AHIP Final Exam (Medicare
Certification) 150 Questions
and correct answers from
latest update 2026
This document tests mastering core concepts across Medicare eligibility, plan
structures (such as Medicare Advantage, Part D, MSAs, and PFFS),
compliance rules, and Fraud, Waste, and Abuse (FWA) regulations.
Table of contents
1. Section 1: Medicare Basics and Eligibility (Questions 1–30)
2. Section 2: Medicare Advantage (Part C) Plan Types (Questions 31–60)
3. Section 3: Part D Prescription Drug Plans (Questions 61–85)
4. Section 4: Marketing, Compliance, and Sales Rules (Questions 86–120)
5. Section 5: Fraud, Waste, and Abuse (FWA) (Questions 121–150)
Section 1: Medicare Basics and Eligibility
(Questions 1–30)
Q: What governmental organization administers the Medicare program? A:
The Centers for Medicare & Medicaid Services (CMS).
Q: What is the standard age requirement for automatic Medicare eligibility?
A: Age 65.
Q: Besides age 65, what two major categories of individuals qualify for
Medicare? A: Individuals receiving Social Security Disability Insurance (SSDI)
for 24 months and individuals with End-Stage Renal Disease (ESRD) or
Amyotrophic Lateral Sclerosis (ALS).
Q: What does Medicare Part A primarily cover? A: Inpatient hospital stays,
care in a skilled nursing facility, hospice care, and some home health care.
, Q: What does Medicare Part B primarily cover? A: Doctor services, outpatient
care, medical supplies, and preventive services.
Q: What is commonly referred to as Medicare Part C? A: Medicare Advantage
plans, which are health plan options approved by Medicare and run by
private insurance companies.
Q: What does Medicare Part D cover? A: Prescription drug coverage.
Q: Is Medicare Part A generally premium-free for most workers? A: Yes, for
individuals who have worked and paid Medicare taxes for at least 10 years
(40 quarters).
Q: What is the standard monthly premium for Medicare Part B for most
beneficiaries? A: It changes annually and can be higher for individuals with
higher modified adjusted gross incomes (IRMAA).
Q: During what window can an individual first sign up for Medicare around
their 65th birthday? A: The Initial Enrollment Period (IEP), which spans 7
months (the 3 months before, the month of, and the 3 months after the 65th
birthday).
Q: What happens if an eligible individual fails to enroll in Part B during their
Initial Enrollment Period without other creditable coverage? A: They may face
a permanent late enrollment penalty added to their monthly Part B premium.
Q: What is the General Enrollment Period (GEP) for Medicare Parts A and B?
A: January 1 through March 31 of each year, with coverage beginning the
month after enrollment.
Q: When does the Medicare Annual Enrollment Period (AEP) occur annually?
A: October 15 through December 7.
Q: What changes can a beneficiary make during the AEP? A: They can join,
switch, or drop a Medicare Advantage plan or Part D prescription drug plan,
effective January 1 of the following year.
Q: What is the Medicare Advantage Open Enrollment Period (MA OEP)
timeline? A: January 1 through March 31.
Q: What can a Medicare Advantage enrollee do during the MA OEP? A: Switch
to another Medicare Advantage plan or disenroll from Medicare Advantage
and return to Original Medicare with a standalone Part D plan.
Certification) 150 Questions
and correct answers from
latest update 2026
This document tests mastering core concepts across Medicare eligibility, plan
structures (such as Medicare Advantage, Part D, MSAs, and PFFS),
compliance rules, and Fraud, Waste, and Abuse (FWA) regulations.
Table of contents
1. Section 1: Medicare Basics and Eligibility (Questions 1–30)
2. Section 2: Medicare Advantage (Part C) Plan Types (Questions 31–60)
3. Section 3: Part D Prescription Drug Plans (Questions 61–85)
4. Section 4: Marketing, Compliance, and Sales Rules (Questions 86–120)
5. Section 5: Fraud, Waste, and Abuse (FWA) (Questions 121–150)
Section 1: Medicare Basics and Eligibility
(Questions 1–30)
Q: What governmental organization administers the Medicare program? A:
The Centers for Medicare & Medicaid Services (CMS).
Q: What is the standard age requirement for automatic Medicare eligibility?
A: Age 65.
Q: Besides age 65, what two major categories of individuals qualify for
Medicare? A: Individuals receiving Social Security Disability Insurance (SSDI)
for 24 months and individuals with End-Stage Renal Disease (ESRD) or
Amyotrophic Lateral Sclerosis (ALS).
Q: What does Medicare Part A primarily cover? A: Inpatient hospital stays,
care in a skilled nursing facility, hospice care, and some home health care.
, Q: What does Medicare Part B primarily cover? A: Doctor services, outpatient
care, medical supplies, and preventive services.
Q: What is commonly referred to as Medicare Part C? A: Medicare Advantage
plans, which are health plan options approved by Medicare and run by
private insurance companies.
Q: What does Medicare Part D cover? A: Prescription drug coverage.
Q: Is Medicare Part A generally premium-free for most workers? A: Yes, for
individuals who have worked and paid Medicare taxes for at least 10 years
(40 quarters).
Q: What is the standard monthly premium for Medicare Part B for most
beneficiaries? A: It changes annually and can be higher for individuals with
higher modified adjusted gross incomes (IRMAA).
Q: During what window can an individual first sign up for Medicare around
their 65th birthday? A: The Initial Enrollment Period (IEP), which spans 7
months (the 3 months before, the month of, and the 3 months after the 65th
birthday).
Q: What happens if an eligible individual fails to enroll in Part B during their
Initial Enrollment Period without other creditable coverage? A: They may face
a permanent late enrollment penalty added to their monthly Part B premium.
Q: What is the General Enrollment Period (GEP) for Medicare Parts A and B?
A: January 1 through March 31 of each year, with coverage beginning the
month after enrollment.
Q: When does the Medicare Annual Enrollment Period (AEP) occur annually?
A: October 15 through December 7.
Q: What changes can a beneficiary make during the AEP? A: They can join,
switch, or drop a Medicare Advantage plan or Part D prescription drug plan,
effective January 1 of the following year.
Q: What is the Medicare Advantage Open Enrollment Period (MA OEP)
timeline? A: January 1 through March 31.
Q: What can a Medicare Advantage enrollee do during the MA OEP? A: Switch
to another Medicare Advantage plan or disenroll from Medicare Advantage
and return to Original Medicare with a standalone Part D plan.
