AHIP Medicare Certification 2027 2028
Questions Answers PDF Study Guide Latest
Updated Pack A+
Medicare Program Basics & Eligibility
1. Which parts of Medicare are provided directly by the federal government?
• A) All four parts (A, B, C, and D)
• B) Part A and Part B
• C) Only Part A
• D) Part A and Part D
Correct Answer: B
Rationale: Medicare Part A (Hospital Insurance) and Part B (Medical
Insurance) are administered directly by the federal government through CMS. Part
C (Medicare Advantage) and Part D (Prescription Drug Plans) are offered by private
insurance companies that contract with CMS .
2. Which individual is automatically entitled to premium-free Medicare Part A?
• A) A 62-year-old who has paid Medicare taxes for 5 years
• B) A 65-year-old who has paid Medicare taxes for at least 10 years (40
quarters) and is receiving Social Security benefits
• C) A 67-year-old who has never worked
• D) Both B and C
Correct Answer: D
, Rationale: Individuals age 65 or older who have paid Medicare taxes for at
least 40 quarters qualify for premium-free Part A. Additionally, individuals at least
65 entitled to Social Security benefits based on a spouse's work record may also
qualify .
3. What is the primary purpose of Medicare?
• A) To provide health insurance for all U.S. citizens
• B) To provide health insurance for individuals aged 65 and older, and certain
younger individuals with disabilities
• C) To cover benefits for veterans
• D) To offer long-term care insurance
Correct Answer: B
Rationale: Medicare provides health insurance to individuals aged 65 and
older, as well as younger individuals who are disabled or have specific diseases
such as End-Stage Renal Disease (ESRD) .
4. Medicare eligibility is based on which of the following?
• A) Income level
• B) Employment status
• C) Age, disability status, or qualifying conditions
• D) Pre-existing medical conditions
Correct Answer: C
Rationale: Medicare eligibility is based on age (65+), disability status, or
qualifying conditions such as ESRD or Lou Gehrig's disease—not income .
,5. What is the Initial Enrollment Period (IEP) for Medicare?
• A) A 3-month period starting on the 65th birthday
• B) A 7-month period beginning 3 months before the month of the 65th
birthday, including the birthday month, and ending 3 months after
• C) A 12-month period beginning at age 65
• D) A one-time open enrollment period at any age
Correct Answer: B
Rationale: The IEP is a 7-month window: 3 months before the month you turn
65, the month you turn 65, and 3 months after. Enrolling during this period helps
avoid late enrollment penalties .
6. Medicare Part A primarily covers which services?
• A) Outpatient services and doctor visits
• B) Prescription drugs
• C) Hospital inpatient care, skilled nursing facility care, hospice, and some
home health care
• D) Dental and vision services
Correct Answer: C
Rationale: Part A (Hospital Insurance) covers inpatient hospital stays, skilled
nursing facility care (not custodial), hospice care, and some home health care. Part
B covers outpatient services .
7. Medicare Part D specifically provides coverage for:
• A) Hospital stays
• B) Diagnostic tests
, • C) Preventive services
• D) Prescription drugs
Correct Answer: D
Rationale: Part D is specifically designed to cover prescription drugs, helping
beneficiaries afford medications necessary for managing health conditions .
8. Which of the following is NOT covered by Original Medicare (Parts A and B)?
• A) Hospital stays
• B) Routine dental care, eye exams for glasses, and hearing aids
• C) Doctor visits
• D) Preventive screenings
Correct Answer: B
Rationale: Original Medicare generally does not cover routine dental care,
most eye exams for glasses, or hearing aids. These may be covered by Medicare
Advantage plans as supplemental benefits .
9. Mrs. Chen is turning 65 and considering Medicare Advantage. Which
statement about Part C is correct?
