AHIP 2026 FINAL EXAM ANSWER KEY
For Certification Period
Verified Answers for Medicare Certification | A Graded — 150 Questions
Total Questions 150 (multiple choice, 4 options each)
Sections 9 sections spanning Medicare basics through advanced case studies
Cognitive Mix 25% Recall | 50% Application | 25% Analysis
Question Style 75% scenario-based (member situations, enrollment cases, compliance) |
25% direct knowledge
Curriculum Aligned with AHIP Medicare training program standards, CMS
regulations (42 CFR Parts 422 & 423), and Medicare Advantage / Part D
compliance requirements
Audience Agents, brokers, and plan personnel preparing for AHIP 2026/2027
certification
This practice examination package is independently authored for educational purposes and is not affiliated with,
endorsed by, or sponsored by America’s Health Insurance Plans (AHIP), the Centers for Medicare & Medicaid
Services (CMS), or any official testing body. Questions reflect publicly available AHIP Medicare training content, CMS
regulations in 42 CFR Parts 422 and 423, the Medicare Prescription Drug, Improvement, and Modernization Act of
2003, the Inflation Reduction Act of 2022, and the CMS 2024 Final Rule on agent/broker compensation, current as of
the 2026/2027 certification period. Candidates should always consult the official AHIP module materials and current
CMS guidance for the authoritative scope of their certification examination.
1 Verified Answers for Medicare Certification | A Graded — 150 Questions Page 1
,AHIP 2026 Final Exam Answer Key — 2026/2027 Certification Period
Table of Contents
Section Topic # Qs
Section 1 Medicare Basics, Eligibility, & Entitlement 20
Section 2 Medicare Advantage Plans (MA & MAPD) 25
Section 3 Medicare Part D Prescription Drug Plans 20
Section 4 Enrollment Periods & Election Processes 20
Section 5 Compliance, Fraud, Waste, & Abuse 15
Section 6 Marketing Guidelines & Member Communications 15
Section 7 Appeals, Grievances, & Coverage Determinations 15
Section 8 Agent/Broker Standards, Compensation, & Ethics 10
Section 9 Advanced Case Studies & Scenarios 10
TOTAL All Sections Combined 150
Each question presents one correct answer (marked *[CORRECT]*) and includes a 2–3 sentence rationale citing the relevant
CMS regulation (42 CFR Parts 422 & 423, the Social Security Act, the Inflation Reduction Act, or the CMS 2024 Final Rule)
and the AHIP training module reference. Page numbers are automatically maintained by the running header.
2 Verified Answers for Medicare Certification | A Graded — 150 Questions Page 2
,AHIP 2026 Final Exam Answer Key — 2026/2027 Certification Period
Section 1: Medicare Basics, Eligibility, & Entitlement
Part A, Part B, Part C overview; premiums, deductibles, cost-sharing, MSP, Medigap basics — 20 questions
Q1: A 64-year-old woman whose husband has active employer-sponsored group health coverage for
both of them asks when she must enroll in Medicare Part B. Her husband plans to keep working until
age 67. What should the agent advise?
A. She must enroll in Part B during her Initial Enrollment Period (IEP) at age 65 or face a lifetime
late-enrollment penalty.
B. She can delay Part B enrollment without penalty while she is covered as a dependent under her
husband's active-employment group health plan, and enroll later during an 8-month Special
Enrollment Period (SEP) that begins the month employment or coverage ends. *[CORRECT]*
C. She must enroll in Part B at age 65 but will lose her group coverage automatically.
D. She can only enroll in Part B during the Annual Enrollment Period (AEP).
Correct Answer: B
Rationale: Under 42 CFR § 407.11, individuals covered by an active-employment group health plan (their own or a
spouse's) may delay Part B without lifetime late-enrollment penalties and enroll later during an 8-month SEP that begins
the month employment or group coverage ends. The IEP at age 65 is not the only option when current active coverage
exists (CMS Medicare & You 2026; AHIP Module 1: Medicare Basics).
