AHIP Final Exam 2026/2027 –
Comprehensive Medicare and Compliance
Assessment Complete 100 Q&A Study Guide
with Detailed Rationales
1. Mr. Capadona would like to purchase a Medicare Advantage (MA) plan
and a Medigap plan to pick up costs not covered by that plan. What should
you tell him?
• A) He can enroll in both as long as he pays two separate premiums
• B) He should enroll in Medigap first, then MA
• C) It is illegal to sell Mr. Capadona a Medigap plan if he is enrolled in
an MA plan, and Medigap only works with Original Medicare
• D) He can use Medigap to cover MA deductibles
Rationale: It is illegal to sell a Medigap policy to someone enrolled in a Medicare
Advantage plan. Medigap plans only coordinate with Original Medicare (Parts A
and B), not with Medicare Advantage plans.
2. Mrs. West is a 67-year-old newly eligible Medicare beneficiary. When is her
Initial Enrollment Period (IEP)?
• A) 3 months before, the month of, and 3 months after her 65th birthday
• B) Only during her birth month
• C) 6 months before and 6 months after turning 65
• D) Only during the month of her 65th birthday
Rationale: The Initial Enrollment Period (IEP) for Medicare is a 7-month window
that includes the 3 months before the month of the 65th birthday, the birthday
month, and the 3 months after.
,3. Mr. Diaz continued working with his company and was insured under his
employer's group plan until he reached age 68. He has heard that there is a
premium penalty for those who did not sign up for Part B when first eligible.
What should you tell him?
• A) He will pay a 10% penalty for each year he delayed enrollment
• B) He will not pay any penalty because he had continuous coverage
under his employer's plan
• C) He will pay a 20% penalty
• D) He must pay the penalty regardless of prior coverage
Rationale: Mr. Diaz will not pay any penalty because he had continuous creditable
coverage under his employer's group plan. The Part B late enrollment penalty
applies only to individuals who did not have creditable coverage.
4. Mr. Moy will soon turn age 65. He wants to understand what coverage
Medicare Supplemental Insurance provides. What could you tell Mr. Moy?
• A) It covers everything Original Medicare does not
• B) It provides prescription drug coverage
• C) Medicare Supplemental Insurance would help cover his Part A
deductible and Part B coinsurance or copayments in Original Fee-for-
Service (FFS) Medicare as well as possibly some services that Medicare
does not cover
• D) It is only available for Medicare Advantage enrollees
Rationale: Medigap policies pay many out-of-pocket costs in Original Medicare,
including Part A deductibles and Part B coinsurance or copayments. They may also
cover some services that Medicare does not cover.
5. Edward suffered from serious kidney disease and became eligible for
Medicare due to end-stage renal disease (ESRD). A close relative donated
their kidney and Edward successfully underwent transplant surgery 12
,months ago. Edward is now age 50 and asks if his Medicare coverage will
continue. What should you say?
• A) His Medicare coverage will continue indefinitely
• B) Individuals eligible for Medicare based on ESRD generally lose
eligibility 36 months after the month in which they receive a kidney
transplant unless they are eligible on another basis
• C) He will lose eligibility immediately after the transplant
• D) He can keep Medicare for life
Rationale: Individuals eligible for Medicare based on ESRD generally lose
eligibility 36 months after the month of the kidney transplant unless they are
eligible on another basis such as age or disability.
6. What is the minimum age for Medicare eligibility for most individuals?
• A) 60 years old
• B) 65 years old
• C) 67 years old
• D) 70 years old
Rationale: Most individuals become eligible for Medicare at age 65. Exceptions
include individuals with disabilities or end-stage renal disease (ESRD).
7. Medicare Part A primarily covers which of the following?
• A) Hospital inpatient care, skilled nursing facility care, hospice, and
some home health care
• B) Outpatient medical services and preventive care
• C) Prescription drugs
• D) Dental and vision services
, Rationale: Medicare Part A covers inpatient hospital care, skilled nursing facility
care, hospice, and some home health care. Part B covers outpatient services, and
Part D covers prescription drugs.
8. Medicare Part B primarily covers which of the following?
• A) Hospital inpatient care
• B) Outpatient medical services, physician visits, and preventive care
• C) Prescription drugs
• D) Long-term care
Rationale: Medicare Part B covers outpatient medical services, physician visits,
preventive care, and some durable medical equipment. Part A covers inpatient
care.
9. Which of the following is TRUE about Medicare Part D?
• A) It covers all prescription drugs with no formulary restrictions
• B) It provides prescription drug coverage through private plans
approved by Medicare
• C) It is automatically included with Original Medicare
• D) It covers only generic medications
Rationale: Medicare Part D provides prescription drug coverage through private
plans approved by Medicare. Plans have formularies and may use step therapy or
prior authorization.
