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AHIP 2025/2026 Final Actual Exam –
Updated Questions and Full Verified
Answers | 100% Guaranteed Pass with
Complete Module 1–5 Coverage
Below are 150 non-repeating, updated, and realistic multiple-choice questions for the AHIP
2025/2026 Final Exam, covering Modules 1–5 (Medicare Program Basics, Medicare Health
Plans, Medicare Part D, Marketing Medicare Advantage and Part D Plans, and Enrollment
Guidance). The questions reflect Medicare marketing guidelines, fraud, waste, and abuse (FWA),
enrollment periods, plan types, and compliance. Each question includes the correct answer in
blue followed by a concise, expert-level explanation based on current CMS guidelines and AHIP
training standards.
Module 1: Overview of Medicare Program Basics: Choices,
Eligibility, and Benefits
1. Who is eligible for Medicare Part A without paying a premium?
A. Individuals under 65 with private insurance
B. Individuals 65 or older who paid Medicare taxes for at least 40 quarters
C. Non-residents of the United States
D. Individuals enrolled in a Medicare Advantage plan
Correct Answer: B. Individuals 65 or older who paid Medicare taxes for at least 40
quarters
Explanation: Individuals aged 65 or older who have paid Medicare taxes for at least 40
quarters (10 years) qualify for premium-free Part A. Those under 65 may qualify due to
disability or ESRD, but not private insurance. Non-residents and MA enrollment do not
affect Part A eligibility.
2. What does Medicare Part B primarily cover?
A. Inpatient hospital stays
B. Outpatient physician services
C. Prescription drugs
D. Long-term nursing home care
Correct Answer: B. Outpatient physician services
Explanation: Part B covers outpatient services, including physician visits, diagnostic
tests, and preventive care. Part A covers inpatient stays, Part D covers prescription drugs,
and long-term nursing home care is not covered by Medicare.
3. Which group is automatically enrolled in Medicare Part B upon turning 65?
A. Individuals receiving Social Security benefits
B. Individuals with employer-sponsored coverage
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C. Non-citizens residing in the U.S.
D. Individuals enrolled in Medicaid only
Correct Answer: A. Individuals receiving Social Security benefits
Explanation: Individuals receiving Social Security benefits are automatically enrolled in
Parts A and B at 65. Others must manually enroll during their Initial Enrollment Period
(IEP).
4. What is the penalty for late enrollment in Medicare Part B for someone without
creditable coverage?
A. 5% premium increase per year delayed
B. 10% premium increase per year delayed
C. One-time $500 fine
D. No penalty applies
Correct Answer: B. 10% premium increase per year delayed
Explanation: Late enrollment in Part B without creditable coverage incurs a 10%
premium increase for each 12-month period of delay, applied permanently to the
premium.
5. Which service is covered under Original Medicare with no cost-sharing for
beneficiaries?
A. Routine dental care
B. Preventive services like annual wellness visits
C. Cosmetic surgery
D. Prescription eyeglasses
Correct Answer: B. Preventive services like annual wellness visits
Explanation: Original Medicare covers many preventive services (e.g., annual wellness
visits, screenings) with no cost-sharing if criteria are met. Dental care, cosmetic surgery,
and eyeglasses are generally not covered.
6. Mrs. Chen, a U.S. citizen for 15 years, is turning 65 and has worked full-time for 12
years. Is she eligible for premium-free Part A?
A. No, she must work for 15 years
B. Yes, she qualifies based on her work history
C. No, she must be a citizen for 20 years
D. Yes, but only if enrolled in Part B
Correct Answer: B. Yes, she qualifies based on her work history
Explanation: Mrs. Chen qualifies for premium-free Part A because she paid Medicare
taxes for over 40 quarters (10 years). Citizenship duration and Part B enrollment do not
affect Part A eligibility.
7. What is the duration of the Initial Enrollment Period (IEP) for Medicare?
A. 3 months before and after the 65th birthday
B. 3 months before, the month of, and 3 months after the 65th birthday
C. 6 months after the 65th birthday
D. 12 months before the 65th birthday
Correct Answer: B. 3 months before, the month of, and 3 months after the 65th
birthday
Explanation: The IEP for Medicare is a 7-month period: 3 months before, the month of,
and 3 months after the individual’s 65th birthday.
