AHIP 2027 FINAL EXAM – MEDICARE CERTIFICATION – ACTUAL QUESTIONS &
ANSWERS (AHIP) GUARANTEE PASS
SECTION 1: MEDICARE BASICS AND ELIGIBILITY (QUESTIONS 1-40)
1. Mrs. Chen is turning 65 next month and asks which parts of Medicare are
administered directly by the federal government. What should you tell her?
A. All four parts (A, B, C, and D) are provided directly by the federal government
B. Part A and Part B are administered by the federal government, while Part C and Part D are
offered by private insurers
C. Only Part A is federally administered
D. Part A and Part D are federally administered
B. Part A (Hospital Insurance) and Part B (Medical Insurance) are administered directly
by CMS, while Part C (Medicare Advantage) and Part D (Prescription Drug) are offered
by private companies contracting with Medicare.
2. Which individual is automatically entitled to premium-free Medicare Part A?
A. A 62-year-old who has paid Medicare taxes for 5 years
B. A 65-year-old who has paid Medicare taxes for at least 10 years (40 quarters) and is
receiving Social Security benefits
C. A 67-year-old who has never worked but is married to someone with 10 years of
Medicare taxes
D. A 64-year-old receiving Social Security disability benefits for 18 months
,B. Individuals age 65 or older who have paid Medicare taxes for at least 40 quarters
qualify for premium-free Part A. Those entitled to Social Security benefits based on a
spouse's work record may also qualify.
3. Medicare eligibility includes which of the following groups?
A. Individuals age 65 and older only
B. Individuals under 65 with certain disabilities
C. Individuals with End-Stage Renal Disease (ESRD)
D. All of the above
D. Medicare eligibility includes individuals age 65 and older, individuals under 65 who
have received Social Security disability benefits for 24 months, and individuals of any
age with ESRD or ALS.
4. Mr. Rodriguez is enrolled in Original Medicare and considering a Medicare
Advantage plan. Which statement about Medicare Advantage is correct?
A. Medicare Advantage plans are only available to individuals who also have Medicaid
B. Medicare Advantage plans are offered by private companies that contract with Medicare
and must cover all services covered by Original Medicare
C. Medicare Advantage plans are not allowed to offer additional benefits beyond Original
Medicare
D. Medicare Advantage plans replace Part A but not Part B
B. Medicare Advantage plans are offered by private insurers approved by Medicare.
They must cover all services that Original Medicare covers, except hospice care, and
may offer additional benefits such as vision, dental, and hearing.
5. What is the Medicare Initial Enrollment Period (IEP)?
A. A 7-month period that begins 3 months before the month of eligibility and ends 3 months
after
B. A 6-month period that begins 2 months before and ends 4 months after
C. A 3-month period that begins the month of eligibility
D. A 12-month period that begins 6 months before and ends 6 months after
,A. The IEP is a 7-month window including the 3 months before, the month of, and the 3
months after the individual turns 65 or becomes eligible.
6. A beneficiary turns 65 on August 10, 2026. She is still actively working at a company
with 150 employees and has had employer group health coverage since age 62. She
wants to delay Part B without penalty. She retires on March 15, 2027, and employer
coverage ends March 31, 2027. What is the last day of her Special Enrollment Period to
enroll in Part B without a late enrollment penalty?
A. August 10, 2027 (12 months after turning 65)
B. September 30, 2027 (6 months after employer coverage ends)
C. November 30, 2027 (8 months after employer coverage ends)
D. December 31, 2027 (end of calendar year after coverage ends)
C. The Part B SEP for active employment-based coverage lasts 8 months after
employment ends or group health coverage ends, whichever comes first. Coverage
ended March 31, 2027, plus 8 months equals November 30, 2027.
7. What is the Medicare Part D late enrollment penalty?
A. A one-time fee
B. A penalty added to the monthly premium for each month of uncovered coverage
C. A penalty that increases the deductible
D. No penalty exists for Part D late enrollment
B. The Part D late enrollment penalty is calculated as 1% of the national base
beneficiary premium for each full month an individual was eligible for Part D but did
not enroll and did not have creditable coverage.
8. What is the primary purpose of Medicare Part D?
A. Hospital inpatient coverage
B. Physician services and outpatient care
C. Prescription drug coverage
D. Long-term custodial care
, C. Medicare Part D provides prescription drug coverage. Part A covers hospital
services, Part B covers physician services, and Part D specifically addresses
prescription medications.
9. Mr. Smith is admitted to the hospital as an inpatient for 4 days. He is discharged and
remains out of the hospital for 30 days. He is then readmitted for the same condition
on Day 31. How does Medicare Part A handle this?
A. It is a new benefit period with a new deductible
B. It is considered a single benefit period, and no new deductible is applied
C. It falls under the 60-day "spell of illness" rule requiring no new deductible
D. He must pay 20% coinsurance for the second stay
B. A benefit period begins the day of admission and ends when the beneficiary has
been out of the hospital or SNF for 60 consecutive days. Since he was out for only 30
days, this is the same benefit period and no new deductible applies.
10. Larry Miller is an Original Medicare beneficiary. Larry is admitted to Good Care
Hospital in January for three days. Six months later in July, Larry is admitted with a
broken leg and stays for one week. In December, Larry is admitted once again with the
flu. How many Part A deductibles will Larry be responsible for?
A. One Part A deductible
B. Two Part A deductibles
C. Three Part A deductibles
D. No Part A deductibles
C. Each hospitalization represents a separate benefit period because they are
separated by more than 60 days. The Part A deductible applies to each benefit period.
