AHIP FINAL EXAM
MEDICARE & FRAUD, WASTE, AND ABUSE
OBJECTIVE ASSESSMENT EXAM
Actual Questions and Answers
100% Guarantee Pass
2026-2027 Update Exam
This Exam contains:
➢ 200 Questions and Answers
➢ 100% Guarantee Pass
➢ Multiple-Choice (A–D) / Verified Q&A
➢ Each Question Includes The Correct Answer
➢ Expert-Verified explanation
,1. Which part of Medicare covers inpatient hospital services?
Answer: Part A Correct answer ✔✔
Rationale: Medicare Part A pays for inpatient stays, skilled nursing facility care, hospice, and
some home health.
2. A beneficiary turning 65 and already receiving Social Security benefits is automatically
enrolled in:
Answer: Part A and Part B Correct answer ✔✔
Rationale: Automatic enrollment occurs when receiving SSA benefits prior to 65.
3. The penalty for delaying Medicare Part B enrollment without creditable coverage is:
Answer: 10% for every 12 months delayed Correct answer ✔✔
Rationale: CMS applies a 10% surcharge for each full uncovered year.
4. Medicare Advantage plans must cover:
Answer: All services covered by Original Medicare Correct answer ✔✔
Rationale: MA plans are required to provide equal or greater coverage than Parts A and B.
5. What is the main requirement to join a Medicare Advantage plan?
Answer: Must have both Part A and Part B Correct answer ✔✔
Rationale: Enrollment in both parts is mandatory for MA.
6. The six protected drug classes under Part D ensure:
Answer: Broad access to critical medications Correct answer ✔✔
Rationale: Plans must cover all or nearly all drugs in these categories.
7. An agent must obtain a Scope of Appointment (SOA):
,Answer: Before discussing specific plan benefits Correct answer ✔✔
Rationale: CMS requires SOAs to document beneficiary permission.
8. LIS (Low-Income Subsidy) helps beneficiaries with:
Answer: Part D premium, deductible, and cost-sharing Correct answer ✔✔
Rationale: LIS reduces or eliminates drug plan costs for low-income enrollees.
9. What is considered marketing?
Answer: Materials intended to steer beneficiaries toward enrollment Correct answer ✔✔
Rationale: CMS defines marketing by intent and content.
10. Medicare Part B covers:
Answer: Outpatient services and preventive care Correct answer ✔✔
Rationale: Part B includes doctor visits, screenings, DME, and outpatient services.
11. A Special Enrollment Period (SEP) for Part B exists when:
Answer: A beneficiary has creditable employer coverage and delays enrollment Correct
answer ✔✔
Rationale: SEP avoids penalties when credible employer insurance exists.
12. Medicare Advantage plans receive payment from CMS through:
Answer: Monthly capitated payments Correct answer ✔✔
Rationale: Plans get a fixed per-member amount regardless of service use.
13. Upcoding by a provider is an example of:
Answer: Fraud Correct answer ✔✔
Rationale: Intentionally coding higher levels of service is deceptive and illegal.
, 14. Waste refers to:
Answer: Over-utilization of services Correct answer ✔✔
Rationale: Waste does not require intent to break rules.
15. Which program helps pay Medicare costs for individuals with limited income?
Answer: Medicare Savings Programs (MSPs) Correct answer ✔✔
Rationale: MSPs cover Part A/B premiums and sometimes cost-sharing.
16. A marketing event allows an agent to:
Answer: Present plan-specific information Correct answer ✔✔
Rationale: Unlike educational events, marketing events permit discussing benefits.
17. A PPO Medicare Advantage plan allows members to:
Answer: See out-of-network providers at higher cost Correct answer ✔✔
Rationale: PPOs offer flexibility, but at increased OOP costs.
18. Which plan type restricts members to their network for all non-emergency care?
Answer: HMO Correct answer ✔✔
Rationale: HMOs generally require in-network providers.
19. Which of the following is required for enrollment in a Special Needs Plan (SNP)?
Answer: Must meet the SNP's eligibility criteria Correct answer ✔✔
Rationale: SNPs require chronic conditions, institutional status, or dual eligibility.
20. The Medicare Part D coverage gap ("donut hole") occurs after:
Answer: The initial coverage limit is reached Correct answer ✔✔
Rationale: After the limit, members pay a percentage of drug costs until catastrophic coverage.
