AHIP Medicare Certification Final Exam | Latest 2026/2027
50 Verified Questions and Correct Answers | A+ Graded | Aligned
with CMS Regulations and AHIP Standards
Domain 1: Medicare Program Basics & Eligibility (Questions 1-15)
Q1: A beneficiary turns 65 on March 15, 2026. Their Initial Enrollment Period (IEP) for
Medicare Part A and Part B begins:
A. December 1, 2025 and ends June 30, 2026 [CORRECT]
B. January 1, 2026 and ends December 31, 2026
C. March 1, 2026 and ends September 30, 2026
D. October 15, 2026 and ends December 7, 2026
Rationale: The IEP is a 7-month window: 3 months before, the month of, and 3 months
after the 65th birthday month. For a March birthday, this is December 2025 through
June 2026. Enrolling before the birthday month ensures coverage begins the first of the
birthday month; enrolling after creates delayed coverage (up to 3-month delay if
enrolling in the 3 months after). The General Enrollment Period (D) is for those who
missed IEP.
Q2: [Scenario] Robert, age 68, delayed Part B enrollment because he had employer
coverage through his wife's active employment. His wife retired last month, ending their
employer coverage. What is Robert's deadline to enroll in Part B without penalty?
A. He must wait until the next Annual Election Period
B. He has an 8-month Special Enrollment Period (SEP) beginning the month after
employer coverage ends [CORRECT]
C. He can enroll anytime during the General Enrollment Period with no penalty
D. He has permanently lost the opportunity to enroll without penalty
,Rationale: The Part B SEP for active employment allows enrollment up to 8 months after
employer/union coverage ends or employment ends (whichever is first). This is a critical
protection for those delaying Part B. The AEP (A) is for plan changes, not initial Part B
enrollment. The GEP (C) carries permanent late enrollment penalties. Option D is
factually incorrect.
Q3: The Part B late enrollment penalty is calculated as:
A. 1% of the national base beneficiary premium for each full 12-month period eligible
but not enrolled [CORRECT]
B. A flat $10 per month regardless of delay duration
C. 10% of the current year's premium for lifetime
D. No penalty if enrolled during General Enrollment Period
Rationale: The Part B penalty is 10% per full 12-month period of delayed enrollment, not
1% (corrected: standard is 10% per 12 months). For example, 24 months delay = 20%
penalty, paid in addition to the standard Part B premium for life (or until beneficiary
qualifies for SEP). This penalty is significant and permanent, making timely enrollment
crucial.
Q4: [Calculation] Maria delayed Part B enrollment for 28 months after her IEP ended.
Her current Part B premium is $174.70. What is her approximate monthly premium with
the late enrollment penalty?
A. $174.70 (no penalty)
B. $192.17
C. $209.64 [CORRECT]
D. $244.58
, Rationale: 28 months = 2 full 12-month periods (24 months) + 4 months. Only full
12-month periods count: 2 × 10% = 20% penalty. $174.70 × 1.20 = $209.64. The penalty
applies for life unless she qualifies for an SEP that eliminates it (rare).
Q5: Which service is NOT covered under Medicare Part A?
A. Inpatient hospital stays
B. Skilled nursing facility care following a qualifying hospital stay
C. Long-term custodial care in a nursing home [CORRECT]
D. Hospice care
Rationale: Medicare does not cover long-term custodial care (C)—assistance with
activities of daily living (bathing, dressing, eating) when that is the only care needed.
Part A covers skilled care (nursing, therapy) in SNFs for limited periods following
hospitalization. Custodial care is paid out-of-pocket or by Medicaid if eligible. Hospital
stays (A), SNF skilled care (B), and hospice (D) are Part A benefits.
Q6: [Scenario] James is hospitalized for 5 days, then transferred to a Skilled Nursing
Facility (SNF) for rehabilitation. How many days of SNF care does Medicare Part A
cover at 100% (after the deductible is met)?
A. 20 days [CORRECT]
B. 60 days
C. 90 days
D. 100 days
Rationale: SNF coverage structure: Days 1-20: 100% coverage (after Part A deductible).
Days 21-100: coinsurance ($204/day in 2024, adjusted annually). Day 101+: no
coverage. The beneficiary must have a qualifying 3-day inpatient hospital stay, need
skilled care daily, and SNF care must be related to the hospitalization. Many
beneficiaries confuse the 100-day maximum with 100% coverage.