Q2: Which statement accurately describes Medicare Part A premium rules for most beneficiaries?
A. Everyone age 65 or older must pay a monthly Part A premium regardless of work history.
B. Most people qualify for premium-free Part A because they (or their spouse) earned 40 quarters of
Social Security-covered employment; those with fewer than 30 quarters may buy Part A and pay the
full monthly premium (about $506 in 2025, indexed for 2026). *[CORRECT]*
C. Part A is always free for everyone, including non-citizens who never worked in the U.S.
D. Only U.S.-born citizens qualify for premium-free Part A.
Correct Answer: B
Rationale: Premium-free Part A requires 40 quarters of Social Security-covered employment (or a spouse's). Individuals
with 30–39 quarters pay a reduced monthly premium; fewer than 30 quarters pay the full premium. Citizenship alone
does not confer premium-free Part A (CMS Medicare & You 2026; AHIP Module 1).
3 Verified Answers for Medicare Certification | A Graded — 150 Questions Page 3
, AHIP 2026 Final Exam Answer Key — 2026/2027 Certification Period
Q3: A beneficiary is admitted to the hospital as an inpatient for 4 days in 2026. What cost-sharing
does Original Medicare Part A impose?
A. $0 deductible and 20% coinsurance for all 4 days.
B. A single deductible of approximately $1,676 (2026) covers the first 60 days of inpatient care per
benefit period; days 1–60 have no daily coinsurance, days 61–90 carry daily coinsurance (~$419/day),
and days 91–150 use lifetime reserve days (~$838/day). *[CORRECT]*
C. A flat $250 per day for all 4 days.
D. Part A has no deductible for inpatient hospital stays.
Correct Answer: B
Rationale: Part A inpatient cost-sharing is a single deductible (~$1,676 in 2026) covering days 1–60 per benefit period;
days 61–90 carry daily coinsurance (~$419); days 91–150 use 60 lifetime reserve days (~$838). A new benefit period
begins after 60 consecutive days out of the hospital (CMS Medicare & You 2026; AHIP Module 1).
Q4: A Medicare beneficiary is discharged from a 5-day inpatient hospital stay to a skilled nursing
facility (SNF). What conditions must be met for Part A SNF coverage?
A. A 3-day inpatient hospital stay (3 midnights, observation days excluded) within 30 days before SNF
admission, a doctor's order for skilled care, and the need for skilled nursing or rehabilitation services
on a daily basis. *[CORRECT]*
B. Only a doctor's order, regardless of prior hospital stay.
C. A 1-day hospital stay followed by a doctor's certification.
D. The SNF stay must be in the same hospital system as the prior admission.
Correct Answer: A
Rationale: Part A SNF coverage requires a 3-day inpatient hospital stay (3 midnights; observation days excluded) within
30 days before SNF admission, a physician order for skilled care, and daily skilled services. Coverage is up to 100 days
per benefit period: $0 coinsurance days 1–20 and ~$209.50/day coinsurance days 21–100 in 2026 (CMS Medicare &
You 2026; AHIP Module 1).
Q5: An agent explains hospice benefits to a terminally ill Medicare beneficiary. Which statement is
correct?
A. Hospice coverage under Part A requires the patient to forgo curative treatment for the terminal
illness, certify a life expectancy of 6 months or less if the illness runs its normal course, and elect
palliative care. *[CORRECT]*
B. Hospice coverage is provided under Part B and requires a 3-day hospital stay.
C. Hospice covers only pain medication and nothing else.
D. Hospice is only available for cancer patients.
Correct Answer: A
Rationale: The Medicare hospice benefit (Part A) requires the beneficiary to elect hospice, certify a life expectancy of 6
months or less if the illness runs its normal course, and forgo curative treatment for the terminal illness while receiving
palliative care for that illness. Curative treatment for unrelated conditions remains covered (42 CFR § 418; CMS
Medicare & You 2026; AHIP Module 1).
