AHIP Medicare Practice Exam – 120 Questions with Answers and Rationales

AHIP Medicare Practice Exam

1. What does Medicare Part A primarily cover?
A. Physician services
B. Inpatient hospital care
C. Outpatient prescription drugs
D. Routine dental care
Answer: B
Rationale: Part A is Medicare's hospital insurance. It covers inpatient hospital stays,
skilled nursing facility care, hospice, and limited home health services.

2. Which of the following is NOT covered under Medicare Part B?
A. Physician office visits
B. Durable medical equipment
C. Inpatient hospital stays
D. Preventive screenings
Answer: C
Rationale: Inpatient hospital stays are covered under Part A, not Part B. Part B covers
outpatient and physician-based services.

3. Most people do not pay a monthly premium for Part A because:
A. It is funded entirely by general tax revenue
B. They or a spouse paid Medicare payroll taxes for at least 40 quarters
C. It is means-tested
D. Congress waives it for all seniors
Answer: B
Rationale: Part A is generally premium-free for those with at least 40 quarters (10
years) of Medicare-covered employment, since it is funded through payroll taxes paid
during that time.

,4. Medicare Part B premiums may be higher for beneficiaries who:
A. Live in rural areas
B. Have higher modified adjusted gross income (IRMAA)
C. Enrolled late by choice
D. Have a Medigap policy
Answer: B
Rationale: The Income-Related Monthly Adjustment Amount (IRMAA) increases Part B
(and Part D) premiums for higher-income beneficiaries, based on IRS income data
from two years prior.

5. Which government agency administers the Medicare program?
A. Department of Labor
B. Centers for Medicare & Medicaid Services (CMS)
C. Social Security Administration only
D. Internal Revenue Service
Answer: B
Rationale: CMS, part of the Department of Health and Human Services, administers
Medicare, while the Social Security Administration primarily handles enrollment and
premium withholding.

6. A Medicare Part A benefit period begins:
A. January 1 each year
B. The day a beneficiary is admitted as an inpatient
C. The day they enroll in Medicare
D. Every 90 days automatically
Answer: B
Rationale: A benefit period starts the day of inpatient admission and ends after the
beneficiary has been out of the hospital or SNF for 60 consecutive days.

,7. Under Original Medicare, after meeting the Part B deductible, a beneficiary
typically pays what coinsurance for most covered services?
A. 10%
B. 20%
C. 50%
D. 100%
Answer: B
Rationale: Original Medicare Part B generally requires the beneficiary to pay 20%
coinsurance for most covered services after the annual deductible is met.

8. Which part of Medicare is commonly referred to as 'Medical Insurance'?
A. Part A
B. Part B
C. Part C
D. Part D
Answer: B
Rationale: Part B is known as Medical Insurance, covering physician services,
outpatient care, and certain preventive services, as distinguished from Part A's hospital
insurance.

9. Skilled nursing facility (SNF) care is covered under:
A. Part D only
B. Part B only
C. Part A, following a qualifying inpatient hospital stay
D. Medicare does not cover SNF care
Answer: C
Rationale: Part A covers SNF care for a limited period when it follows a medically
necessary, qualifying inpatient hospital stay of at least three days.

10. Hospice care under Original Medicare is covered under:
A. Part A
B. Part B
C. Part C only
D. Part D
Answer: A
Rationale: Hospice benefits, including most related drugs, equipment, and support
services, are covered under Part A for beneficiaries certified as terminally ill.

, 11. Which statement about Medicare eligibility based on age is correct?
A. Eligibility begins at 62
B. Eligibility generally begins at 65
C. Eligibility begins at 70
D. There is no age-based eligibility
Answer: B
Rationale: Most people become eligible for Medicare at age 65, though eligibility can
also occur earlier due to disability or certain medical conditions.

12. A beneficiary may qualify for Medicare before age 65 if they:
A. Have been receiving Social Security Disability Insurance (SSDI) for 24 months
B. Are unemployed
C. Have private insurance
D. Live below the poverty line
Answer: A
Rationale: Individuals under 65 generally become eligible for Medicare after receiving
SSDI benefits for 24 months; special rules also apply for ALS and End-Stage Renal
Disease.

13. The 'donut hole' historically referred to a coverage gap in which part of
Medicare?
A. Part A
B. Part B
C. Part C
D. Part D
Answer: D
Rationale: The coverage gap, or 'donut hole,' was a phase in the Part D drug benefit
where cost-sharing temporarily increased; recent legislation has restructured this
benefit design.