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2026 AHIP Medicare Certification Practice Exam: Original Questions with Answers
Section 1: Medicare Program Basics (Questions 1–25)
Q1. Which part of Medicare covers inpatient hospital stays, skilled nursing facility care,
hospice care, and some home health care?
A. Medicare Part A
B. Medicare Part B
C. Medicare Part C
D. Medicare Part D
Answer: A
Rationale: Medicare Part A specifically covers institutional and inpatient care services, such
as hospital stays, skilled nursing facility care, hospice care, and some home health care .
Q2. How many quarters of coverage must an individual (or their spouse) earn through
payroll taxes to be entitled to Medicare Part A without paying a monthly premium?
A. 20 quarters
B. 30 quarters
C. 40 quarters
D. 50 quarters
Answer: C
Rationale: Individuals who have worked at least 40 quarters (10 years) in Medicare-covered
employment do not have to pay a premium for Part A .
Q3. What is the standard monthly premium for Medicare Part B based upon?
A. The beneficiary's zip code
B. The beneficiary's modified adjusted gross income (MAGI)
C. The beneficiary's health status and pre-existing conditions
D. The number of years the beneficiary has been retired
Answer: B
Rationale: Higher-income beneficiaries pay a higher Part B premium based on their Modified
Adjusted Gross Income, known as the Income-Related Monthly Adjustment Amount
(IRMAA) .
Q4. Medicare Part B covers which of the following services?
A. Inpatient surgery
B. Outpatient physician services and preventive care
C. Long-term custodial care in a nursing home
D. Routine cosmetic procedures
, 2
Answer: B
Rationale: Part B covers medically necessary outpatient services, doctor visits, durable
medical equipment, and preventive care .
Q5. What percentage of the Medicare-approved amount does a beneficiary typically pay for
Part B covered services after meeting their annual deductible?
A. 10%
B. 20%
C. 30%
D. 50%
Answer: B
Rationale: Under Original Medicare Part B, the beneficiary is responsible for a 20%
coinsurance after the annual deductible is satisfied .
Q6. What is another common name for Medicare Part C plans?
A. Medicare Supplement Plans
B. Medicare Advantage Plans
C. Standalone Prescription Drug Plans
D. Medicaid Wrap Plans
Answer: B
Rationale: Medicare Part C is officially known as the Medicare Advantage program, which
allows private insurance companies approved by CMS to deliver Part A and Part B benefits .
Q7. Which of the following is true regarding a beneficiary enrolled in a Medicare Advantage
plan?
A. They lose their Medicare rights and protections
B. They must still pay their Medicare Part B monthly premium
C. They no longer have coverage for emergency room care
D. They cannot be billed any copayments or deductibles
Answer: B
Rationale: To enroll and remain in a Medicare Advantage plan, a beneficiary must continue
to pay their Medicare Part B monthly premium .
Q8. Which organization establishes many of the regulations governing Medicare Advantage
and Part D plans?
A. State insurance departments
B. CMS (Centers for Medicare & Medicaid Services)
C. The Department of Labor
D. The Federal Trade Commission
, 3
Answer: B
Rationale: CMS establishes and enforces federal regulations for Medicare Advantage and
Medicare Part D plans .
Q9. Which individual would generally qualify for Medicare before reaching age 65?
A. A healthy 40-year-old employed full time
B. A 52-year-old with a qualifying disability who meets Medicare eligibility requirements
C. A 60-year-old with employer-sponsored insurance only
D. A 45-year-old who purchases private insurance
Answer: B
Rationale: Individuals under age 65 may qualify for Medicare because of certain disabilities
or qualifying medical conditions established under federal law .
Q10. Which statement best describes the difference between Medicare and Medicaid?
A. Medicare is state-administered, while Medicaid is federally administered
B. Medicare is a federal health insurance program for eligible individuals, while Medicaid is a
joint federal-state program for eligible individuals based on state-specific rules
C. Medicare and Medicaid are the same program with different names
D. Medicaid automatically replaces Medicare once a person turns 65
Answer: B
Rationale: Medicare and Medicaid are separate programs with different eligibility
requirements, funding structures, and administration .
Q11. Which document provides the official evidence of Medicare coverage for a beneficiary?
A. Social Security card
B. Medicare identification card
C. Driver's license
D. Birth certificate
Answer: B
Rationale: The Medicare identification card confirms Medicare enrollment and contains
information needed to verify coverage .
Q12. An insurance agent should primarily rely on which source when explaining Medicare
benefits to a beneficiary?