4 Verified Answers for Medicare Certification | A Graded — 150 Questions Page 4
For Certification Period
Verified Answers for Medicare Certification | A Graded — 150 Questions
Total Questions 150 (multiple choice, 4 options each)
Sections 9 sections spanning Medicare basics through advanced case studies
Cognitive Mix 25% Recall | 50% Application | 25% Analysis
Question Style 75% scenario-based (member situations, enrollment cases, compliance) |
25% direct knowledge
Curriculum Aligned with AHIP Medicare training program standards, CMS
regulations (42 CFR Parts 422 & 423), and Medicare Advantage / Part D
compliance requirements
Audience Agents, brokers, and plan personnel preparing for AHIP 2026/2027
certification
This practice examination package is independently authored for educational purposes and is not affiliated with,
endorsed by, or sponsored by America’s Health Insurance Plans (AHIP), the Centers for Medicare & Medicaid
Services (CMS), or any official testing body. Questions reflect publicly available AHIP Medicare training content, CMS
regulations in 42 CFR Parts 422 and 423, the Medicare Prescription Drug, Improvement, and Modernization Act of
2003, the Inflation Reduction Act of 2022, and the CMS 2024 Final Rule on agent/broker compensation, current as of
the 2026/2027 certification period. Candidates should always consult the official AHIP module materials and current
CMS guidance for the authoritative scope of their certification examination.
1 Verified Answers for Medicare Certification | A Graded — 150 Questions Page 1
,AHIP 2026 Final Exam Answer Key — 2026/2027 Certification Period
Table of Contents
Section Topic # Qs
Section 1 Medicare Basics, Eligibility, & Entitlement 20
Section 2 Medicare Advantage Plans (MA & MAPD) 25
Section 3 Medicare Part D Prescription Drug Plans 20
Section 4 Enrollment Periods & Election Processes 20
Section 5 Compliance, Fraud, Waste, & Abuse 15
Section 6 Marketing Guidelines & Member Communications 15
Section 7 Appeals, Grievances, & Coverage Determinations 15
Section 8 Agent/Broker Standards, Compensation, & Ethics 10
Section 9 Advanced Case Studies & Scenarios 10
TOTAL All Sections Combined 150
Each question presents one correct answer (marked *[CORRECT]*) and includes a 2–3 sentence rationale citing the relevant
CMS regulation (42 CFR Parts 422 & 423, the Social Security Act, the Inflation Reduction Act, or the CMS 2024 Final Rule)
and the AHIP training module reference. Page numbers are automatically maintained by the running header.
2 Verified Answers for Medicare Certification | A Graded — 150 Questions Page 2
,AHIP 2026 Final Exam Answer Key — 2026/2027 Certification Period
Section 1: Medicare Basics, Eligibility, & Entitlement
Part A, Part B, Part C overview; premiums, deductibles, cost-sharing, MSP, Medigap basics — 20 questions
Q1: A 64-year-old woman whose husband has active employer-sponsored group health coverage for
both of them asks when she must enroll in Medicare Part B. Her husband plans to keep working until
age 67. What should the agent advise?
A. She must enroll in Part B during her Initial Enrollment Period (IEP) at age 65 or face a lifetime
late-enrollment penalty.
B. She can delay Part B enrollment without penalty while she is covered as a dependent under her
husband's active-employment group health plan, and enroll later during an 8-month Special
Enrollment Period (SEP) that begins the month employment or coverage ends. *[CORRECT]*
C. She must enroll in Part B at age 65 but will lose her group coverage automatically.
D. She can only enroll in Part B during the Annual Enrollment Period (AEP).
Correct Answer: B
Rationale: Under 42 CFR § 407.11, individuals covered by an active-employment group health plan (their own or a
spouse's) may delay Part B without lifetime late-enrollment penalties and enroll later during an 8-month SEP that begins
the month employment or group coverage ends. The IEP at age 65 is not the only option when current active coverage
exists (CMS Medicare & You 2026; AHIP Module 1: Medicare Basics).
