AHIP MEDICARE CERTIFICATION
2026/2027: 400 PRACTICE QUESTIONS
& VERIFIED ANSWERS – MEDICARE
CERTIFICATION FINAL COMPLETE
EXAM REVIEW ALREADY GRADED A+
GUARANTEED PASS [MOST RECENT!!]
1. Mr. Wells is trying to understand the difference between Original Medicare
and Medicare Advantage. What would be a correct description?
• Answer: Medicare Advantage is a way of covering all the Original Medicare
benefits through private health insurance companies .
2. Juan Hernandez is turning 65 next month and legally entered the U.S. over
20 years ago but is not a citizen. He has worked and contributed to Medicare.
He asks if he can enroll in a Medicare Advantage plan you represent. How
would you respond?
• Answer: Juan is eligible to enroll in a Medicare Advantage plan as long as he
is entitled to Part A and enrolled in Part B. He should enroll in Medicare Part A
and B through Social Security if he hasn't already .
3. Mr. Schultz was working and had creditable employer coverage when he first
qualified for Medicare. He decided not to enroll in Part D. It is now a year later
and he has lost his employer group coverage within the last two weeks. How
would you advise him?
• Answer: Mr. Schultz should enroll in a Part D plan before he has a 63-day
break in coverage to avoid a premium penalty .
4. Mrs. Quinn has just turned 65, is in excellent health, and does not use
medications. She sees no reason to spend money on a Part D plan and has no
creditable coverage. What could you tell her?
• Answer: If she does not sign up for a Part D plan when first eligible and later
enrolls, her premium will be permanently increased by 1% of the national
average premium for every month she was not covered .
,5. Which statement is correct about whether a Medicare Supplement (Medigap)
policy works with a Medicare Advantage plan?
• Answer: No. Medigap policies are designed to supplement Original Medicare,
not Medicare Advantage plans .
6. May a Medicare Advantage plan charge different copayments for different
medical services?
• Answer: Yes. Cost-sharing varies by service according to the plan's Evidence
of Coverage .
7. A beneficiary believes her enrollment request was processed incorrectly
because the plan entered the wrong effective date. Which issue is being
questioned?
• Answer: Enrollment processing .
8. An agent learns that another producer is signing beneficiaries' names on
enrollment forms without permission. What is the most appropriate action?
• Answer: Report the suspected misconduct through appropriate compliance
channels .
9. A beneficiary enrolled in a Medicare Advantage plan elects hospice care.
What happens to their coverage?
• Answer: Hospice services are generally covered under Original Medicare,
while the Medicare Advantage plan continues covering other non-hospice
services .
10. Mrs. Wilson enrolled in a Medicare Advantage HMO six months ago. She
has permanently moved to another state where her current plan is unavailable.
Which enrollment opportunity does she most likely receive?
• Answer: A Special Enrollment Period (SEP) .
11. An agent is meeting with a beneficiary to discuss Medicare Advantage
plans. The beneficiary asks about life insurance, which was not listed on the
Scope of Appointment. What should the agent do?
• Answer: Schedule another appointment or complete a new Scope of
Appointment before discussing it .
12. An insurance company intentionally submits false claims to Medicare to
receive higher reimbursements. This activity is an example of:
, • Answer: Fraud .
13. Mrs. Garcia becomes eligible for Medicare because of disability before age
65. Which statement is true?
• Answer: Some individuals under age 65 qualify because of disability or certain
medical conditions .
14. An agent receives Protected Health Information (PHI) from a beneficiary
during enrollment. What is the agent's responsibility?
• Answer: Protect the information and use it only as permitted .
15. Mrs. West wears glasses and dentures and receives acupuncture for pain
relief. She is concerned about whether Medicare will cover these items and
services. What should you tell her?
• Answer: Medicare does not cover acupuncture, or, in general, glasses or
dentures .
16. Mr. Capadona would like to purchase a Medicare Advantage (MA) plan. He
is 67 and enrolled in Original Medicare Parts A and B. Which enrollment period
is he in if he wants to join an MA plan?
• Answer: Annual Enrollment Period (AEP) .
17. Mr. Singh is enrolled in Original Medicare Parts A and B and wants to obtain
prescription drug coverage. What should you tell him?
• Answer: Mr. Singh can enroll in a stand-alone Part D plan and continue to be
covered for Part A and B services through Original Fee-for-Service Medicare .
18. Mrs. Cook is an elderly retiree with a low fixed income. What might be of
assistance?
• Answer: She should contact her state Medicaid agency to see if she qualifies
for a program that can help with Medicare costs .