• A) MA plans are only available to individuals who also have Medicaid
• B) MA plans are offered by private companies that contract with Medicare
and must cover all services covered by Original Medicare
• C) MA plans cannot offer additional benefits beyond Original Medicare
• D) MA plans replace Part A but not Part B
Correct Answer: B
Questions Answers PDF Study Guide Latest
Updated Pack A+
Medicare Program Basics & Eligibility
1. Which parts of Medicare are provided directly by the federal government?
• A) All four parts (A, B, C, and D)
• B) Part A and Part B
• C) Only Part A
• D) Part A and Part D
Correct Answer: B
Rationale: Medicare Part A (Hospital Insurance) and Part B (Medical
Insurance) are administered directly by the federal government through CMS. Part
C (Medicare Advantage) and Part D (Prescription Drug Plans) are offered by private
insurance companies that contract with CMS .
2. Which individual is automatically entitled to premium-free Medicare Part A?
• A) A 62-year-old who has paid Medicare taxes for 5 years
• B) A 65-year-old who has paid Medicare taxes for at least 10 years (40
quarters) and is receiving Social Security benefits
• C) A 67-year-old who has never worked
• D) Both B and C
Correct Answer: D
, Rationale: Individuals age 65 or older who have paid Medicare taxes for at
least 40 quarters qualify for premium-free Part A. Additionally, individuals at least
65 entitled to Social Security benefits based on a spouse's work record may also
qualify .
3. What is the primary purpose of Medicare?
• A) To provide health insurance for all U.S. citizens
• B) To provide health insurance for individuals aged 65 and older, and certain
younger individuals with disabilities
• C) To cover benefits for veterans
• D) To offer long-term care insurance
Correct Answer: B
Rationale: Medicare provides health insurance to individuals aged 65 and
older, as well as younger individuals who are disabled or have specific diseases
such as End-Stage Renal Disease (ESRD) .
4. Medicare eligibility is based on which of the following?
• A) Income level
• B) Employment status
• C) Age, disability status, or qualifying conditions
• D) Pre-existing medical conditions
Correct Answer: C
Rationale: Medicare eligibility is based on age (65+), disability status, or
qualifying conditions such as ESRD or Lou Gehrig's disease—not income .
,5. What is the Initial Enrollment Period (IEP) for Medicare?
• A) A 3-month period starting on the 65th birthday
• B) A 7-month period beginning 3 months before the month of the 65th
birthday, including the birthday month, and ending 3 months after
• C) A 12-month period beginning at age 65
• D) A one-time open enrollment period at any age
Correct Answer: B
Rationale: The IEP is a 7-month window: 3 months before the month you turn
65, the month you turn 65, and 3 months after. Enrolling during this period helps
avoid late enrollment penalties .
6. Medicare Part A primarily covers which services?
• A) Outpatient services and doctor visits
• B) Prescription drugs
• C) Hospital inpatient care, skilled nursing facility care, hospice, and some
home health care
• D) Dental and vision services
Correct Answer: C
Rationale: Part A (Hospital Insurance) covers inpatient hospital stays, skilled
nursing facility care (not custodial), hospice care, and some home health care. Part
B covers outpatient services .
7. Medicare Part D specifically provides coverage for:
• A) Hospital stays
• B) Diagnostic tests
, • C) Preventive services
• D) Prescription drugs
Correct Answer: D
Rationale: Part D is specifically designed to cover prescription drugs, helping
beneficiaries afford medications necessary for managing health conditions .
8. Which of the following is NOT covered by Original Medicare (Parts A and B)?
• A) Hospital stays
• B) Routine dental care, eye exams for glasses, and hearing aids
• C) Doctor visits
• D) Preventive screenings
Correct Answer: B
Rationale: Original Medicare generally does not cover routine dental care,
most eye exams for glasses, or hearing aids. These may be covered by Medicare
Advantage plans as supplemental benefits .
9. Mrs. Chen is turning 65 and considering Medicare Advantage. Which
statement about Part C is correct?
• A) MA plans are only available to individuals who also have Medicaid
• B) MA plans are offered by private companies that contract with Medicare
and must cover all services covered by Original Medicare
• C) MA plans cannot offer additional benefits beyond Original Medicare
• D) MA plans replace Part A but not Part B
Correct Answer: B
