AHIP Medicare Advantage Examination
Questions And Correct Answers (Verified
Answers) Plus Rationales 2026 Q&A |
Instant Download Pdf
1. Which statement best describes Medicare Advantage (MA), also
known as Medicare Part C?
A. It is a Medicare supplement policy that pays only after Original
Medicare pays.
B. It is a federal program available only to people with Medicaid.
C. It is a Medicare-approved plan offered by a private company that
provides Medicare-covered benefits and may include additional
benefits.
D. It is a prescription drug program that replaces Medicare Part B.
Answer: C
Rationale: Medicare Advantage plans are offered by Medicare-
approved private organizations and provide Medicare Part A and Part
B coverage through the plan, except hospice care, which remains
covered under Original Medicare. Many MA plans also provide
additional benefits and may include Part D prescription drug
coverage.
2. Which two parts of Original Medicare are generally provided
through a Medicare Advantage plan?
A. Part A and Part B
B. Part B and Part D only
,C. Part A and Medigap
D. Part D and Medigap
Answer: A
Rationale: A Medicare Advantage enrollee receives Medicare Part A
and Part B benefits through the MA plan rather than directly through
Original Medicare. Prescription drug coverage may also be included
when the plan is an MA-PD plan.
3. What is a major difference between Original Medicare and
Medicare Advantage?
A. Original Medicare never covers hospital services.
B. Medicare Advantage does not require enrollment in Part A.
C. Original Medicare is administered exclusively by private insurers.
D. Medicare Advantage coverage is provided through a Medicare-
approved private plan.
Answer: D
Rationale: Original Medicare is the traditional fee-for-service
Medicare program consisting primarily of Part A and Part B.
Medicare Advantage uses private Medicare-approved organizations to
administer covered Medicare benefits under plan-specific rules.
4. A beneficiary enrolled in Medicare Advantage generally must
continue paying which Medicare premium when applicable?
A. Only a Medigap premium
B. The Part B premium
C. A mandatory Part C premium to Medicare in every case
D. A mandatory Part D premium to Medicare in every case
Answer: B
,Rationale: Most Medicare Advantage beneficiaries must remain
enrolled in Medicare Part B and continue paying the applicable Part B
premium. Some MA plans may help pay part or all of a member's Part
B premium, but this varies by plan.
5. Which organization may offer a Medicare Advantage plan?
A. A private company approved by Medicare
B. Any individual insurance agent
C. An employer without Medicare approval
D. Any hospital without a Medicare contract
Answer: A
Rationale: Medicare Advantage plans are offered by private
organizations that contract with Medicare and meet applicable federal
requirements. The organization may be an insurance company or
another qualified plan sponsor.
6. Which type of Medicare Advantage plan commonly requires
members to use a network for routine care?
A. Medicare Supplement plan
B. Original Medicare
C. Health Maintenance Organization (HMO)
D. Stand-alone Part D plan
Answer: C
Rationale: Medicare Advantage HMOs generally use provider
networks and require members to obtain covered care from network
providers except in circumstances such as emergencies or urgent care.
Specific rules vary by plan.
7. What is a typical characteristic of a Medicare Advantage Preferred
Provider Organization (PPO)?
, A. It never permits out-of-network care.
B. It does not cover Medicare Part A services.
C. It automatically replaces Medicare Part B enrollment.
D. It generally allows members to receive covered services from both
in-network and out-of-network providers, usually at different cost-
sharing levels.
Answer: D
Rationale: PPO plans typically provide a network of preferred
providers but allow members to use non-preferred providers for
covered services, subject to plan rules and generally higher cost
sharing.
8. Which Medicare Advantage plan type generally permits members
to see specialists without a primary care provider referral, subject
to plan rules?
A. HMO
B. PPO
C. Medicare Supplement
D. Original Medicare only
Answer: B
Rationale: PPOs generally provide greater flexibility than HMOs
regarding provider access and commonly do not require referrals for
specialist care. However, members should always review the specific
plan's rules because requirements can differ.
9. What is an important characteristic of an HMO Medicare
Advantage plan?
A. Members generally receive covered routine care from providers
in the plan's network.