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8. Which of the following is NOT covered by Medicare Part A?
A. Hospice care
B. Skilled nursing facility care
C. Routine vision exams
D. Home health services
Correct Answer: C. Routine vision exams
Explanation: Part A covers hospice, skilled nursing facility care (with conditions), and
home health services. Routine vision exams are not covered by Part A or B.
9. Mr. Patel is 66 and wants to know his hospital costs under Original Medicare. What
should you tell him?
A. No costs for the first 30 days
B. A single deductible for the first 60 days, then daily coinsurance
C. A daily copayment for all days
D. Full coverage with no out-of-pocket costs
Correct Answer: B. A single deductible for the first 60 days, then daily coinsurance
Explanation: Under Original Medicare, Part A has a deductible for the first 60 days of
inpatient hospital stays, followed by daily coinsurance for days 61–90.
10. Who can enroll in Medicare Part A due to end-stage renal disease (ESRD)?
A. Only individuals over 65
B. Individuals of any age with ESRD
C. Only U.S. citizens
D. Only those with private insurance
Correct Answer: B. Individuals of any age with ESRD
Explanation: Individuals with ESRD are eligible for Medicare Part A regardless of age,
provided they meet other criteria (e.g., Social Security eligibility).
11. What is the General Enrollment Period (GEP) for Medicare Parts A and B?
A. October 15–December 7
B. January 1–March 31
C. April 1–June 30
D. July 1–September 30
Correct Answer: B. January 1–March 31
Explanation: The GEP runs from January 1 to March 31 annually for those who missed
their IEP, with coverage starting July 1. Penalties may apply.
12. Which Medicare part covers home health services for medically necessary care?
A. Part A
B. Part B
C. Part C
D. Part D
Correct Answer: A. Part A
Explanation: Part A covers medically necessary home health services (e.g., skilled
nursing, therapy) for homebound beneficiaries. Part B may cover some outpatient
services.
13. Mrs. Quinn, 66, is automatically enrolled in Part B. What are her cost-sharing
responsibilities?
A. No costs for any services
B. Monthly premium and 20% coinsurance for most services
AHIP 2025/2026 Final Actual Exam –
Updated Questions and Full Verified
Answers | 100% Guaranteed Pass with
Complete Module 1–5 Coverage
Below are 150 non-repeating, updated, and realistic multiple-choice questions for the AHIP
2025/2026 Final Exam, covering Modules 1–5 (Medicare Program Basics, Medicare Health
Plans, Medicare Part D, Marketing Medicare Advantage and Part D Plans, and Enrollment
Guidance). The questions reflect Medicare marketing guidelines, fraud, waste, and abuse (FWA),
enrollment periods, plan types, and compliance. Each question includes the correct answer in
blue followed by a concise, expert-level explanation based on current CMS guidelines and AHIP
training standards.
Module 1: Overview of Medicare Program Basics: Choices,
Eligibility, and Benefits
1. Who is eligible for Medicare Part A without paying a premium?
A. Individuals under 65 with private insurance
B. Individuals 65 or older who paid Medicare taxes for at least 40 quarters
C. Non-residents of the United States
D. Individuals enrolled in a Medicare Advantage plan
Correct Answer: B. Individuals 65 or older who paid Medicare taxes for at least 40
quarters
Explanation: Individuals aged 65 or older who have paid Medicare taxes for at least 40
quarters (10 years) qualify for premium-free Part A. Those under 65 may qualify due to
disability or ESRD, but not private insurance. Non-residents and MA enrollment do not
affect Part A eligibility.
2. What does Medicare Part B primarily cover?
A. Inpatient hospital stays
B. Outpatient physician services
C. Prescription drugs
D. Long-term nursing home care
Correct Answer: B. Outpatient physician services
Explanation: Part B covers outpatient services, including physician visits, diagnostic
tests, and preventive care. Part A covers inpatient stays, Part D covers prescription drugs,
and long-term nursing home care is not covered by Medicare.
3. Which group is automatically enrolled in Medicare Part B upon turning 65?
A. Individuals receiving Social Security benefits
B. Individuals with employer-sponsored coverage
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C. Non-citizens residing in the U.S.