11. Which of the following services is NOT covered under Medicare Part A?
A. Semi-private room in a Skilled Nursing Facility
B. Home Health Aide services (part-time)
C. Custodial care in a nursing home (assistance with ADLs only)
D. Inpatient hospital care
ANSWERS (AHIP) GUARANTEE PASS
SECTION 1: MEDICARE BASICS AND ELIGIBILITY (QUESTIONS 1-40)
1. Mrs. Chen is turning 65 next month and asks which parts of Medicare are
administered directly by the federal government. What should you tell her?
A. All four parts (A, B, C, and D) are provided directly by the federal government
B. Part A and Part B are administered by the federal government, while Part C and Part D are
offered by private insurers
C. Only Part A is federally administered
D. Part A and Part D are federally administered
B. Part A (Hospital Insurance) and Part B (Medical Insurance) are administered directly
by CMS, while Part C (Medicare Advantage) and Part D (Prescription Drug) are offered
by private companies contracting with Medicare.
2. Which individual is automatically entitled to premium-free Medicare Part A?
A. A 62-year-old who has paid Medicare taxes for 5 years
B. A 65-year-old who has paid Medicare taxes for at least 10 years (40 quarters) and is
receiving Social Security benefits
C. A 67-year-old who has never worked but is married to someone with 10 years of
Medicare taxes
D. A 64-year-old receiving Social Security disability benefits for 18 months
,B. Individuals age 65 or older who have paid Medicare taxes for at least 40 quarters
qualify for premium-free Part A. Those entitled to Social Security benefits based on a
spouse's work record may also qualify.
3. Medicare eligibility includes which of the following groups?
A. Individuals age 65 and older only
B. Individuals under 65 with certain disabilities
C. Individuals with End-Stage Renal Disease (ESRD)
D. All of the above
D. Medicare eligibility includes individuals age 65 and older, individuals under 65 who
have received Social Security disability benefits for 24 months, and individuals of any
age with ESRD or ALS.
4. Mr. Rodriguez is enrolled in Original Medicare and considering a Medicare
Advantage plan. Which statement about Medicare Advantage is correct?
A. Medicare Advantage plans are only available to individuals who also have Medicaid
B. Medicare Advantage plans are offered by private companies that contract with Medicare
and must cover all services covered by Original Medicare
C. Medicare Advantage plans are not allowed to offer additional benefits beyond Original
Medicare
D. Medicare Advantage plans replace Part A but not Part B
B. Medicare Advantage plans are offered by private insurers approved by Medicare.
They must cover all services that Original Medicare covers, except hospice care, and
may offer additional benefits such as vision, dental, and hearing.
5. What is the Medicare Initial Enrollment Period (IEP)?
A. A 7-month period that begins 3 months before the month of eligibility and ends 3 months
after
B. A 6-month period that begins 2 months before and ends 4 months after
C. A 3-month period that begins the month of eligibility
D. A 12-month period that begins 6 months before and ends 6 months after
,A. The IEP is a 7-month window including the 3 months before, the month of, and the 3
months after the individual turns 65 or becomes eligible.
6. A beneficiary turns 65 on August 10, 2026. She is still actively working at a company
with 150 employees and has had employer group health coverage since age 62. She
wants to delay Part B without penalty. She retires on March 15, 2027, and employer
coverage ends March 31, 2027. What is the last day of her Special Enrollment Period to
enroll in Part B without a late enrollment penalty?
A. August 10, 2027 (12 months after turning 65)
B. September 30, 2027 (6 months after employer coverage ends)
C. November 30, 2027 (8 months after employer coverage ends)
D. December 31, 2027 (end of calendar year after coverage ends)
C. The Part B SEP for active employment-based coverage lasts 8 months after
employment ends or group health coverage ends, whichever comes first. Coverage
ended March 31, 2027, plus 8 months equals November 30, 2027.
7. What is the Medicare Part D late enrollment penalty?
A. A one-time fee
B. A penalty added to the monthly premium for each month of uncovered coverage
C. A penalty that increases the deductible
D. No penalty exists for Part D late enrollment
B. The Part D late enrollment penalty is calculated as 1% of the national base
beneficiary premium for each full month an individual was eligible for Part D but did
not enroll and did not have creditable coverage.
8. What is the primary purpose of Medicare Part D?
A. Hospital inpatient coverage
B. Physician services and outpatient care
C. Prescription drug coverage
D. Long-term custodial care
, C. Medicare Part D provides prescription drug coverage. Part A covers hospital
services, Part B covers physician services, and Part D specifically addresses
prescription medications.
9. Mr. Smith is admitted to the hospital as an inpatient for 4 days. He is discharged and
remains out of the hospital for 30 days. He is then readmitted for the same condition
on Day 31. How does Medicare Part A handle this?
A. It is a new benefit period with a new deductible
B. It is considered a single benefit period, and no new deductible is applied
C. It falls under the 60-day "spell of illness" rule requiring no new deductible
D. He must pay 20% coinsurance for the second stay
B. A benefit period begins the day of admission and ends when the beneficiary has
been out of the hospital or SNF for 60 consecutive days. Since he was out for only 30
days, this is the same benefit period and no new deductible applies.
10. Larry Miller is an Original Medicare beneficiary. Larry is admitted to Good Care
Hospital in January for three days. Six months later in July, Larry is admitted with a
broken leg and stays for one week. In December, Larry is admitted once again with the
flu. How many Part A deductibles will Larry be responsible for?
A. One Part A deductible
B. Two Part A deductibles
C. Three Part A deductibles
D. No Part A deductibles
C. Each hospitalization represents a separate benefit period because they are
separated by more than 60 days. The Part A deductible applies to each benefit period.
11. Which of the following services is NOT covered under Medicare Part A?
A. Semi-private room in a Skilled Nursing Facility
B. Home Health Aide services (part-time)
C. Custodial care in a nursing home (assistance with ADLs only)
D. Inpatient hospital care
