AHIP 2027 Final Exam – Medicare
Certification | Complete Study Guide with
Actual Questions & Answers
THIS EXAM INCLUDES;
➢ Medicare Part A, Part B, Part C (Medicare Advantage), and Part D
➢ Medicare eligibility and enrollment periods
➢ Medicare Advantage plan types (HMO, PPO, PFFS, MSA, Cost Plans)
➢ Prescription Drug Plans (PDPs)
➢ Medigap (Medicare Supplement) basics
➢ Low-Income Subsidy (LIS) and other assistance programs
➢ CMS marketing and communication guidelines
➢ Compliance requirements and ethical sales practices
➢ Fraud, Waste, and Abuse (FWA) prevention
➢ Beneficiary rights, grievances, appeals, and protections
➢ Practice multiple-choice questions with answer explanations or rationales
designed for exam preparation.
,Question 1
Mrs. Andrews is comparing her employer's retiree insurance to Original Medicare
and would like to know which of the following services Original Medicare will
cover if the appropriate criteria are met. What could you tell her?
A) Original Medicare covers ambulance services
B) Original Medicare covers dental services
C) Original Medicare covers hearing aids
D) Original Medicare covers routine vision exams
Answer: A) Original Medicare covers ambulance services
Explanation: Original Medicare covers ambulance services when transportation in any
other vehicle could endanger the beneficiary's health and the services are medically
necessary. While Original Medicare covers many services, it generally does not cover
routine dental, hearing, or vision services.
Question 2
What impact, if any, have recent regulatory changes had on Medigap plans?
A) The Part B deductible is no longer covered for individuals newly eligible for Medicare
starting January 1, 2020
B) All Medigap plans now cover the Part B deductible
C) Medigap plans are no longer available to anyone
D) Medigap plans now cover prescription drugs
Answer: A) The Part B deductible is no longer covered for individuals newly
eligible for Medicare starting January 1, 2020
Explanation: The Medicare Access and CHIP Reauthorization Act (MACRA) of 2015
eliminated Medigap plans that cover the Part B deductible for individuals newly eligible
for Medicare on or after January 1, 2020. This means Plans C and F are no longer
,available to new Medicare beneficiaries, though those already enrolled can keep their
plans.
Question 3
Joan and Loretta are both enrolled in Medicare. Joan pays a premium for Part A
coverage. Loretta does not. Which of the following statements best explains this
difference?
A) Joan chose to pay for Part A while Loretta chose not to
B) Joan worked only a short time and did not accumulate sufficient work credits. Loretta
worked for well over 10 years accumulating credit for more than 40 quarters of
contributions to the Medicare program.
C) Joan is under 65 and disabled, Loretta is over 65
D) Joan lives in a different state than Loretta
Answer: B) Joan worked only a short time and did not accumulate sufficient work
credits. Loretta worked for well over 10 years accumulating credit for more than
40 quarters of contributions to the Medicare program.
Explanation: Most people are entitled to premium-free Part A if they or their spouse
paid Medicare taxes while working for at least 10 years (40 quarters). Those who have
not accumulated sufficient work credits must pay a monthly premium for Part A
coverage.
Question 4
Larry Miller is an Original Medicare beneficiary with Parts A and B coverage. Larry
is admitted to Good Care Hospital in January with pneumonia and stays for three
days before being discharged. Six months later in July, Larry takes a bad fall and is
admitted to Good Care Hospital with a broken leg. After emergency surgery to
repair his broken leg, Larry is hospitalized for a week before being discharged
home. In December, Larry is admitted to Mount Wellness Hospital once again with
, a serious case of the flu. For how many Part A deductibles will Larry be responsible
for?
A) One Part A deductible
B) Two Part A deductibles
C) Three Part A deductibles
D) No Part A deductibles
Answer: C) Three Part A deductibles
Explanation: Medicare Part A has a deductible per benefit period. A benefit period
begins the day a beneficiary is admitted as an inpatient and ends when the beneficiary
has been out of the hospital or skilled nursing facility for 60 consecutive days. Since
Larry's three hospital admissions were separated by more than 60 days (January to July
and July to December), each admission represents a separate benefit period with its own
deductible.
Question 5
Kevin Birch enrolled in Original Medicare (Parts A and B). Mr. Birch has been
receiving rehabilitation services in a skilled nursing facility. He calls you to say that
he has just received a notice that Medicare will no longer cover his stay and he still
cannot walk properly. He thinks they are ending his services too soon. What do
you tell him?
A) He should accept the decision and find other payment options
B) He should file a complaint with his state insurance department
C) He should follow the directions on the notice to file a fast appeal. Mr. Birch should file
it by noon of the calendar day following receipt of the provider's notice of termination
of services.
D) He should contact his primary care physician
Answer: C) He should follow the directions on the notice to file a fast appeal. Mr.
Birch should file it by noon of the calendar day following receipt of the provider's
notice of termination of services.
