AHIP Final Exam Latest (2025/2026) | 50
Verified Questions and Correct Answers |
A+ Graded
AHIP Practice Questions (2025/2026)
1. Which of the following is true about Medicare Part A?
A) It covers prescription drugs
B) It is optional and requires a monthly premium for most people
C) It covers inpatient hospital care, skilled nursing facility care, and some home health services
D) It covers routine dental and vision care
Answer: C
Explanation: Medicare Part A primarily covers inpatient hospital care, skilled nursing facility
care, hospice, and some home health services. Most people receive it premium-free if they paid
Medicare taxes while working.
2. Medicare Part B covers:
A) Inpatient hospital stays
B) Outpatient services, doctor visits, and preventive services
C) Prescription drugs
D) Long-term nursing home care
Answer: B
Explanation: Part B pays for outpatient services, doctor visits, preventive screenings, and
durable medical equipment. It usually requires a monthly premium.
3. A Medicare Advantage Plan is:
A) Another name for Original Medicare
B) A plan offered by private insurers that covers Parts A, B, and usually D
C) Only for people under 65
D) Mandatory for all Medicare beneficiaries
,Answer: B
Explanation: Medicare Advantage (Part C) plans are offered by private insurers and combine
Medicare Part A, Part B, and often Part D benefits.
4. Which period allows beneficiaries to join, switch, or drop a Medicare Advantage plan
each year?
A) Open Enrollment Period (OEP)
B) Annual Election Period (AEP)
C) Initial Enrollment Period (IEP)
D) Special Enrollment Period (SEP)
Answer: B
Explanation: The Annual Election Period runs from October 15 to December 7, allowing
beneficiaries to make changes to their Medicare Advantage or Part D plans.
5. What is the “donut hole” in Medicare Part D?
A) A gap in coverage after initial drug costs until catastrophic coverage starts
B) Free preventive drug coverage
C) Coverage for brand-name drugs only
D) Extra benefits for low-income beneficiaries
Answer: A
Explanation: The coverage gap (“donut hole”) occurs after total drug costs reach a certain
limit, before catastrophic coverage begins, where beneficiaries pay a higher cost share.
6. Which type of plan charges a network-based premium and often requires referrals for
specialists?
A) PPO
B) HMO
C) Original Medicare
D) Medigap
Answer: B
Explanation: Health Maintenance Organization (HMO) plans require members to use network
providers and often need referrals to see specialists.
7. Medigap (Medicare Supplement) plans:
A) Replace Medicare Part A and B
, B) Help cover out-of-pocket costs in Original Medicare
C) Are included with Medicare Advantage plans
D) Cover prescription drugs
Answer: B
Explanation: Medigap plans help pay deductibles, coinsurance, and copayments in Original
Medicare. They do not cover prescription drugs.
8. HIPAA primarily protects:
A) Prescription coverage
B) Private health information
C) Medicare Advantage enrollment
D) Health insurance premiums
Answer: B
Explanation: The Health Insurance Portability and Accountability Act (HIPAA) protects the
privacy and security of personal health information.
9. During a Special Enrollment Period (SEP), a beneficiary can:
A) Only enroll in Part D
B) Make plan changes due to qualifying life events (e.g., moving or losing other coverage)
C) Switch any plan at any time without reason
D) Delay paying premiums
Answer: B
Explanation: SEPs allow plan changes outside the Annual Election Period for qualifying life
events, such as relocation, loss of coverage, or dual-eligibility.
10. CMS stands for:
A) Center for Medicare Services
B) Centers for Medicare & Medicaid Services
C) Certified Medical Specialist
D) Coverage Management System
Answer: B
Explanation: CMS oversees Medicare, Medicaid, and related health programs, ensuring
compliance and program integrity.
Verified Questions and Correct Answers |
A+ Graded
AHIP Practice Questions (2025/2026)
1. Which of the following is true about Medicare Part A?
A) It covers prescription drugs
B) It is optional and requires a monthly premium for most people
C) It covers inpatient hospital care, skilled nursing facility care, and some home health services
D) It covers routine dental and vision care
Answer: C
Explanation: Medicare Part A primarily covers inpatient hospital care, skilled nursing facility
care, hospice, and some home health services. Most people receive it premium-free if they paid
Medicare taxes while working.
2. Medicare Part B covers:
A) Inpatient hospital stays
B) Outpatient services, doctor visits, and preventive services
C) Prescription drugs
D) Long-term nursing home care
Answer: B
Explanation: Part B pays for outpatient services, doctor visits, preventive screenings, and
durable medical equipment. It usually requires a monthly premium.
3. A Medicare Advantage Plan is:
A) Another name for Original Medicare
B) A plan offered by private insurers that covers Parts A, B, and usually D
C) Only for people under 65
D) Mandatory for all Medicare beneficiaries
,Answer: B
Explanation: Medicare Advantage (Part C) plans are offered by private insurers and combine
Medicare Part A, Part B, and often Part D benefits.
4. Which period allows beneficiaries to join, switch, or drop a Medicare Advantage plan
each year?
A) Open Enrollment Period (OEP)
B) Annual Election Period (AEP)
C) Initial Enrollment Period (IEP)
D) Special Enrollment Period (SEP)
Answer: B
Explanation: The Annual Election Period runs from October 15 to December 7, allowing
beneficiaries to make changes to their Medicare Advantage or Part D plans.
5. What is the “donut hole” in Medicare Part D?
A) A gap in coverage after initial drug costs until catastrophic coverage starts
B) Free preventive drug coverage
C) Coverage for brand-name drugs only
D) Extra benefits for low-income beneficiaries
Answer: A
Explanation: The coverage gap (“donut hole”) occurs after total drug costs reach a certain
limit, before catastrophic coverage begins, where beneficiaries pay a higher cost share.
6. Which type of plan charges a network-based premium and often requires referrals for
specialists?
A) PPO
B) HMO
C) Original Medicare
D) Medigap
Answer: B
Explanation: Health Maintenance Organization (HMO) plans require members to use network
providers and often need referrals to see specialists.
7. Medigap (Medicare Supplement) plans:
A) Replace Medicare Part A and B
, B) Help cover out-of-pocket costs in Original Medicare
C) Are included with Medicare Advantage plans
D) Cover prescription drugs
Answer: B
Explanation: Medigap plans help pay deductibles, coinsurance, and copayments in Original
Medicare. They do not cover prescription drugs.
8. HIPAA primarily protects:
A) Prescription coverage
B) Private health information
C) Medicare Advantage enrollment
D) Health insurance premiums
Answer: B
Explanation: The Health Insurance Portability and Accountability Act (HIPAA) protects the
privacy and security of personal health information.
9. During a Special Enrollment Period (SEP), a beneficiary can:
A) Only enroll in Part D
B) Make plan changes due to qualifying life events (e.g., moving or losing other coverage)
C) Switch any plan at any time without reason
D) Delay paying premiums
Answer: B
Explanation: SEPs allow plan changes outside the Annual Election Period for qualifying life
events, such as relocation, loss of coverage, or dual-eligibility.
10. CMS stands for:
A) Center for Medicare Services
B) Centers for Medicare & Medicaid Services
C) Certified Medical Specialist
D) Coverage Management System
Answer: B
Explanation: CMS oversees Medicare, Medicaid, and related health programs, ensuring
compliance and program integrity.