Q2: Which statement accurately describes Medicare Part A premium rules for most beneficiaries?
A. Everyone age 65 or older must pay a monthly Part A premium regardless of work history.
B. Most people qualify for premium-free Part A because they (or their spouse) earned 40 quarters of
Social Security-covered employment; those with fewer than 30 quarters may buy Part A and pay the
full monthly premium (about $506 in 2025, indexed for 2026). *[CORRECT]*
C. Part A is always free for everyone, including non-citizens who never worked in the U.S.
D. Only U.S.-born citizens qualify for premium-free Part A.
Correct Answer: B
Rationale: Premium-free Part A requires 40 quarters of Social Security-covered employment (or a spouse's). Individuals
with 30–39 quarters pay a reduced monthly premium; fewer than 30 quarters pay the full premium. Citizenship alone
does not confer premium-free Part A (CMS Medicare & You 2026; AHIP Module 1).
3 Verified Answers for Medicare Certification | A Graded — 150 Questions Page 3
, AHIP 2026 Final Exam Answer Key — 2026/2027 Certification Period
Q3: A beneficiary is admitted to the hospital as an inpatient for 4 days in 2026. What cost-sharing
does Original Medicare Part A impose?
A. $0 deductible and 20% coinsurance for all 4 days.
B. A single deductible of approximately $1,676 (2026) covers the first 60 days of inpatient care per
benefit period; days 1–60 have no daily coinsurance, days 61–90 carry daily coinsurance (~$419/day),
and days 91–150 use lifetime reserve days (~$838/day). *[CORRECT]*
C. A flat $250 per day for all 4 days.
D. Part A has no deductible for inpatient hospital stays.
Correct Answer: B
Rationale: Part A inpatient cost-sharing is a single deductible (~$1,676 in 2026) covering days 1–60 per benefit period;
days 61–90 carry daily coinsurance (~$419); days 91–150 use 60 lifetime reserve days (~$838). A new benefit period
begins after 60 consecutive days out of the hospital (CMS Medicare & You 2026; AHIP Module 1).
Q4: A Medicare beneficiary is discharged from a 5-day inpatient hospital stay to a skilled nursing
facility (SNF). What conditions must be met for Part A SNF coverage?
A. A 3-day inpatient hospital stay (3 midnights, observation days excluded) within 30 days before SNF
admission, a doctor's order for skilled care, and the need for skilled nursing or rehabilitation services
on a daily basis. *[CORRECT]*
B. Only a doctor's order, regardless of prior hospital stay.
C. A 1-day hospital stay followed by a doctor's certification.
D. The SNF stay must be in the same hospital system as the prior admission.
Correct Answer: A
Rationale: Part A SNF coverage requires a 3-day inpatient hospital stay (3 midnights; observation days excluded) within
30 days before SNF admission, a physician order for skilled care, and daily skilled services. Coverage is up to 100 days
per benefit period: $0 coinsurance days 1–20 and ~$209.50/day coinsurance days 21–100 in 2026 (CMS Medicare &
You 2026; AHIP Module 1).
Q5: An agent explains hospice benefits to a terminally ill Medicare beneficiary. Which statement is
correct?
A. Hospice coverage under Part A requires the patient to forgo curative treatment for the terminal
illness, certify a life expectancy of 6 months or less if the illness runs its normal course, and elect
palliative care. *[CORRECT]*
B. Hospice coverage is provided under Part B and requires a 3-day hospital stay.
C. Hospice covers only pain medication and nothing else.
D. Hospice is only available for cancer patients.
Correct Answer: A
Rationale: The Medicare hospice benefit (Part A) requires the beneficiary to elect hospice, certify a life expectancy of 6
months or less if the illness runs its normal course, and forgo curative treatment for the terminal illness while receiving
palliative care for that illness. Curative treatment for unrelated conditions remains covered (42 CFR § 418; CMS
Medicare & You 2026; AHIP Module 1).
4 Verified Answers for Medicare Certification | A Graded — 150 Questions Page 4
