AHIP Medicare Certification Exam Questions & Answers| Latest Update 2027

AHIP Medicare Certification Exam
Questions & Answers
Questions with Answers and Rationales




1. Which part of Medicare is generally known as "hospital insurance" and covers
inpatient hospital stays, skilled nursing facility care, and hospice?
A. Medicare Part A
B. Medicare Part B
C. Medicare Part C
D. Medicare Part D
Answer: A
Rationale: Medicare Part A is hospital insurance, covering inpatient hospital
care, skilled nursing facility care (following a qualifying hospital stay), hospice
care, and some home health services.


2. Which part of Medicare covers physician services, outpatient care, preventive
services, and durable medical equipment?
A. Medicare Part A
B. Medicare Part B
C. Medicare Part C
D. Medicare Part D
Answer: B
Rationale: Medicare Part B is medical insurance covering outpatient services,
physician visits, preventive care, and durable medical equipment, and requires
a monthly premium for most beneficiaries.


3. Medicare Part C is also known as:
A. Original Medicare

, B. Medicare Advantage
C. Medigap
D. Medicare Supplement
Answer: B
Rationale: Medicare Part C, or Medicare Advantage, allows beneficiaries to
receive their Medicare Part A and Part B benefits (and often Part D) through
private insurance plans approved by Medicare, often including additional
benefits.


4. Which part of Medicare provides outpatient prescription drug coverage?
A. Part A
B. Part B
C. Part C only, never separately
D. Part D
Answer: D
Rationale: Medicare Part D provides outpatient prescription drug coverage,
offered through private stand-alone Prescription Drug Plans (PDPs) or bundled
within many Medicare Advantage plans (MA-PDs).


5. To be eligible for Original Medicare based on age, an individual must
generally be:
A. Age 62 or older
B. Age 65 or older (or otherwise qualify due to disability or specific conditions)
C. Age 70 or older
D. Any age, with no restrictions
Answer: B
Rationale: Most individuals become eligible for Medicare at age 65; individuals
may also qualify earlier due to certain disabilities, End-Stage Renal Disease
(ESRD), or ALS (Lou Gehrig's disease).

,6. Under Original Medicare, after meeting the Part A deductible for a benefit
period, a beneficiary hospitalized for days 1-60 generally pays:
A. The full cost of care
B. $0 for covered inpatient hospital services after the deductible
C. A daily coinsurance amount for all 60 days
D. 20% coinsurance for all inpatient days
Answer: B
Rationale: Under Original Medicare Part A, after the beneficiary meets the
inpatient hospital deductible, days 1-60 of a benefit period typically require no
additional daily coinsurance for covered services; coinsurance begins on day 61.


7. What is a "benefit period" under Medicare Part A?
A. A fixed calendar year
B. A period that begins the day a beneficiary is admitted as an inpatient and
ends after they have been out of the hospital or skilled nursing facility for 60
consecutive days
C. A lifetime, one-time benefit
D. A monthly billing cycle
Answer: B
Rationale: A Part A benefit period begins upon inpatient admission and ends
once the beneficiary has not received inpatient hospital or skilled nursing
facility care for 60 consecutive days; a new benefit period (with a new
deductible) begins with any subsequent admission.


8. Which of the following is generally NOT covered by Original Medicare (Parts A
and B)?
A. Inpatient hospital care
B. Routine dental, vision, and hearing care
C. Physician office visits
D. Preventive screenings such as mammograms
Answer: B

, Rationale: Original Medicare generally does not cover routine dental, vision, or
hearing services; these are often offered as supplemental benefits under many
Medicare Advantage plans.


9. What is the standard Medicare Part B annual deductible structure?
A. There is no deductible for Part B
B. Beneficiaries pay a set annual deductible before Medicare begins paying its
share of covered Part B services
C. The deductible resets monthly
D. The deductible only applies to prescription drugs
Answer: B
Rationale: Medicare Part B has an annual deductible that beneficiaries must
meet before Medicare begins paying its standard share (typically 80%) of
covered Part B services, with the beneficiary generally responsible for the
remaining coinsurance.


10. Which statement best describes Medicare Part B coinsurance for most
covered services?
A. Beneficiaries typically pay 20% of the Medicare-approved amount after
meeting the deductible
B. Beneficiaries pay 50% of all costs
C. There is no coinsurance under Part B
D. Beneficiaries pay a flat $10 copay for all services
Answer: A
Rationale: After meeting the Part B deductible, beneficiaries are generally
responsible for 20% coinsurance of the Medicare-approved amount for most
Part B services, while Medicare pays the remaining 80%.


11. A beneficiary enrolled only in Original Medicare (Parts A and B) with no
additional coverage may face which of the following?
A. No out-of-pocket costs at all