A. Personal experience with Medicare
B. Official CMS-approved materials
C. Social media posts
D. Unofficial online forums
2026 AHIP Medicare Certification Practice Exam: Original Questions with Answers
Section 1: Medicare Program Basics (Questions 1–25)
Q1. Which part of Medicare covers inpatient hospital stays, skilled nursing facility care,
hospice care, and some home health care?
A. Medicare Part A
B. Medicare Part B
C. Medicare Part C
D. Medicare Part D
Answer: A
Rationale: Medicare Part A specifically covers institutional and inpatient care services, such
as hospital stays, skilled nursing facility care, hospice care, and some home health care .
Q2. How many quarters of coverage must an individual (or their spouse) earn through
payroll taxes to be entitled to Medicare Part A without paying a monthly premium?
A. 20 quarters
B. 30 quarters
C. 40 quarters
D. 50 quarters
Answer: C
Rationale: Individuals who have worked at least 40 quarters (10 years) in Medicare-covered
employment do not have to pay a premium for Part A .
Q3. What is the standard monthly premium for Medicare Part B based upon?
A. The beneficiary's zip code
B. The beneficiary's modified adjusted gross income (MAGI)
C. The beneficiary's health status and pre-existing conditions
D. The number of years the beneficiary has been retired
Answer: B
Rationale: Higher-income beneficiaries pay a higher Part B premium based on their Modified
Adjusted Gross Income, known as the Income-Related Monthly Adjustment Amount
(IRMAA) .
Q4. Medicare Part B covers which of the following services?
A. Inpatient surgery
B. Outpatient physician services and preventive care
C. Long-term custodial care in a nursing home
D. Routine cosmetic procedures
, 2
Answer: B
Rationale: Part B covers medically necessary outpatient services, doctor visits, durable
medical equipment, and preventive care .
Q5. What percentage of the Medicare-approved amount does a beneficiary typically pay for
Part B covered services after meeting their annual deductible?
A. 10%
B. 20%
C. 30%
D. 50%
Answer: B
Rationale: Under Original Medicare Part B, the beneficiary is responsible for a 20%
coinsurance after the annual deductible is satisfied .
Q6. What is another common name for Medicare Part C plans?
A. Medicare Supplement Plans
B. Medicare Advantage Plans
C. Standalone Prescription Drug Plans
D. Medicaid Wrap Plans
Answer: B
Rationale: Medicare Part C is officially known as the Medicare Advantage program, which
allows private insurance companies approved by CMS to deliver Part A and Part B benefits .
Q7. Which of the following is true regarding a beneficiary enrolled in a Medicare Advantage
plan?
A. They lose their Medicare rights and protections
B. They must still pay their Medicare Part B monthly premium
C. They no longer have coverage for emergency room care
D. They cannot be billed any copayments or deductibles
Answer: B
Rationale: To enroll and remain in a Medicare Advantage plan, a beneficiary must continue
to pay their Medicare Part B monthly premium .
Q8. Which organization establishes many of the regulations governing Medicare Advantage
and Part D plans?
A. State insurance departments
B. CMS (Centers for Medicare & Medicaid Services)
C. The Department of Labor
D. The Federal Trade Commission
, 3
Answer: B
Rationale: CMS establishes and enforces federal regulations for Medicare Advantage and
Medicare Part D plans .
Q9. Which individual would generally qualify for Medicare before reaching age 65?
A. A healthy 40-year-old employed full time
B. A 52-year-old with a qualifying disability who meets Medicare eligibility requirements
C. A 60-year-old with employer-sponsored insurance only
D. A 45-year-old who purchases private insurance
Answer: B
Rationale: Individuals under age 65 may qualify for Medicare because of certain disabilities
or qualifying medical conditions established under federal law .
Q10. Which statement best describes the difference between Medicare and Medicaid?
A. Medicare is state-administered, while Medicaid is federally administered
B. Medicare is a federal health insurance program for eligible individuals, while Medicaid is a
joint federal-state program for eligible individuals based on state-specific rules
C. Medicare and Medicaid are the same program with different names
D. Medicaid automatically replaces Medicare once a person turns 65
Answer: B
Rationale: Medicare and Medicaid are separate programs with different eligibility
requirements, funding structures, and administration .
Q11. Which document provides the official evidence of Medicare coverage for a beneficiary?
A. Social Security card
B. Medicare identification card
C. Driver's license
D. Birth certificate
Answer: B
Rationale: The Medicare identification card confirms Medicare enrollment and contains
information needed to verify coverage .
Q12. An insurance agent should primarily rely on which source when explaining Medicare
benefits to a beneficiary?
A. Personal experience with Medicare
B. Official CMS-approved materials
C. Social media posts
D. Unofficial online forums
