AHIP Final Exam 2027| Complete 50-Question Practice Test with 100%
Verified Answers | Medicare & ACA Focused | Updated Study Guide for
Certification Success | Graded A+
Which part of Medicare covers inpatient hospital stays?
A. Part A
B. Part B
C. Part C
D. Part D
Answer: A. Part A
What is the “donut hole” in Medicare Part D?
A. A gap in coverage where beneficiaries pay full drug cost
B. A penalty for late enrollment
C. The deductible
D. A subsidy period
Answer: A. A gap in coverage where beneficiaries pay full drug cost
Which law mandates coverage for preventive services without cost-sharing?
A. HIPAA
B. ACA
C. COBRA
D. ERISA
Answer: B. ACA
Which period allows a beneficiary to make changes due to special circumstances (e.g.
moving)?
A. Annual Enrollment Period
B. Open Enrollment Period
C. Special Enrollment Period
D. Guaranteed Issue
Answer: C. Special Enrollment Period
What is “prior authorization” in insurance?
A. Automatic approval
B. Required approval before services are covered
C. Payment after service
D. Denial of claim
Answer: B. Required approval before services are covered
, Which entity enforces compliance and sets penalties for Medicare regulation violations?
A. OMB
B. HHS / CMS
C. SSA
D. Medicaid
Answer: B. HHS / CMS
Which election period allows a one-time switch from Medicare Advantage to Original
Medicare?
A. Initial Enrollment
B. Annual Enrollment
C. Open Enrollment
D. Medigap Open Enrollment
Answer: C. Open Enrollment
Which of the following is an example of a cost control mechanism in health plans?
A. Unlimited benefits
B. Copayments
C. No networks
D. Guaranteed issue
Answer: B. Copayments
Which of these is true about “maximum out-of-pocket” (MOOP) in Medicare
Advantage?
A. No limit
B. Cap on total spending on covered services
C. Only applies to drugs
D. Applies to non-covered services
Answer: B. Cap on total spending on covered services
What is “appeals process” in insurance?
A. Enrolling in a plan
B. Requesting coverage reconsideration
C. Change premiums
D. Canceling coverage
Answer: B. Requesting coverage reconsideration
Which plan type allows use of out-of-network providers at higher cost?
A. HMO
B. PPO
C. EPO
D. SNP
Answer: B. PPO
Which factor determines Medicare Advantage plan reimbursements?
A. Enrollee’s zip code
Verified Answers | Medicare & ACA Focused | Updated Study Guide for
Certification Success | Graded A+
Which part of Medicare covers inpatient hospital stays?
A. Part A
B. Part B
C. Part C
D. Part D
Answer: A. Part A
What is the “donut hole” in Medicare Part D?
A. A gap in coverage where beneficiaries pay full drug cost
B. A penalty for late enrollment
C. The deductible
D. A subsidy period
Answer: A. A gap in coverage where beneficiaries pay full drug cost
Which law mandates coverage for preventive services without cost-sharing?
A. HIPAA
B. ACA
C. COBRA
D. ERISA
Answer: B. ACA
Which period allows a beneficiary to make changes due to special circumstances (e.g.
moving)?
A. Annual Enrollment Period
B. Open Enrollment Period
C. Special Enrollment Period
D. Guaranteed Issue
Answer: C. Special Enrollment Period
What is “prior authorization” in insurance?
A. Automatic approval
B. Required approval before services are covered
C. Payment after service
D. Denial of claim
Answer: B. Required approval before services are covered
, Which entity enforces compliance and sets penalties for Medicare regulation violations?
A. OMB
B. HHS / CMS
C. SSA
D. Medicaid
Answer: B. HHS / CMS
Which election period allows a one-time switch from Medicare Advantage to Original
Medicare?
A. Initial Enrollment
B. Annual Enrollment
C. Open Enrollment
D. Medigap Open Enrollment
Answer: C. Open Enrollment
Which of the following is an example of a cost control mechanism in health plans?
A. Unlimited benefits
B. Copayments
C. No networks
D. Guaranteed issue
Answer: B. Copayments
Which of these is true about “maximum out-of-pocket” (MOOP) in Medicare
Advantage?
A. No limit
B. Cap on total spending on covered services
C. Only applies to drugs
D. Applies to non-covered services
Answer: B. Cap on total spending on covered services
What is “appeals process” in insurance?
A. Enrolling in a plan
B. Requesting coverage reconsideration
C. Change premiums
D. Canceling coverage
Answer: B. Requesting coverage reconsideration
Which plan type allows use of out-of-network providers at higher cost?
A. HMO
B. PPO
C. EPO
D. SNP
Answer: B. PPO
Which factor determines Medicare Advantage plan reimbursements?
A. Enrollee’s zip code
