primarily of Part A and Part B, while Medicare Advantage is an
alternative way to receive Medicare benefits through a private plan.
D. Medicare Advantage replaces Medicare Part D for every beneficiary.
Correct Answer: C. Original Medicare consists primarily of Part A and Part B, while
Medicare Advantage is an alternative way to receive Medicare benefits through a private
plan.
Original Medicare consists of Part A and Part B and is administered through the federal
Medicare program. Medicare Advantage plans are offered by private organizations approved
by Medicare. A Medicare Advantage plan may include prescription drug coverage and
additional benefits.
,6. Which statement about Medicare eligibility is generally correct?
A. Medicare is available only to individuals younger than 50.
B. Medicare eligibility can result from age or certain qualifying disabilities or medical
conditions.
C. Medicare automatically covers every U.S. resident regardless of eligibility.
D. Medicare is available only to individuals receiving Medicaid.
Correct Answer: B. Medicare eligibility can result from age or certain qualifying disabilities
or medical conditions.
Medicare primarily serves people age 65 and older but also covers certain younger
individuals who meet disability-related requirements. Certain individuals with specific
conditions can also qualify. Medicare eligibility should be evaluated using the applicable
federal eligibility rules.
7. Which statement best describes Medicaid in relation to Medicare?
A. Medicaid is a private Medicare Advantage plan.
B. Medicaid and Medicare are identical programs.
C. Medicaid is a joint federal-state program that can provide assistance to eligible low-
income individuals.
D. Medicaid is Medicare Part D.
Correct Answer: C. Medicaid is a joint federal-state program that can provide assistance to
eligible low-income individuals.
Medicaid is administered jointly by the federal government and states, subject to federal
requirements and state-specific rules. Medicare is a federal health insurance program. Some
individuals qualify for both programs and are referred to as dual-eligible beneficiaries.
8. What is the primary purpose of Medicare Supplement Insurance, commonly called
Medigap?
A. To replace Medicaid
B. To help pay certain Medicare cost-sharing amounts under Original Medicare
C. To provide employer-sponsored insurance
D. To provide only prescription drug coverage
Correct Answer: B. To help pay certain Medicare cost-sharing amounts under Original
Medicare
, Medigap policies are designed to supplement Original Medicare by helping with certain
deductibles, coinsurance, and other eligible cost-sharing amounts depending on the policy.
Medigap is not the same as Medicare Advantage. A beneficiary generally cannot have a
Medigap policy and Medicare Advantage plan simultaneously.
9. Which individual would generally need to evaluate whether enrollment in Part B is
appropriate when first eligible?
A. Someone who already has Medicare Part A only
B. Someone who has no healthcare needs
C. Someone who wants to avoid all insurance decisions
D. Someone who is automatically enrolled in every Medicare component
Correct Answer: A. Someone who already has Medicare Part A only
Part A and Part B are separate Medicare components. Eligibility for Part A does not mean
that an individual must automatically choose Part B in every circumstance. Employment
coverage, retirement coverage, and other circumstances can affect the timing and
consequences of Part B enrollment.
10. Which statement best describes Medicare Advantage?
A. It is administered only by state Medicaid agencies.
B. It is a private insurance alternative through which beneficiaries receive Medicare-covered
benefits.
C. It provides only dental coverage.
D. It is identical to a Medigap policy.
Correct Answer: B. It is a private insurance alternative through which beneficiaries receive
Medicare-covered benefits.
Medicare Advantage organizations contract with Medicare to provide Medicare-covered
benefits. Plans may use networks, cost-sharing structures, and additional benefits permitted
under program rules. Beneficiaries should compare plan benefits, provider access, pharmacy
arrangements, and costs before enrolling.
SECTION 2 — ELIGIBILITY AND ENROLLMENT
11. Which requirement generally applies to an individual enrolling in a Medicare Part D
plan?