10. A beneficiary who is eligible for both Medicare and Medicaid is known as:
• A) A Medicare Advantage enrollee
• B) A dual-eligible beneficiary
• C) A Medigap enrollee
• D) A PACE participant
Comprehensive Medicare and Compliance
Assessment Complete 100 Q&A Study Guide
with Detailed Rationales
1. Mr. Capadona would like to purchase a Medicare Advantage (MA) plan
and a Medigap plan to pick up costs not covered by that plan. What should
you tell him?
• A) He can enroll in both as long as he pays two separate premiums
• B) He should enroll in Medigap first, then MA
• C) It is illegal to sell Mr. Capadona a Medigap plan if he is enrolled in
an MA plan, and Medigap only works with Original Medicare
• D) He can use Medigap to cover MA deductibles
Rationale: It is illegal to sell a Medigap policy to someone enrolled in a Medicare
Advantage plan. Medigap plans only coordinate with Original Medicare (Parts A
and B), not with Medicare Advantage plans.
2. Mrs. West is a 67-year-old newly eligible Medicare beneficiary. When is her
Initial Enrollment Period (IEP)?
• A) 3 months before, the month of, and 3 months after her 65th birthday
• B) Only during her birth month
• C) 6 months before and 6 months after turning 65
• D) Only during the month of her 65th birthday
Rationale: The Initial Enrollment Period (IEP) for Medicare is a 7-month window
that includes the 3 months before the month of the 65th birthday, the birthday
month, and the 3 months after.
,3. Mr. Diaz continued working with his company and was insured under his
employer's group plan until he reached age 68. He has heard that there is a
premium penalty for those who did not sign up for Part B when first eligible.
What should you tell him?
• A) He will pay a 10% penalty for each year he delayed enrollment
• B) He will not pay any penalty because he had continuous coverage
under his employer's plan
• C) He will pay a 20% penalty
• D) He must pay the penalty regardless of prior coverage
Rationale: Mr. Diaz will not pay any penalty because he had continuous creditable
coverage under his employer's group plan. The Part B late enrollment penalty
applies only to individuals who did not have creditable coverage.
4. Mr. Moy will soon turn age 65. He wants to understand what coverage
Medicare Supplemental Insurance provides. What could you tell Mr. Moy?
• A) It covers everything Original Medicare does not
• B) It provides prescription drug coverage
• C) Medicare Supplemental Insurance would help cover his Part A
deductible and Part B coinsurance or copayments in Original Fee-for-
Service (FFS) Medicare as well as possibly some services that Medicare
does not cover
• D) It is only available for Medicare Advantage enrollees
Rationale: Medigap policies pay many out-of-pocket costs in Original Medicare,
including Part A deductibles and Part B coinsurance or copayments. They may also
cover some services that Medicare does not cover.
5. Edward suffered from serious kidney disease and became eligible for
Medicare due to end-stage renal disease (ESRD). A close relative donated
their kidney and Edward successfully underwent transplant surgery 12
,months ago. Edward is now age 50 and asks if his Medicare coverage will
continue. What should you say?
• A) His Medicare coverage will continue indefinitely
• B) Individuals eligible for Medicare based on ESRD generally lose
eligibility 36 months after the month in which they receive a kidney
transplant unless they are eligible on another basis
• C) He will lose eligibility immediately after the transplant
• D) He can keep Medicare for life
Rationale: Individuals eligible for Medicare based on ESRD generally lose
eligibility 36 months after the month of the kidney transplant unless they are
eligible on another basis such as age or disability.
6. What is the minimum age for Medicare eligibility for most individuals?
• A) 60 years old
• B) 65 years old
• C) 67 years old
• D) 70 years old
Rationale: Most individuals become eligible for Medicare at age 65. Exceptions
include individuals with disabilities or end-stage renal disease (ESRD).
7. Medicare Part A primarily covers which of the following?
• A) Hospital inpatient care, skilled nursing facility care, hospice, and
some home health care
• B) Outpatient medical services and preventive care
• C) Prescription drugs
• D) Dental and vision services
, Rationale: Medicare Part A covers inpatient hospital care, skilled nursing facility
care, hospice, and some home health care. Part B covers outpatient services, and
Part D covers prescription drugs.
8. Medicare Part B primarily covers which of the following?
• A) Hospital inpatient care
• B) Outpatient medical services, physician visits, and preventive care
• C) Prescription drugs
• D) Long-term care
Rationale: Medicare Part B covers outpatient medical services, physician visits,
preventive care, and some durable medical equipment. Part A covers inpatient
care.
9. Which of the following is TRUE about Medicare Part D?
• A) It covers all prescription drugs with no formulary restrictions
• B) It provides prescription drug coverage through private plans
approved by Medicare
• C) It is automatically included with Original Medicare
• D) It covers only generic medications
Rationale: Medicare Part D provides prescription drug coverage through private
plans approved by Medicare. Plans have formularies and may use step therapy or
prior authorization.
10. A beneficiary who is eligible for both Medicare and Medicaid is known as:
• A) A Medicare Advantage enrollee
• B) A dual-eligible beneficiary
• C) A Medigap enrollee
• D) A PACE participant
