AHIP MEDICARE CERTIFICATION EXAM NEWEST EVALUATED EXAM PRACTICE 120
QUESTIONS 2026-2027|ORIGINAL QUESTIONS & ANSWERS |DETAILED
RATIONALES |*HINTED* COMPLETE EXAM PREP GRADED A+**INSTANT
DOWNLOAD PDF**
1. A beneficiary is enrolled in Original Medicare and wants coverage for
physician services, outpatient care, and durable medical equipment. Which part
of Medicare primarily provides these benefits?
A. Part A
B. Part C
C. Part B
D. Part D
Answer: C. Part B
Part B is Medicare Medical Insurance and generally covers physician services,
outpatient services, medically necessary equipment, and certain preventive
services.
2. Which Medicare Part provides coverage for inpatient hospital care, skilled
nursing facility care under qualifying circumstances, hospice care, and certain
home health services?
A. Part B
B. Part A
C. Part C
D. Part D
Answer: B. Part A
Part A is Hospital Insurance and covers specified inpatient and institutional
services.
3. Which statement best describes Medicare Part C?
A. It provides only prescription drug coverage.
B. It replaces Social Security retirement benefits.
,C. It allows beneficiaries to receive Medicare-covered Parts A and B benefits
through a Medicare Advantage plan offered by a Medicare-contracted private
organization.
D. It provides only Medigap benefits.
Answer: C. It allows beneficiaries to receive Medicare-covered Parts A and B
benefits through a Medicare Advantage plan offered by a Medicare-contracted
private organization.
Medicare Advantage is Medicare Part C. MA plans are offered by private
organizations that contract with Medicare.
4. Which Medicare component primarily provides outpatient prescription drug
coverage?
A. Part A
B. Part B
C. Part C
D. Part D
Answer: D. Part D
Part D provides Medicare prescription drug coverage through Medicare-approved
private plans.
5. A beneficiary wants to enroll in a Medicare Advantage plan. Which coverage
generally must the beneficiary have before enrolling?
A. Part A only
B. Part B only
C. Both Part A and Part B
D. Part D only
Answer: C. Both Part A and Part B
Eligibility for Medicare Advantage generally requires entitlement to both Medicare
Part A and Part B.
,6. Which individual generally meets the basic eligibility requirements for
enrollment in a Medicare Advantage plan?
A. A person with Part A but without Part B
B. A person with Part B but without Part A
C. A person entitled to both Part A and Part B who lives in the plan's service area
D. A person with only private employer insurance
Answer: C. A person entitled to both Part A and Part B who lives in the plan's
service area
Medicare Advantage enrollment generally requires both Parts A and B and
residence in the plan's service area.
7. Which statement concerning Medicare Advantage premiums is correct?
A. Enrolling in Medicare Advantage automatically eliminates the Part B premium.
B. Beneficiaries never pay any premium when enrolled in Medicare Advantage.
C. A beneficiary generally continues to owe the Medicare Part B premium, in
addition to any plan-specific premium that may apply.
D. The beneficiary pays only the Part D premium.
Answer: C. A beneficiary generally continues to owe the Medicare Part B
premium, in addition to any plan-specific premium that may apply.
Enrollment in Medicare Advantage generally does not eliminate the beneficiary's
obligation to pay the Part B premium.
8. Which Medicare Advantage plan type generally requires members to use a
network of providers except for emergencies and other permitted
circumstances?
A. PFFS
B. HMO
C. MSA
D. Original Medicare
Answer: B. HMO
, Medicare Advantage HMOs generally use a provider network and establish rules
governing access to participating providers.
9. A beneficiary enrolled in an HMO wants to see a specialist. Under the plan's
normal rules, what may be required?
A. A Medigap policy
B. A Part D enrollment
C. A referral from the primary care provider
D. A federal waiver
Answer: C. A referral from the primary care provider
Many Medicare Advantage HMOs require a referral before a member receives
specialist services, subject to the plan's specific rules and exceptions.
10. Which Medicare Advantage plan generally permits members to obtain
covered services from providers outside the plan network, although costs may
be higher?
A. HMO
B. PPO
C. SNP only
D. Original Medicare Part D
Answer: B. PPO
Medicare Advantage PPOs generally provide both in-network and out-of-network
coverage, with different cost-sharing requirements.