Certification | Complete Study Guide with
Actual Questions & Answers
THIS EXAM INCLUDES;
➢ Medicare Part A, Part B, Part C (Medicare Advantage), and Part D
➢ Medicare eligibility and enrollment periods
➢ Medicare Advantage plan types (HMO, PPO, PFFS, MSA, Cost Plans)
➢ Prescription Drug Plans (PDPs)
➢ Medigap (Medicare Supplement) basics
➢ Low-Income Subsidy (LIS) and other assistance programs
➢ CMS marketing and communication guidelines
➢ Compliance requirements and ethical sales practices
➢ Fraud, Waste, and Abuse (FWA) prevention
➢ Beneficiary rights, grievances, appeals, and protections
➢ Practice multiple-choice questions with answer explanations or rationales
designed for exam preparation.
,Question 1
Mrs. Andrews is comparing her employer's retiree insurance to Original Medicare
and would like to know which of the following services Original Medicare will
cover if the appropriate criteria are met. What could you tell her?
A) Original Medicare covers ambulance services
B) Original Medicare covers dental services
C) Original Medicare covers hearing aids
D) Original Medicare covers routine vision exams
Answer: A) Original Medicare covers ambulance services
Explanation: Original Medicare covers ambulance services when transportation in any
other vehicle could endanger the beneficiary's health and the services are medically
necessary. While Original Medicare covers many services, it generally does not cover
routine dental, hearing, or vision services.
Question 2
What impact, if any, have recent regulatory changes had on Medigap plans?
A) The Part B deductible is no longer covered for individuals newly eligible for Medicare
starting January 1, 2020
B) All Medigap plans now cover the Part B deductible
C) Medigap plans are no longer available to anyone
D) Medigap plans now cover prescription drugs
Answer: A) The Part B deductible is no longer covered for individuals newly
eligible for Medicare starting January 1, 2020
Explanation: The Medicare Access and CHIP Reauthorization Act (MACRA) of 2015
eliminated Medigap plans that cover the Part B deductible for individuals newly eligible
for Medicare on or after January 1, 2020. This means Plans C and F are no longer
,available to new Medicare beneficiaries, though those already enrolled can keep their
plans.
Question 3
Joan and Loretta are both enrolled in Medicare. Joan pays a premium for Part A
coverage. Loretta does not. Which of the following statements best explains this
difference?
A) Joan chose to pay for Part A while Loretta chose not to
B) Joan worked only a short time and did not accumulate sufficient work credits. Loretta
worked for well over 10 years accumulating credit for more than 40 quarters of
contributions to the Medicare program.
C) Joan is under 65 and disabled, Loretta is over 65
D) Joan lives in a different state than Loretta
Answer: B) Joan worked only a short time and did not accumulate sufficient work
credits. Loretta worked for well over 10 years accumulating credit for more than
40 quarters of contributions to the Medicare program.
Explanation: Most people are entitled to premium-free Part A if they or their spouse
paid Medicare taxes while working for at least 10 years (40 quarters). Those who have
not accumulated sufficient work credits must pay a monthly premium for Part A
coverage.
Question 4
Larry Miller is an Original Medicare beneficiary with Parts A and B coverage. Larry
is admitted to Good Care Hospital in January with pneumonia and stays for three
days before being discharged. Six months later in July, Larry takes a bad fall and is
admitted to Good Care Hospital with a broken leg. After emergency surgery to
repair his broken leg, Larry is hospitalized for a week before being discharged
home. In December, Larry is admitted to Mount Wellness Hospital once again with
, a serious case of the flu. For how many Part A deductibles will Larry be responsible
for?
A) One Part A deductible
B) Two Part A deductibles
C) Three Part A deductibles
D) No Part A deductibles
Answer: C) Three Part A deductibles
Explanation: Medicare Part A has a deductible per benefit period. A benefit period
begins the day a beneficiary is admitted as an inpatient and ends when the beneficiary
has been out of the hospital or skilled nursing facility for 60 consecutive days. Since
Larry's three hospital admissions were separated by more than 60 days (January to July
and July to December), each admission represents a separate benefit period with its own
deductible.
Question 5
Kevin Birch enrolled in Original Medicare (Parts A and B). Mr. Birch has been
receiving rehabilitation services in a skilled nursing facility. He calls you to say that
he has just received a notice that Medicare will no longer cover his stay and he still
cannot walk properly. He thinks they are ending his services too soon. What do
you tell him?
A) He should accept the decision and find other payment options
B) He should file a complaint with his state insurance department
C) He should follow the directions on the notice to file a fast appeal. Mr. Birch should file
it by noon of the calendar day following receipt of the provider's notice of termination
of services.
D) He should contact his primary care physician
Answer: C) He should follow the directions on the notice to file a fast appeal. Mr.
Birch should file it by noon of the calendar day following receipt of the provider's
notice of termination of services.