19. Ms. Henderson believes she will qualify for Medicare coverage at age 65
without paying any premiums because of her work history. What should you
tell her?
• Answer: To obtain Part B coverage, she must pay a standard monthly
premium, though it is higher for individuals with higher incomes .
, 20. Mrs. Foster is covered by Original Medicare and needs skilled nursing and
rehabilitative care after a hospital stay. What should you tell them about
Original Medicare's coverage of care in a skilled nursing facility?
• Answer: Medicare will cover Mrs. Foster's skilled nursing services during the
first 20 days of her stay, after which she would have a copay until she has
been in the facility for 100 days .
21. Which of the following statements is correct about a Medicare Savings
Account (MSA) Plan?
• Answer: MSA plans cover Part A and Part B benefits but not Part D
prescription drug benefits. Non-network providers must accept the same
amount that Original Medicare would pay them as payment in full .
22. Mr. Arias, a naturalized citizen, previously enrolled in Part B but has
stopped paying his premium. He is still covered by Part A and wants to enroll in
a Medicare Advantage plan. What should you tell him?
• Answer: He is not eligible to enroll in a Medicare Advantage plan until he re-
enrolls in Medicare Part B .
23. Mr. Kelly wants to know whether he is eligible to sign up for a Private Fee-
for-Service (PFFS) plan. What questions would you need to ask to determine his
eligibility?
• Answer: You would need to ask Mr. Kelly if he is entitled to Part A, enrolled in
Part B, and if he lives in the PFFS plan's service area .
24. Dr. Elizabeth Brennan does not contract with the ABC PFFS plan but accepts
the plan's terms and conditions for payment. Mary Rodgers sees Dr. Brennan
for treatment. How much may Dr. Brennan charge?
• Answer: Dr. Brennan can charge Mary no more than the cost sharing specified
in the PFFS plan's terms and conditions of payment, which may include
balance billing up to 15% of the Medicare rate .
25. Ms. Gibson recently lost her employer group health and drug coverage and
wants to enroll in a PPO that does not include drug coverage. What should you
tell her about obtaining drug coverage?
• Answer: She can enroll in the PPO, but she will not be able to purchase a
stand-alone Medicare Part D prescription drug plan .
26. Mrs. Radford asks whether there are any special eligibility requirements for
Medicare Advantage. How should you respond?
2026/2027: 400 PRACTICE QUESTIONS
& VERIFIED ANSWERS – MEDICARE
CERTIFICATION FINAL COMPLETE
EXAM REVIEW ALREADY GRADED A+
GUARANTEED PASS [MOST RECENT!!]
1. Mr. Wells is trying to understand the difference between Original Medicare
and Medicare Advantage. What would be a correct description?
• Answer: Medicare Advantage is a way of covering all the Original Medicare
benefits through private health insurance companies .
2. Juan Hernandez is turning 65 next month and legally entered the U.S. over
20 years ago but is not a citizen. He has worked and contributed to Medicare.
He asks if he can enroll in a Medicare Advantage plan you represent. How
would you respond?
• Answer: Juan is eligible to enroll in a Medicare Advantage plan as long as he
is entitled to Part A and enrolled in Part B. He should enroll in Medicare Part A
and B through Social Security if he hasn't already .
3. Mr. Schultz was working and had creditable employer coverage when he first
qualified for Medicare. He decided not to enroll in Part D. It is now a year later
and he has lost his employer group coverage within the last two weeks. How
would you advise him?
• Answer: Mr. Schultz should enroll in a Part D plan before he has a 63-day
break in coverage to avoid a premium penalty .
4. Mrs. Quinn has just turned 65, is in excellent health, and does not use
medications. She sees no reason to spend money on a Part D plan and has no
creditable coverage. What could you tell her?
• Answer: If she does not sign up for a Part D plan when first eligible and later
enrolls, her premium will be permanently increased by 1% of the national
average premium for every month she was not covered .
,5. Which statement is correct about whether a Medicare Supplement (Medigap)
policy works with a Medicare Advantage plan?
• Answer: No. Medigap policies are designed to supplement Original Medicare,
not Medicare Advantage plans .
6. May a Medicare Advantage plan charge different copayments for different
medical services?
• Answer: Yes. Cost-sharing varies by service according to the plan's Evidence
of Coverage .
7. A beneficiary believes her enrollment request was processed incorrectly
because the plan entered the wrong effective date. Which issue is being
questioned?
• Answer: Enrollment processing .
8. An agent learns that another producer is signing beneficiaries' names on
enrollment forms without permission. What is the most appropriate action?
