,AHIP Final Exam – Medicare Certification –
Q&A (2026/2027) | AHIP
1. A Medicare beneficiary is enrolled in Original Medicare and wants
prescription drug coverage. Which of the following is required to obtain this
coverage?
A) Enroll in a Medicare Advantage plan that includes drug coverage
B) Enroll in a standalone Medicare Part D plan
C) Purchase a Medigap policy with drug coverage
D) Apply for Medicaid
Correct Answer: B) Enroll in a standalone Medicare Part D plan
Rationale: Beneficiaries with Original Medicare can obtain prescription drug
coverage by enrolling in a standalone Part D plan. Medicare Advantage plans
that include drug coverage (MA‑PD) are an alternative, but the question
specifies Original Medicare.
2. Mr. Thomas is turning 65 next month and wants to know when he can first
sign up for Medicare. The Initial Enrollment Period (IEP) is a:
A) 3‑month window starting the month of his 65th birthday
B) 7‑month window that begins 3 months before the month of his 65th birthday
and ends 3 months after
C) 6‑month window starting the month he becomes eligible
D) Year‑round open enrollment
,Correct Answer: B) 7‑month window that begins 3 months before the month of
his 65th birthday and ends 3 months after
Rationale: The IEP includes the three months before, the month of, and the
three months after the beneficiary's 65th birthday, providing a full seven
months to enroll.
3. Which statement about Medicare Part A is correct?
A) It covers outpatient physician services and preventive care
B) It covers prescription drugs
C) It covers inpatient hospital stays, skilled nursing facility care, hospice, and
some home health care
D) It is optional and requires a monthly premium for all beneficiaries
Correct Answer: C) It covers inpatient hospital stays, skilled nursing facility care,
hospice, and some home health care
Rationale: Part A is hospital insurance, covering inpatient care, skilled nursing,
hospice, and limited home health. Most beneficiaries do not pay a premium for
Part A if they or their spouse paid Medicare taxes.
4. A beneficiary wants a Medicare health plan that allows seeing out‑of‑network
providers without a referral. Which type of Medicare Advantage plan typically
offers this flexibility?
A) HMO
B) PPO
C) SNP
, D) MSA
Correct Answer: B) PPO
Rationale: Preferred Provider Organization (PPO) plans allow members to see
out‑of‑network providers, usually at a higher cost, and do not require referrals.
HMOs generally require in‑network use and referrals.
5. Under CMS marketing rules, an agent who wants to meet with a beneficiary
in their home must first:
A) Obtain a Scope of Appointment (SOA) form completed at least 48 hours
before the meeting
B) Call the beneficiary to confirm the appointment the morning of
C) Send a follow‑up email after the meeting
D) Register the meeting with the state insurance department
Correct Answer: A) Obtain a Scope of Appointment (SOA) form completed at
least 48 hours before the meeting
Rationale: CMS requires an SOA to be completed at least 48 hours prior to an
in‑home appointment. The SOA must list the products to be discussed and
cannot be used to market non‑health products.
6. Which of the following is prohibited during a Medicare Advantage marketing
event?
A) Providing educational materials about Medicare
B) Asking attendees to complete a Scope of Appointment form
Q&A (2026/2027) | AHIP
1. A Medicare beneficiary is enrolled in Original Medicare and wants
prescription drug coverage. Which of the following is required to obtain this
coverage?
A) Enroll in a Medicare Advantage plan that includes drug coverage
B) Enroll in a standalone Medicare Part D plan
C) Purchase a Medigap policy with drug coverage
D) Apply for Medicaid
Correct Answer: B) Enroll in a standalone Medicare Part D plan
Rationale: Beneficiaries with Original Medicare can obtain prescription drug
coverage by enrolling in a standalone Part D plan. Medicare Advantage plans
that include drug coverage (MA‑PD) are an alternative, but the question
specifies Original Medicare.
2. Mr. Thomas is turning 65 next month and wants to know when he can first
sign up for Medicare. The Initial Enrollment Period (IEP) is a:
A) 3‑month window starting the month of his 65th birthday
B) 7‑month window that begins 3 months before the month of his 65th birthday
and ends 3 months after
C) 6‑month window starting the month he becomes eligible
D) Year‑round open enrollment
,Correct Answer: B) 7‑month window that begins 3 months before the month of
his 65th birthday and ends 3 months after
Rationale: The IEP includes the three months before, the month of, and the
three months after the beneficiary's 65th birthday, providing a full seven
months to enroll.
3. Which statement about Medicare Part A is correct?
A) It covers outpatient physician services and preventive care
B) It covers prescription drugs
C) It covers inpatient hospital stays, skilled nursing facility care, hospice, and
some home health care
D) It is optional and requires a monthly premium for all beneficiaries
Correct Answer: C) It covers inpatient hospital stays, skilled nursing facility care,
hospice, and some home health care
Rationale: Part A is hospital insurance, covering inpatient care, skilled nursing,
hospice, and limited home health. Most beneficiaries do not pay a premium for
Part A if they or their spouse paid Medicare taxes.
4. A beneficiary wants a Medicare health plan that allows seeing out‑of‑network
providers without a referral. Which type of Medicare Advantage plan typically
offers this flexibility?
A) HMO
B) PPO
C) SNP
, D) MSA
Correct Answer: B) PPO
Rationale: Preferred Provider Organization (PPO) plans allow members to see
out‑of‑network providers, usually at a higher cost, and do not require referrals.
HMOs generally require in‑network use and referrals.
5. Under CMS marketing rules, an agent who wants to meet with a beneficiary
in their home must first:
A) Obtain a Scope of Appointment (SOA) form completed at least 48 hours
before the meeting
B) Call the beneficiary to confirm the appointment the morning of
C) Send a follow‑up email after the meeting
D) Register the meeting with the state insurance department
Correct Answer: A) Obtain a Scope of Appointment (SOA) form completed at
least 48 hours before the meeting
Rationale: CMS requires an SOA to be completed at least 48 hours prior to an
in‑home appointment. The SOA must list the products to be discussed and
cannot be used to market non‑health products.
6. Which of the following is prohibited during a Medicare Advantage marketing
event?
A) Providing educational materials about Medicare
B) Asking attendees to complete a Scope of Appointment form
