AHIP 2026/2027 FINAL EXAM | 155
VERIFIED QUESTIONS & ANSWERS
WITH RATIONALES | MEDICARE
ADVANTAGE & PART D
CERTIFICATION | INSTANT
DOWNLOAD PDF
Medicare Basics & Eligibility
Q1. Ms. Henderson believes she will qualify for Medicare coverage at age 65
without paying any premiums because she worked for 40 years. What should
you tell her?
• A) All Medicare coverage is premium-free after 40 years of work.
• B) To obtain Part B coverage, she must pay a standard monthly premium,
though it is higher for individuals with higher incomes.
• C) Both Part A and Part B will be premium-free.
• D) She will not qualify for any Medicare coverage.
Answer: B.
Rationale: While most people do not pay a premium for Part A based on work history
(40 quarters), Part B always requires a monthly premium. This premium is subject to
income-related increases (IRMAA) for higher-income individuals .
Q2. A 67-year-old individual with a high annual income of $250,000 asks if they
are eligible for Medicare. Which statement is correct?
• A) They are ineligible for Medicare due to high income.
• B) They are eligible for Medicare, but high income may increase their Part B
and Part D premiums.
• C) They can only enroll in Medicare Advantage, not Original Medicare.
• D) They must wait until age 70 to enroll.
Answer: B.
Rationale: Medicare eligibility is not income-based; it is based on age (65+) or
,qualifying disabilities. However, high-income beneficiaries pay Income-Related
Monthly Adjustment Amounts (IRMAA) for Parts B and D .
Q3. Which of the following services is covered under Medicare Part A?
• A) Annual wellness visit with a primary care physician.
• B) Inpatient hospital stay and skilled nursing facility care.
• C) Outpatient physical therapy.
• D) Prescription drugs purchased at a retail pharmacy.
Answer: B.
Rationale: Part A covers inpatient hospital care, skilled nursing facility (SNF) care,
hospice, and limited home health. Annual wellness visits and outpatient therapy are
Part B services. Retail prescription drugs are covered under Part D .
Enrollment & Special Enrollment Periods (SEPs)
Q4. Anthony turned 65 but was not receiving Social Security benefits. Before he
could enroll, a natural disaster was declared in his area, and his Initial
Enrollment Period (IEP) expired. How can he obtain Medicare coverage now?
• A) He cannot enroll until the next Annual Enrollment Period.
• B) He is eligible for a Special Enrollment Period (SEP) of six months after the
end of the disaster declaration.
• C) He must pay a late penalty for Part B regardless of the disaster.
• D) He must wait until he turns 70.
Answer: B.
Rationale: CMS provides Special Enrollment Periods (SEPs) for individuals affected by
declared disasters or emergencies, allowing them extra time to enroll without penalty .
Q5. Juan Perez is turning 65 and works for a company with 15 employees that
offers group health coverage. How would you respond about Medicare?
• A) Juan will not be entitled to Medicare until he retires.
• B) Juan will be eligible for Medicare; if he enrolls, Medicare would become the
primary payor, and the small employer plan may be secondary.
• C) Juan should keep only his employer coverage and decline Medicare.
• D) Juan is ineligible for Medicare since the company has only 15 employees.
Answer: B.
Rationale: When an employer has fewer than 20 employees, Medicare becomes the
,primary payor for employees aged 65+. The employer group health plan may be
secondary or may decline to provide coverage comparable to those under 65 .
Medigap & Coordination of Benefits
Q6. Mr. Capadona wants to purchase a Medicare Advantage (MA) plan and a
Medigap plan to pick up costs not covered by the MA plan. What should you
tell him?
• A) You can sell him a Medigap plan to help with costs not covered under
Medicare Advantage.
• B) It is illegal for you to sell him a Medigap plan if he is enrolled in an MA
plan; Medigap only works with Original Medicare.
• C) Medigap plans are designed to work alongside Medicare Advantage plans.
• D) He must enroll in Medigap first before joining an MA plan.
Answer: B.
Rationale: Federal law prohibits the issuance of a Medigap policy to anyone currently
enrolled in a Medicare Advantage plan. Medigap cannot pay costs associated with MA
plans. This ensures coordination of benefits and prevents duplicate coverage .
