,AHIP Final Exam (PDF) | (2026/2027) Medicare Compliance &
Fraud, Waste, Abuse Q&A | AHIP Certification
1. Which of the following is covered under Medicare Part A?
A) Hospital inpatient stays, skilled nursing facility care, hospice, and some home
health services
B) Outpatient physician visits and durable medical equipment
C) Prescription drug coverage through private plans
D) Routine dental and vision exams
Correct Answer: Hospital inpatient stays, skilled nursing facility care, hospice,
and some home health services
Rationale: Part A is hospital insurance covering inpatient care, skilled nursing,
hospice, and limited home health. Part B covers outpatient services and DME,
Part D covers drugs. Routine dental and vision are not covered by Original
Medicare.
2. What is the standard Part B late enrollment penalty?
A) 1% of the national base beneficiary premium per month of delay
B) 10% of the standard Part B premium for each full 12‑month period a person
was eligible but did not enroll
C) 5% of the standard Part B premium per year of delay
D) A one‑time flat fee of $250
Correct Answer: 10% of the standard Part B premium for each full 12‑month
period a person was eligible but did not enroll
,Rationale: The Part B penalty is 10% for each full 12‑month period without
coverage, and it continues for life. The Part D penalty is 1% per month. No
one‑time fee exists.
3. Most beneficiaries receive premium‑free Part A if they or their spouse
worked and paid Medicare taxes for at least how many quarters?
A) 30 quarters
B) 20 quarters
C) 40 quarters
D) 50 quarters
Correct Answer: 40 quarters
Rationale: Premium‑free Part A requires 40 quarters (10 years) of
Medicare‑covered employment. Fewer quarters may result in a monthly
premium.
4. The Initial Enrollment Period (IEP) for Medicare spans a total of how many
months?
A) 3 months
B) 6 months
C) 10 months
D) 7 months
Correct Answer: 7 months
, Rationale: The IEP includes the three months before the birth month, the birth
month, and the three months after, for a total of seven months. Enrolling during
this window avoids penalties.
5. Which part of Medicare provides prescription drug coverage through private
insurance plans?
A) Part D
B) Part A
C) Part B
D) Part C
Correct Answer: Part D
Rationale: Part D specifically covers outpatient prescription drugs. Part A is
hospital insurance, Part B is medical insurance, and Part C (Medicare Advantage)
often includes drug coverage but the standalone drug benefit is Part D.
6. During the Annual Election Period (AEP), which action may a beneficiary
legally take?
A) Switch from a Medicare Advantage plan back to Original Medicare and enroll
in a stand‑alone Part D plan
B) Enroll in a Medigap policy without medical underwriting regardless of health
status
C) Change Medicare payroll tax withholding amounts
D) Disenroll from Part A only
Fraud, Waste, Abuse Q&A | AHIP Certification
1. Which of the following is covered under Medicare Part A?
A) Hospital inpatient stays, skilled nursing facility care, hospice, and some home
health services
B) Outpatient physician visits and durable medical equipment
C) Prescription drug coverage through private plans
D) Routine dental and vision exams
Correct Answer: Hospital inpatient stays, skilled nursing facility care, hospice,
and some home health services
Rationale: Part A is hospital insurance covering inpatient care, skilled nursing,
hospice, and limited home health. Part B covers outpatient services and DME,
Part D covers drugs. Routine dental and vision are not covered by Original
Medicare.
2. What is the standard Part B late enrollment penalty?
A) 1% of the national base beneficiary premium per month of delay
B) 10% of the standard Part B premium for each full 12‑month period a person
was eligible but did not enroll
C) 5% of the standard Part B premium per year of delay
D) A one‑time flat fee of $250
Correct Answer: 10% of the standard Part B premium for each full 12‑month
period a person was eligible but did not enroll
,Rationale: The Part B penalty is 10% for each full 12‑month period without
coverage, and it continues for life. The Part D penalty is 1% per month. No
one‑time fee exists.
3. Most beneficiaries receive premium‑free Part A if they or their spouse
worked and paid Medicare taxes for at least how many quarters?
A) 30 quarters
B) 20 quarters
C) 40 quarters
D) 50 quarters
Correct Answer: 40 quarters
Rationale: Premium‑free Part A requires 40 quarters (10 years) of
Medicare‑covered employment. Fewer quarters may result in a monthly
premium.
4. The Initial Enrollment Period (IEP) for Medicare spans a total of how many
months?
A) 3 months
B) 6 months
C) 10 months
D) 7 months
Correct Answer: 7 months
, Rationale: The IEP includes the three months before the birth month, the birth
month, and the three months after, for a total of seven months. Enrolling during
this window avoids penalties.
5. Which part of Medicare provides prescription drug coverage through private
insurance plans?
A) Part D
B) Part A
C) Part B
D) Part C
Correct Answer: Part D
Rationale: Part D specifically covers outpatient prescription drugs. Part A is
hospital insurance, Part B is medical insurance, and Part C (Medicare Advantage)
often includes drug coverage but the standalone drug benefit is Part D.
6. During the Annual Election Period (AEP), which action may a beneficiary
legally take?
A) Switch from a Medicare Advantage plan back to Original Medicare and enroll
in a stand‑alone Part D plan
B) Enroll in a Medigap policy without medical underwriting regardless of health
status
C) Change Medicare payroll tax withholding amounts
D) Disenroll from Part A only