MEDICARE & FRAUD, WASTE, AND ABUSE
OBJECTIVE ASSESSMENT EXAM
Actual Questions and Answers
100% Guarantee Pass
2026-2027 Update Exam
This Exam contains:
➢ 200 Questions and Answers
➢ 100% Guarantee Pass
➢ Multiple-Choice (A–D) / Verified Q&A
➢ Each Question Includes The Correct Answer
➢ Expert-Verified explanation
,1. Which part of Medicare covers inpatient hospital services?
Answer: Part A Correct answer ✔✔
Rationale: Medicare Part A pays for inpatient stays, skilled nursing facility care, hospice, and
some home health.
2. A beneficiary turning 65 and already receiving Social Security benefits is automatically
enrolled in:
Answer: Part A and Part B Correct answer ✔✔
Rationale: Automatic enrollment occurs when receiving SSA benefits prior to 65.
3. The penalty for delaying Medicare Part B enrollment without creditable coverage is:
Answer: 10% for every 12 months delayed Correct answer ✔✔
Rationale: CMS applies a 10% surcharge for each full uncovered year.
4. Medicare Advantage plans must cover:
Answer: All services covered by Original Medicare Correct answer ✔✔
Rationale: MA plans are required to provide equal or greater coverage than Parts A and B.
5. What is the main requirement to join a Medicare Advantage plan?
Answer: Must have both Part A and Part B Correct answer ✔✔
Rationale: Enrollment in both parts is mandatory for MA.
6. The six protected drug classes under Part D ensure:
Answer: Broad access to critical medications Correct answer ✔✔
Rationale: Plans must cover all or nearly all drugs in these categories.
7. An agent must obtain a Scope of Appointment (SOA):
,Answer: Before discussing specific plan benefits Correct answer ✔✔
Rationale: CMS requires SOAs to document beneficiary permission.
8. LIS (Low-Income Subsidy) helps beneficiaries with:
Answer: Part D premium, deductible, and cost-sharing Correct answer ✔✔
Rationale: LIS reduces or eliminates drug plan costs for low-income enrollees.
9. What is considered marketing?
Answer: Materials intended to steer beneficiaries toward enrollment Correct answer ✔✔
Rationale: CMS defines marketing by intent and content.
10. Medicare Part B covers:
Answer: Outpatient services and preventive care Correct answer ✔✔
Rationale: Part B includes doctor visits, screenings, DME, and outpatient services.
11. A Special Enrollment Period (SEP) for Part B exists when:
Answer: A beneficiary has creditable employer coverage and delays enrollment Correct
answer ✔✔
Rationale: SEP avoids penalties when credible employer insurance exists.
12. Medicare Advantage plans receive payment from CMS through:
Answer: Monthly capitated payments Correct answer ✔✔
Rationale: Plans get a fixed per-member amount regardless of service use.
13. Upcoding by a provider is an example of:
Answer: Fraud Correct answer ✔✔
Rationale: Intentionally coding higher levels of service is deceptive and illegal.
, 14. Waste refers to:
Answer: Over-utilization of services Correct answer ✔✔
Rationale: Waste does not require intent to break rules.
15. Which program helps pay Medicare costs for individuals with limited income?
Answer: Medicare Savings Programs (MSPs) Correct answer ✔✔
Rationale: MSPs cover Part A/B premiums and sometimes cost-sharing.
16. A marketing event allows an agent to:
Answer: Present plan-specific information Correct answer ✔✔
Rationale: Unlike educational events, marketing events permit discussing benefits.
17. A PPO Medicare Advantage plan allows members to:
Answer: See out-of-network providers at higher cost Correct answer ✔✔
Rationale: PPOs offer flexibility, but at increased OOP costs.
18. Which plan type restricts members to their network for all non-emergency care?
Answer: HMO Correct answer ✔✔
Rationale: HMOs generally require in-network providers.
19. Which of the following is required for enrollment in a Special Needs Plan (SNP)?
Answer: Must meet the SNP's eligibility criteria Correct answer ✔✔
Rationale: SNPs require chronic conditions, institutional status, or dual eligibility.
20. The Medicare Part D coverage gap ("donut hole") occurs after:
Answer: The initial coverage limit is reached Correct answer ✔✔
Rationale: After the limit, members pay a percentage of drug costs until catastrophic coverage.