Part D & Low-Income Assistance
Q7. Mrs. Cook is an elderly retiree with a low fixed income. What could you tell
her that might be of assistance with her Medicare costs?
• A) She should apply for a Medigap policy.
• B) She should contact her state Medicaid agency to see if she qualifies for
programs that help with Medicare costs.
• C) She is not eligible for financial assistance.
• D) Only the federal government offers help.
Answer: B.
Rationale: Most states offer Medicare Savings Programs (MSPs) and Medicaid, which
can pay Medicare premiums, deductibles, and coinsurance for low-income seniors.
Eligibility varies by state .
, Compliance & Marketing (FWA)
Q8. Which of the following is considered "creditable coverage" for Part D
purposes?
• A) A discount drug card.
• B) Coverage through the VA that pays as much as standard Part D.
• C) A hospital indemnity policy.
• D) A short-term limited-duration plan.
Answer: B.
Rationale: Creditable coverage is prescription drug coverage that is expected to pay,
on average, at least as much as Medicare's standard Part D coverage. VA drug
coverage is generally considered creditable .
Enrollment & Eligibility
Q9. Margaret turned 65 on March 15, 2026. She has not yet enrolled in
Medicare. During what time frame is her Initial Enrollment Period (IEP)?
• A) Only during the month of her 65th birthday
• B) The 7-month period that includes 3 months before her 65th birthday, the
month of her birthday, and 3 months after her birthday (December 2025 –
June 2026)
• C) January 1 through March 31, 2027 only
• D) Anytime she decides to enroll after turning 65
Answer: B.
Rationale: The Medicare Initial Enrollment Period is a 7-month window: the 3 months
before the month you turn 65, the birthday month itself, and the 3 months after. For
Margaret, that runs December 2025 through June 2026 .
Q10. Robert is 67 years old and delayed enrolling in Part B because he had
employer coverage through his job. He just retired on July 1, 2026, and lost
that coverage. What type of enrollment period does Robert have?
• A) Initial Enrollment Period (IEP)
• B) Annual Enrollment Period (AEP)
• C) Special Enrollment Period (SEP) due to loss of employer-based coverage
• D) Open Enrollment Period (OEP)
Answer: C.
Rationale: When someone delays Part B enrollment because of creditable employer
VERIFIED QUESTIONS & ANSWERS
WITH RATIONALES | MEDICARE
ADVANTAGE & PART D
CERTIFICATION | INSTANT
DOWNLOAD PDF
Medicare Basics & Eligibility
Q1. Ms. Henderson believes she will qualify for Medicare coverage at age 65
without paying any premiums because she worked for 40 years. What should
you tell her?
• A) All Medicare coverage is premium-free after 40 years of work.
• B) To obtain Part B coverage, she must pay a standard monthly premium,
though it is higher for individuals with higher incomes.
• C) Both Part A and Part B will be premium-free.
• D) She will not qualify for any Medicare coverage.
Answer: B.
Rationale: While most people do not pay a premium for Part A based on work history
(40 quarters), Part B always requires a monthly premium. This premium is subject to
income-related increases (IRMAA) for higher-income individuals .
Q2. A 67-year-old individual with a high annual income of $250,000 asks if they
are eligible for Medicare. Which statement is correct?
• A) They are ineligible for Medicare due to high income.
• B) They are eligible for Medicare, but high income may increase their Part B
and Part D premiums.
• C) They can only enroll in Medicare Advantage, not Original Medicare.
• D) They must wait until age 70 to enroll.
Answer: B.
Rationale: Medicare eligibility is not income-based; it is based on age (65+) or
,qualifying disabilities. However, high-income beneficiaries pay Income-Related
Monthly Adjustment Amounts (IRMAA) for Parts B and D .
Q3. Which of the following services is covered under Medicare Part A?
• A) Annual wellness visit with a primary care physician.
• B) Inpatient hospital stay and skilled nursing facility care.
• C) Outpatient physical therapy.
• D) Prescription drugs purchased at a retail pharmacy.
Answer: B.
Rationale: Part A covers inpatient hospital care, skilled nursing facility (SNF) care,
hospice, and limited home health. Annual wellness visits and outpatient therapy are
Part B services. Retail prescription drugs are covered under Part D .
Enrollment & Special Enrollment Periods (SEPs)
Q4. Anthony turned 65 but was not receiving Social Security benefits. Before he
could enroll, a natural disaster was declared in his area, and his Initial
Enrollment Period (IEP) expired. How can he obtain Medicare coverage now?