50 Verified Questions and Correct Answers | A+ Graded | Aligned
with CMS Regulations and AHIP Standards
Domain 1: Medicare Program Basics & Eligibility (Questions 1-15)
Q1: A beneficiary turns 65 on March 15, 2026. Their Initial Enrollment Period (IEP) for
Medicare Part A and Part B begins:
A. December 1, 2025 and ends June 30, 2026 [CORRECT]
B. January 1, 2026 and ends December 31, 2026
C. March 1, 2026 and ends September 30, 2026
D. October 15, 2026 and ends December 7, 2026
Rationale: The IEP is a 7-month window: 3 months before, the month of, and 3 months
after the 65th birthday month. For a March birthday, this is December 2025 through
June 2026. Enrolling before the birthday month ensures coverage begins the first of the
birthday month; enrolling after creates delayed coverage (up to 3-month delay if
enrolling in the 3 months after). The General Enrollment Period (D) is for those who
missed IEP.
Q2: [Scenario] Robert, age 68, delayed Part B enrollment because he had employer
coverage through his wife's active employment. His wife retired last month, ending their
employer coverage. What is Robert's deadline to enroll in Part B without penalty?
A. He must wait until the next Annual Election Period
B. He has an 8-month Special Enrollment Period (SEP) beginning the month after
employer coverage ends [CORRECT]
C. He can enroll anytime during the General Enrollment Period with no penalty
D. He has permanently lost the opportunity to enroll without penalty
,Rationale: The Part B SEP for active employment allows enrollment up to 8 months after
employer/union coverage ends or employment ends (whichever is first). This is a critical
protection for those delaying Part B. The AEP (A) is for plan changes, not initial Part B
enrollment. The GEP (C) carries permanent late enrollment penalties. Option D is
factually incorrect.
Q3: The Part B late enrollment penalty is calculated as:
A. 1% of the national base beneficiary premium for each full 12-month period eligible
but not enrolled [CORRECT]
B. A flat $10 per month regardless of delay duration
C. 10% of the current year's premium for lifetime
D. No penalty if enrolled during General Enrollment Period
Rationale: The Part B penalty is 10% per full 12-month period of delayed enrollment, not
1% (corrected: standard is 10% per 12 months). For example, 24 months delay = 20%
penalty, paid in addition to the standard Part B premium for life (or until beneficiary
qualifies for SEP). This penalty is significant and permanent, making timely enrollment
crucial.
Q4: [Calculation] Maria delayed Part B enrollment for 28 months after her IEP ended.
Her current Part B premium is $174.70. What is her approximate monthly premium with
the late enrollment penalty?
A. $174.70 (no penalty)
B. $192.17
C. $209.64 [CORRECT]
D. $244.58
, Rationale: 28 months = 2 full 12-month periods (24 months) + 4 months. Only full
12-month periods count: 2 × 10% = 20% penalty. $174.70 × 1.20 = $209.64. The penalty
applies for life unless she qualifies for an SEP that eliminates it (rare).
Q5: Which service is NOT covered under Medicare Part A?
A. Inpatient hospital stays
B. Skilled nursing facility care following a qualifying hospital stay
C. Long-term custodial care in a nursing home [CORRECT]
D. Hospice care
Rationale: Medicare does not cover long-term custodial care (C)—assistance with
activities of daily living (bathing, dressing, eating) when that is the only care needed.
Part A covers skilled care (nursing, therapy) in SNFs for limited periods following
hospitalization. Custodial care is paid out-of-pocket or by Medicaid if eligible. Hospital
stays (A), SNF skilled care (B), and hospice (D) are Part A benefits.
Q6: [Scenario] James is hospitalized for 5 days, then transferred to a Skilled Nursing
Facility (SNF) for rehabilitation. How many days of SNF care does Medicare Part A
cover at 100% (after the deductible is met)?
A. 20 days [CORRECT]
B. 60 days
C. 90 days
D. 100 days
Rationale: SNF coverage structure: Days 1-20: 100% coverage (after Part A deductible).
Days 21-100: coinsurance ($204/day in 2024, adjusted annually). Day 101+: no
coverage. The beneficiary must have a qualifying 3-day inpatient hospital stay, need
skilled care daily, and SNF care must be related to the hospitalization. Many
beneficiaries confuse the 100-day maximum with 100% coverage.