11. What is a Medicare Advantage Special Needs Plan designed to do?
A. Replace Medicare Part A for everyone
B. Provide specialized care and benefits for specified categories of Medicare
beneficiaries
C. Provide only Medigap insurance
D. Provide only dental insurance
QUESTIONS 2026-2027|ORIGINAL QUESTIONS & ANSWERS |DETAILED
RATIONALES |*HINTED* COMPLETE EXAM PREP GRADED A+**INSTANT
DOWNLOAD PDF**
1. A beneficiary is enrolled in Original Medicare and wants coverage for
physician services, outpatient care, and durable medical equipment. Which part
of Medicare primarily provides these benefits?
A. Part A
B. Part C
C. Part B
D. Part D
Answer: C. Part B
Part B is Medicare Medical Insurance and generally covers physician services,
outpatient services, medically necessary equipment, and certain preventive
services.
2. Which Medicare Part provides coverage for inpatient hospital care, skilled
nursing facility care under qualifying circumstances, hospice care, and certain
home health services?
A. Part B
B. Part A
C. Part C
D. Part D
Answer: B. Part A
Part A is Hospital Insurance and covers specified inpatient and institutional
services.
3. Which statement best describes Medicare Part C?
A. It provides only prescription drug coverage.
B. It replaces Social Security retirement benefits.
,C. It allows beneficiaries to receive Medicare-covered Parts A and B benefits
through a Medicare Advantage plan offered by a Medicare-contracted private
organization.
D. It provides only Medigap benefits.
Answer: C. It allows beneficiaries to receive Medicare-covered Parts A and B
benefits through a Medicare Advantage plan offered by a Medicare-contracted
private organization.
Medicare Advantage is Medicare Part C. MA plans are offered by private
organizations that contract with Medicare.
4. Which Medicare component primarily provides outpatient prescription drug
coverage?
A. Part A
B. Part B
C. Part C
D. Part D
Answer: D. Part D
Part D provides Medicare prescription drug coverage through Medicare-approved
private plans.
5. A beneficiary wants to enroll in a Medicare Advantage plan. Which coverage
generally must the beneficiary have before enrolling?
A. Part A only
B. Part B only
C. Both Part A and Part B
D. Part D only
Answer: C. Both Part A and Part B
Eligibility for Medicare Advantage generally requires entitlement to both Medicare
Part A and Part B.
,6. Which individual generally meets the basic eligibility requirements for
enrollment in a Medicare Advantage plan?
A. A person with Part A but without Part B
B. A person with Part B but without Part A
C. A person entitled to both Part A and Part B who lives in the plan's service area
D. A person with only private employer insurance
Answer: C. A person entitled to both Part A and Part B who lives in the plan's
service area
Medicare Advantage enrollment generally requires both Parts A and B and
residence in the plan's service area.
7. Which statement concerning Medicare Advantage premiums is correct?
A. Enrolling in Medicare Advantage automatically eliminates the Part B premium.
B. Beneficiaries never pay any premium when enrolled in Medicare Advantage.
C. A beneficiary generally continues to owe the Medicare Part B premium, in
addition to any plan-specific premium that may apply.
D. The beneficiary pays only the Part D premium.
Answer: C. A beneficiary generally continues to owe the Medicare Part B
premium, in addition to any plan-specific premium that may apply.
Enrollment in Medicare Advantage generally does not eliminate the beneficiary's
obligation to pay the Part B premium.
8. Which Medicare Advantage plan type generally requires members to use a
network of providers except for emergencies and other permitted
circumstances?
A. PFFS
B. HMO
C. MSA
D. Original Medicare
Answer: B. HMO
, Medicare Advantage HMOs generally use a provider network and establish rules
governing access to participating providers.
9. A beneficiary enrolled in an HMO wants to see a specialist. Under the plan's
normal rules, what may be required?
A. A Medigap policy
B. A Part D enrollment
C. A referral from the primary care provider
D. A federal waiver
Answer: C. A referral from the primary care provider
Many Medicare Advantage HMOs require a referral before a member receives
specialist services, subject to the plan's specific rules and exceptions.
10. Which Medicare Advantage plan generally permits members to obtain
covered services from providers outside the plan network, although costs may
be higher?
A. HMO
B. PPO
C. SNP only
D. Original Medicare Part D
Answer: B. PPO
Medicare Advantage PPOs generally provide both in-network and out-of-network
coverage, with different cost-sharing requirements.
11. What is a Medicare Advantage Special Needs Plan designed to do?
A. Replace Medicare Part A for everyone
B. Provide specialized care and benefits for specified categories of Medicare
beneficiaries
C. Provide only Medigap insurance
D. Provide only dental insurance