• A) He cannot enroll until the next Annual Enrollment Period.
• B) He is eligible for a Special Enrollment Period (SEP) of six months after the
end of the disaster declaration.
• C) He must pay a late penalty for Part B regardless of the disaster.
• D) He must wait until he turns 70.
Answer: B.
Rationale: CMS provides Special Enrollment Periods (SEPs) for individuals affected by
declared disasters or emergencies, allowing them extra time to enroll without penalty .
Q5. Juan Perez is turning 65 and works for a company with 15 employees that
offers group health coverage. How would you respond about Medicare?
• A) Juan will not be entitled to Medicare until he retires.
• B) Juan will be eligible for Medicare; if he enrolls, Medicare would become the
primary payor, and the small employer plan may be secondary.
• C) Juan should keep only his employer coverage and decline Medicare.
• D) Juan is ineligible for Medicare since the company has only 15 employees.
Answer: B.
Rationale: When an employer has fewer than 20 employees, Medicare becomes the
,primary payor for employees aged 65+. The employer group health plan may be
secondary or may decline to provide coverage comparable to those under 65 .
Medigap & Coordination of Benefits
Q6. Mr. Capadona wants to purchase a Medicare Advantage (MA) plan and a
Medigap plan to pick up costs not covered by the MA plan. What should you
tell him?
• A) You can sell him a Medigap plan to help with costs not covered under
Medicare Advantage.
• B) It is illegal for you to sell him a Medigap plan if he is enrolled in an MA
plan; Medigap only works with Original Medicare.
• C) Medigap plans are designed to work alongside Medicare Advantage plans.
• D) He must enroll in Medigap first before joining an MA plan.
Answer: B.
Rationale: Federal law prohibits the issuance of a Medigap policy to anyone currently
enrolled in a Medicare Advantage plan. Medigap cannot pay costs associated with MA
plans. This ensures coordination of benefits and prevents duplicate coverage .
Part D & Low-Income Assistance
Q7. Mrs. Cook is an elderly retiree with a low fixed income. What could you tell
her that might be of assistance with her Medicare costs?
• A) She should apply for a Medigap policy.
• B) She should contact her state Medicaid agency to see if she qualifies for
programs that help with Medicare costs.
• C) She is not eligible for financial assistance.
• D) Only the federal government offers help.
Answer: B.
Rationale: Most states offer Medicare Savings Programs (MSPs) and Medicaid, which
can pay Medicare premiums, deductibles, and coinsurance for low-income seniors.
Eligibility varies by state .
, Compliance & Marketing (FWA)
Q8. Which of the following is considered "creditable coverage" for Part D
purposes?
• A) A discount drug card.
• B) Coverage through the VA that pays as much as standard Part D.
• C) A hospital indemnity policy.
• D) A short-term limited-duration plan.
Answer: B.
Rationale: Creditable coverage is prescription drug coverage that is expected to pay,
on average, at least as much as Medicare's standard Part D coverage. VA drug
coverage is generally considered creditable .
Enrollment & Eligibility
Q9. Margaret turned 65 on March 15, 2026. She has not yet enrolled in
Medicare. During what time frame is her Initial Enrollment Period (IEP)?
• A) Only during the month of her 65th birthday
• B) The 7-month period that includes 3 months before her 65th birthday, the
month of her birthday, and 3 months after her birthday (December 2025 –
June 2026)
• C) January 1 through March 31, 2027 only
• D) Anytime she decides to enroll after turning 65
Answer: B.
Rationale: The Medicare Initial Enrollment Period is a 7-month window: the 3 months
before the month you turn 65, the birthday month itself, and the 3 months after. For
Margaret, that runs December 2025 through June 2026 .
Q10. Robert is 67 years old and delayed enrolling in Part B because he had
employer coverage through his job. He just retired on July 1, 2026, and lost
that coverage. What type of enrollment period does Robert have?
• A) Initial Enrollment Period (IEP)
• B) Annual Enrollment Period (AEP)
• C) Special Enrollment Period (SEP) due to loss of employer-based coverage
• D) Open Enrollment Period (OEP)
Answer: C.
Rationale: When someone delays Part B enrollment because of creditable employer