Questions And Correct Answers (Verified
Answers) Plus Rationales 2026 Q&A |
Instant Download Pdf
1. Which statement best describes Medicare Advantage (MA), also
known as Medicare Part C?
A. It is a Medicare supplement policy that pays only after Original
Medicare pays.
B. It is a federal program available only to people with Medicaid.
C. It is a Medicare-approved plan offered by a private company that
provides Medicare-covered benefits and may include additional
benefits.
D. It is a prescription drug program that replaces Medicare Part B.
Answer: C
Rationale: Medicare Advantage plans are offered by Medicare-
approved private organizations and provide Medicare Part A and Part
B coverage through the plan, except hospice care, which remains
covered under Original Medicare. Many MA plans also provide
additional benefits and may include Part D prescription drug
coverage.
2. Which two parts of Original Medicare are generally provided
through a Medicare Advantage plan?
A. Part A and Part B
B. Part B and Part D only
,C. Part A and Medigap
D. Part D and Medigap
Answer: A
Rationale: A Medicare Advantage enrollee receives Medicare Part A
and Part B benefits through the MA plan rather than directly through
Original Medicare. Prescription drug coverage may also be included
when the plan is an MA-PD plan.
3. What is a major difference between Original Medicare and
Medicare Advantage?
A. Original Medicare never covers hospital services.
B. Medicare Advantage does not require enrollment in Part A.
C. Original Medicare is administered exclusively by private insurers.
D. Medicare Advantage coverage is provided through a Medicare-
approved private plan.
Answer: D
Rationale: Original Medicare is the traditional fee-for-service
Medicare program consisting primarily of Part A and Part B.
Medicare Advantage uses private Medicare-approved organizations to
administer covered Medicare benefits under plan-specific rules.
4. A beneficiary enrolled in Medicare Advantage generally must
continue paying which Medicare premium when applicable?
A. Only a Medigap premium
B. The Part B premium
C. A mandatory Part C premium to Medicare in every case
D. A mandatory Part D premium to Medicare in every case
Answer: B
,Rationale: Most Medicare Advantage beneficiaries must remain
enrolled in Medicare Part B and continue paying the applicable Part B
premium. Some MA plans may help pay part or all of a member's Part
B premium, but this varies by plan.
5. Which organization may offer a Medicare Advantage plan?
A. A private company approved by Medicare
B. Any individual insurance agent
C. An employer without Medicare approval
D. Any hospital without a Medicare contract
Answer: A
Rationale: Medicare Advantage plans are offered by private
organizations that contract with Medicare and meet applicable federal
requirements. The organization may be an insurance company or
another qualified plan sponsor.
6. Which type of Medicare Advantage plan commonly requires
members to use a network for routine care?
A. Medicare Supplement plan
B. Original Medicare
C. Health Maintenance Organization (HMO)
D. Stand-alone Part D plan
Answer: C
Rationale: Medicare Advantage HMOs generally use provider
networks and require members to obtain covered care from network
providers except in circumstances such as emergencies or urgent care.
Specific rules vary by plan.
7. What is a typical characteristic of a Medicare Advantage Preferred
Provider Organization (PPO)?
, A. It never permits out-of-network care.
B. It does not cover Medicare Part A services.
C. It automatically replaces Medicare Part B enrollment.
D. It generally allows members to receive covered services from both
in-network and out-of-network providers, usually at different cost-
sharing levels.
Answer: D
Rationale: PPO plans typically provide a network of preferred
providers but allow members to use non-preferred providers for
covered services, subject to plan rules and generally higher cost
sharing.
8. Which Medicare Advantage plan type generally permits members
to see specialists without a primary care provider referral, subject
to plan rules?
A. HMO
B. PPO
C. Medicare Supplement
D. Original Medicare only
Answer: B
Rationale: PPOs generally provide greater flexibility than HMOs
regarding provider access and commonly do not require referrals for
specialist care. However, members should always review the specific
plan's rules because requirements can differ.
9. What is an important characteristic of an HMO Medicare
Advantage plan?
A. Members generally receive covered routine care from providers
in the plan's network.
