AHIP Final Exam Practice 2025/2026 –
Actual 135 Questions with Correct
Answers (100% Verified, Graded A+)
Section 1: Medicare Basics
What services does Original Medicare (Parts A and B) cover?
Answer: Hospital care, physician services, and preventive care
Rationale: Part A covers inpatient hospital stays, and Part B covers outpatient services
and preventive care.
What is Medicare Part A?
Answer: Covers inpatient hospital stays, skilled nursing, and hospice care
Rationale: Part A is hospital insurance for eligible beneficiaries.
What is Medicare Part B?
Answer: Covers physician services, outpatient care, and preventive services
Rationale: Part B is medical insurance with a monthly premium.
Who is eligible for Medicare?
Answer: Individuals aged 65 or older, or those with certain disabilities or ESRD
Rationale: Eligibility includes age, disability, or end-stage renal disease (ESRD).
What is the premium for Medicare Part A if someone worked 40 quarters?
Answer: Free
Rationale: No premium for those who paid Medicare taxes for 40 quarters.
, What is the penalty for late enrollment in Medicare Part A?
Answer: Up to 10% unless enrolled during a Special Enrollment Period
Rationale: Late enrollment incurs a penalty unless covered by employer group plans.
What is the standard monthly premium for Medicare Part B in 2025?
Answer: Varies by income, typically around $185.00
Rationale: Part B premiums are income-based, with a standard base amount.
What does Original Medicare not cover?
Answer: Dental, vision, hearing aids, and most prescription drugs
Rationale: These require supplemental or Part D plans.
What is the General Enrollment Period for Medicare Part B?
Answer: January 1 to March 31, coverage starts July 1
Rationale: For those who missed their Initial Enrollment Period (IEP).
What is the Initial Enrollment Period (IEP) for Medicare?
Answer: Seven-month period around the 65th birthday
Rationale: Three months before, the month of, and three months after turning 65.
Section 2: Medicare Advantage (MA) and Part D Plans
What are types of Medicare Advantage plans?
Answer: HMO, PPO, PFFS, MSA, Cost Plans
Rationale: These plans offer different structures for delivering Medicare benefits.
What is a Medicare Advantage HMO plan?
Answer: Requires use of in-network providers and a primary care physician
Rationale: HMOs emphasize coordinated care within a network.
, What is a Medicare Advantage PPO plan?
Answer: Allows out-of-network providers at a higher cost
Rationale: PPOs offer flexibility with broader provider access.
What is a Medicare Advantage PFFS plan?
Answer: Private Fee-for-Service plan with provider acceptance of plan terms
Rationale: Providers must agree to the plan’s payment terms.
What is a Medicare Advantage MSA plan?
Answer: Combines high-deductible plan with a medical savings account
Rationale: Beneficiaries manage funds for medical expenses.
What is Medicare Part D?
Answer: Prescription drug coverage
Rationale: Offered through private plans approved by CMS.
What is the coverage gap (donut hole) in Part D?
Answer: Phase where beneficiaries pay more until reaching catastrophic coverage
Rationale: Occurs after initial coverage limit is reached.
What happens to Mr. Katz in the Part D coverage gap if his drug costs remain the
same?
Answer: He will face similar out-of-pocket costs as last year
Rationale: Stable plan and drug costs result in consistent gap expenses.
What is the maximum out-of-pocket limit for MA plans in 2025?
Answer: Varies by plan, typically around $8,850 for in-network services
Rationale: CMS sets annual limits to protect beneficiaries.
Can someone with ESRD enroll in a Medicare Advantage plan?
Answer: Yes, since 2021, most MA plans accept ESRD patients
Rationale: CMS expanded MA eligibility for ESRD patients.
Actual 135 Questions with Correct
Answers (100% Verified, Graded A+)
Section 1: Medicare Basics
What services does Original Medicare (Parts A and B) cover?
Answer: Hospital care, physician services, and preventive care
Rationale: Part A covers inpatient hospital stays, and Part B covers outpatient services
and preventive care.
What is Medicare Part A?
Answer: Covers inpatient hospital stays, skilled nursing, and hospice care
Rationale: Part A is hospital insurance for eligible beneficiaries.
What is Medicare Part B?
Answer: Covers physician services, outpatient care, and preventive services
Rationale: Part B is medical insurance with a monthly premium.
Who is eligible for Medicare?
Answer: Individuals aged 65 or older, or those with certain disabilities or ESRD
Rationale: Eligibility includes age, disability, or end-stage renal disease (ESRD).
What is the premium for Medicare Part A if someone worked 40 quarters?
Answer: Free
Rationale: No premium for those who paid Medicare taxes for 40 quarters.
, What is the penalty for late enrollment in Medicare Part A?
Answer: Up to 10% unless enrolled during a Special Enrollment Period
Rationale: Late enrollment incurs a penalty unless covered by employer group plans.
What is the standard monthly premium for Medicare Part B in 2025?
Answer: Varies by income, typically around $185.00
Rationale: Part B premiums are income-based, with a standard base amount.
What does Original Medicare not cover?
Answer: Dental, vision, hearing aids, and most prescription drugs
Rationale: These require supplemental or Part D plans.
What is the General Enrollment Period for Medicare Part B?
Answer: January 1 to March 31, coverage starts July 1
Rationale: For those who missed their Initial Enrollment Period (IEP).
What is the Initial Enrollment Period (IEP) for Medicare?
Answer: Seven-month period around the 65th birthday
Rationale: Three months before, the month of, and three months after turning 65.
Section 2: Medicare Advantage (MA) and Part D Plans
What are types of Medicare Advantage plans?
Answer: HMO, PPO, PFFS, MSA, Cost Plans
Rationale: These plans offer different structures for delivering Medicare benefits.
What is a Medicare Advantage HMO plan?
Answer: Requires use of in-network providers and a primary care physician
Rationale: HMOs emphasize coordinated care within a network.
, What is a Medicare Advantage PPO plan?
Answer: Allows out-of-network providers at a higher cost
Rationale: PPOs offer flexibility with broader provider access.
What is a Medicare Advantage PFFS plan?
Answer: Private Fee-for-Service plan with provider acceptance of plan terms
Rationale: Providers must agree to the plan’s payment terms.
What is a Medicare Advantage MSA plan?
Answer: Combines high-deductible plan with a medical savings account
Rationale: Beneficiaries manage funds for medical expenses.
What is Medicare Part D?
Answer: Prescription drug coverage
Rationale: Offered through private plans approved by CMS.
What is the coverage gap (donut hole) in Part D?
Answer: Phase where beneficiaries pay more until reaching catastrophic coverage
Rationale: Occurs after initial coverage limit is reached.
What happens to Mr. Katz in the Part D coverage gap if his drug costs remain the
same?
Answer: He will face similar out-of-pocket costs as last year
Rationale: Stable plan and drug costs result in consistent gap expenses.
What is the maximum out-of-pocket limit for MA plans in 2025?
Answer: Varies by plan, typically around $8,850 for in-network services
Rationale: CMS sets annual limits to protect beneficiaries.
Can someone with ESRD enroll in a Medicare Advantage plan?
Answer: Yes, since 2021, most MA plans accept ESRD patients
Rationale: CMS expanded MA eligibility for ESRD patients.
