AHIP Final Exam –
Medicare Certification –
Actual Questions &
Answers (AHIP)
Guarantee Pass (Updated
Pdf)
Question 1
A beneficiary enrolls in Medicare Part B for the first time. Which service is covered
once every 12 months at no cost if the provider accepts assignment?
A. Emergency room visit
B. Annual Wellness Visit
C. Cosmetic surgery
D. Routine dental cleaning
Answer: B. Annual Wellness Visit
Explanation: Medicare Part B covers an Annual Wellness Visit once every 12 months
after eligibility requirements are met.
Question 2
,Which part of Medicare primarily covers inpatient hospital services?
A. Part A
B. Part B
C. Part C
D. Part D
Answer: A. Part A
Explanation: Part A helps pay for inpatient hospital care, skilled nursing facility care
(under qualifying conditions), hospice, and some home health services.
Question 3
Medicare Advantage plans are also known as:
A. Medigap Plans
B. Medicare Supplement Plans
C. Medicare Part C Plans
D. Medicaid Expansion Plans
Answer: C. Medicare Part C Plans
Explanation: Medicare Advantage (Part C) is an alternative way to receive Original
Medicare benefits through private insurers approved by Medicare.
Question 4
A beneficiary enrolled in a Medicare Advantage PPO generally:
A. Must always use network providers.
B. Has no provider network.
,C. Can receive care outside the network, usually at a higher cost.
D. Cannot see specialists.
Answer: C. Can receive care outside the network, usually at a higher cost.
Explanation: PPO plans allow out-of-network care but usually require higher cost
sharing.
Question 5
What is the primary purpose of Medicare Part D?
A. Hospital coverage
B. Prescription drug coverage
C. Dental insurance
D. Long-term custodial care
Answer: B. Prescription drug coverage
Explanation: Part D provides outpatient prescription drug coverage through private
plans approved by Medicare.
Question 6
Which statement about Medigap policies is correct?
A. They work with Medicare Advantage plans.
B. They supplement Original Medicare.
C. They include routine dental benefits.
D. They replace Medicare Part B.
Answer: B. They supplement Original Medicare.
, Explanation: Medigap policies help pay certain out-of-pocket costs associated with
Original Medicare.
Question 7
Which beneficiary would generally NOT be eligible to enroll in Medicare based solely
on age?
A. 65 years old
B. 67 years old
C. 62 years old
D. 70 years old
Answer: C. 62 years old
Explanation: Medicare eligibility based on age generally begins at 65.
Question 8
Which Medicare Advantage plan usually requires members to obtain referrals before
seeing specialists?
A. PPO
B. PFFS
C. HMO
D. MSA
Answer: C. HMO
Explanation: Many HMOs require referrals and emphasize using network providers.
Medicare Certification –
Actual Questions &
Answers (AHIP)
Guarantee Pass (Updated
Pdf)
Question 1
A beneficiary enrolls in Medicare Part B for the first time. Which service is covered
once every 12 months at no cost if the provider accepts assignment?
A. Emergency room visit
B. Annual Wellness Visit
C. Cosmetic surgery
D. Routine dental cleaning
Answer: B. Annual Wellness Visit
Explanation: Medicare Part B covers an Annual Wellness Visit once every 12 months
after eligibility requirements are met.
Question 2
,Which part of Medicare primarily covers inpatient hospital services?
A. Part A
B. Part B
C. Part C
D. Part D
Answer: A. Part A
Explanation: Part A helps pay for inpatient hospital care, skilled nursing facility care
(under qualifying conditions), hospice, and some home health services.
Question 3
Medicare Advantage plans are also known as:
A. Medigap Plans
B. Medicare Supplement Plans
C. Medicare Part C Plans
D. Medicaid Expansion Plans
Answer: C. Medicare Part C Plans
Explanation: Medicare Advantage (Part C) is an alternative way to receive Original
Medicare benefits through private insurers approved by Medicare.
Question 4
A beneficiary enrolled in a Medicare Advantage PPO generally:
A. Must always use network providers.
B. Has no provider network.
,C. Can receive care outside the network, usually at a higher cost.
D. Cannot see specialists.
Answer: C. Can receive care outside the network, usually at a higher cost.
Explanation: PPO plans allow out-of-network care but usually require higher cost
sharing.
Question 5
What is the primary purpose of Medicare Part D?
A. Hospital coverage
B. Prescription drug coverage
C. Dental insurance
D. Long-term custodial care
Answer: B. Prescription drug coverage
Explanation: Part D provides outpatient prescription drug coverage through private
plans approved by Medicare.
Question 6
Which statement about Medigap policies is correct?
A. They work with Medicare Advantage plans.
B. They supplement Original Medicare.
C. They include routine dental benefits.
D. They replace Medicare Part B.
Answer: B. They supplement Original Medicare.
, Explanation: Medigap policies help pay certain out-of-pocket costs associated with
Original Medicare.
Question 7
Which beneficiary would generally NOT be eligible to enroll in Medicare based solely
on age?
A. 65 years old
B. 67 years old
C. 62 years old
D. 70 years old
Answer: C. 62 years old
Explanation: Medicare eligibility based on age generally begins at 65.
Question 8
Which Medicare Advantage plan usually requires members to obtain referrals before
seeing specialists?
A. PPO
B. PFFS
C. HMO
D. MSA
Answer: C. HMO
Explanation: Many HMOs require referrals and emphasize using network providers.