• Answer: Report the suspected misconduct through appropriate compliance
channels .
9. A beneficiary enrolled in a Medicare Advantage plan elects hospice care.
What happens to their coverage?
• Answer: Hospice services are generally covered under Original Medicare,
while the Medicare Advantage plan continues covering other non-hospice
services .
10. Mrs. Wilson enrolled in a Medicare Advantage HMO six months ago. She
has permanently moved to another state where her current plan is unavailable.
Which enrollment opportunity does she most likely receive?
• Answer: A Special Enrollment Period (SEP) .
11. An agent is meeting with a beneficiary to discuss Medicare Advantage
plans. The beneficiary asks about life insurance, which was not listed on the
Scope of Appointment. What should the agent do?
• Answer: Schedule another appointment or complete a new Scope of
Appointment before discussing it .
12. An insurance company intentionally submits false claims to Medicare to
receive higher reimbursements. This activity is an example of:
, • Answer: Fraud .
13. Mrs. Garcia becomes eligible for Medicare because of disability before age
65. Which statement is true?
• Answer: Some individuals under age 65 qualify because of disability or certain
medical conditions .
14. An agent receives Protected Health Information (PHI) from a beneficiary
during enrollment. What is the agent's responsibility?
• Answer: Protect the information and use it only as permitted .
15. Mrs. West wears glasses and dentures and receives acupuncture for pain
relief. She is concerned about whether Medicare will cover these items and
services. What should you tell her?
• Answer: Medicare does not cover acupuncture, or, in general, glasses or
dentures .
16. Mr. Capadona would like to purchase a Medicare Advantage (MA) plan. He
is 67 and enrolled in Original Medicare Parts A and B. Which enrollment period
is he in if he wants to join an MA plan?
• Answer: Annual Enrollment Period (AEP) .
17. Mr. Singh is enrolled in Original Medicare Parts A and B and wants to obtain
prescription drug coverage. What should you tell him?
• Answer: Mr. Singh can enroll in a stand-alone Part D plan and continue to be
covered for Part A and B services through Original Fee-for-Service Medicare .
18. Mrs. Cook is an elderly retiree with a low fixed income. What might be of
assistance?
• Answer: She should contact her state Medicaid agency to see if she qualifies
for a program that can help with Medicare costs .
19. Ms. Henderson believes she will qualify for Medicare coverage at age 65
without paying any premiums because of her work history. What should you
tell her?
• Answer: To obtain Part B coverage, she must pay a standard monthly
premium, though it is higher for individuals with higher incomes .
, 20. Mrs. Foster is covered by Original Medicare and needs skilled nursing and
rehabilitative care after a hospital stay. What should you tell them about
Original Medicare's coverage of care in a skilled nursing facility?
• Answer: Medicare will cover Mrs. Foster's skilled nursing services during the
first 20 days of her stay, after which she would have a copay until she has
been in the facility for 100 days .
21. Which of the following statements is correct about a Medicare Savings
Account (MSA) Plan?
• Answer: MSA plans cover Part A and Part B benefits but not Part D
prescription drug benefits. Non-network providers must accept the same
amount that Original Medicare would pay them as payment in full .
22. Mr. Arias, a naturalized citizen, previously enrolled in Part B but has
stopped paying his premium. He is still covered by Part A and wants to enroll in
a Medicare Advantage plan. What should you tell him?
• Answer: He is not eligible to enroll in a Medicare Advantage plan until he re-
enrolls in Medicare Part B .
23. Mr. Kelly wants to know whether he is eligible to sign up for a Private Fee-
for-Service (PFFS) plan. What questions would you need to ask to determine his
eligibility?
• Answer: You would need to ask Mr. Kelly if he is entitled to Part A, enrolled in
Part B, and if he lives in the PFFS plan's service area .
24. Dr. Elizabeth Brennan does not contract with the ABC PFFS plan but accepts
the plan's terms and conditions for payment. Mary Rodgers sees Dr. Brennan
for treatment. How much may Dr. Brennan charge?
• Answer: Dr. Brennan can charge Mary no more than the cost sharing specified
in the PFFS plan's terms and conditions of payment, which may include
balance billing up to 15% of the Medicare rate .
25. Ms. Gibson recently lost her employer group health and drug coverage and
wants to enroll in a PPO that does not include drug coverage. What should you
tell her about obtaining drug coverage?
• Answer: She can enroll in the PPO, but she will not be able to purchase a
stand-alone Medicare Part D prescription drug plan .
26. Mrs. Radford asks whether there are any special eligibility requirements for
Medicare Advantage. How should you respond?