D. Individuals enrolled in Medicaid only
Correct Answer: A. Individuals receiving Social Security benefits
Explanation: Individuals receiving Social Security benefits are automatically enrolled in
Parts A and B at 65. Others must manually enroll during their Initial Enrollment Period
(IEP).
4. What is the penalty for late enrollment in Medicare Part B for someone without
creditable coverage?
A. 5% premium increase per year delayed
B. 10% premium increase per year delayed
C. One-time $500 fine
D. No penalty applies
Correct Answer: B. 10% premium increase per year delayed
Explanation: Late enrollment in Part B without creditable coverage incurs a 10%
premium increase for each 12-month period of delay, applied permanently to the
premium.
5. Which service is covered under Original Medicare with no cost-sharing for
beneficiaries?
A. Routine dental care
B. Preventive services like annual wellness visits
C. Cosmetic surgery
D. Prescription eyeglasses
Correct Answer: B. Preventive services like annual wellness visits
Explanation: Original Medicare covers many preventive services (e.g., annual wellness
visits, screenings) with no cost-sharing if criteria are met. Dental care, cosmetic surgery,
and eyeglasses are generally not covered.
6. Mrs. Chen, a U.S. citizen for 15 years, is turning 65 and has worked full-time for 12
years. Is she eligible for premium-free Part A?
A. No, she must work for 15 years
B. Yes, she qualifies based on her work history
C. No, she must be a citizen for 20 years
D. Yes, but only if enrolled in Part B
Correct Answer: B. Yes, she qualifies based on her work history
Explanation: Mrs. Chen qualifies for premium-free Part A because she paid Medicare
taxes for over 40 quarters (10 years). Citizenship duration and Part B enrollment do not
affect Part A eligibility.
7. What is the duration of the Initial Enrollment Period (IEP) for Medicare?
A. 3 months before and after the 65th birthday
B. 3 months before, the month of, and 3 months after the 65th birthday
C. 6 months after the 65th birthday
D. 12 months before the 65th birthday
Correct Answer: B. 3 months before, the month of, and 3 months after the 65th
birthday
Explanation: The IEP for Medicare is a 7-month period: 3 months before, the month of,
and 3 months after the individual’s 65th birthday.
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8. Which of the following is NOT covered by Medicare Part A?
A. Hospice care
B. Skilled nursing facility care
C. Routine vision exams
D. Home health services
Correct Answer: C. Routine vision exams
Explanation: Part A covers hospice, skilled nursing facility care (with conditions), and
home health services. Routine vision exams are not covered by Part A or B.
9. Mr. Patel is 66 and wants to know his hospital costs under Original Medicare. What
should you tell him?
A. No costs for the first 30 days
B. A single deductible for the first 60 days, then daily coinsurance
C. A daily copayment for all days
D. Full coverage with no out-of-pocket costs
Correct Answer: B. A single deductible for the first 60 days, then daily coinsurance
Explanation: Under Original Medicare, Part A has a deductible for the first 60 days of
inpatient hospital stays, followed by daily coinsurance for days 61–90.
10. Who can enroll in Medicare Part A due to end-stage renal disease (ESRD)?
A. Only individuals over 65
B. Individuals of any age with ESRD
C. Only U.S. citizens
D. Only those with private insurance
Correct Answer: B. Individuals of any age with ESRD
Explanation: Individuals with ESRD are eligible for Medicare Part A regardless of age,
provided they meet other criteria (e.g., Social Security eligibility).
11. What is the General Enrollment Period (GEP) for Medicare Parts A and B?
A. October 15–December 7
B. January 1–March 31
C. April 1–June 30
D. July 1–September 30
Correct Answer: B. January 1–March 31
Explanation: The GEP runs from January 1 to March 31 annually for those who missed
their IEP, with coverage starting July 1. Penalties may apply.
12. Which Medicare part covers home health services for medically necessary care?
A. Part A
B. Part B
C. Part C
D. Part D
Correct Answer: A. Part A
Explanation: Part A covers medically necessary home health services (e.g., skilled
nursing, therapy) for homebound beneficiaries. Part B may cover some outpatient
services.
13. Mrs. Quinn, 66, is automatically enrolled in Part B. What are her cost-sharing
responsibilities?
A. No costs for any services
B. Monthly premium and 20% coinsurance for most services
