2027 AHIP Final Exam – Medicare Certification – Actual
Questions & Answers (AHIP)
SECTION I: MEDICARE PROGRAM BASICS
1. Mrs. Chen, a 65-year-old U.S. citizen who has been a U.S. resident for 12
years, is concerned she won't qualify for Part A coverage because she wasn't
born in the U.S. What should you tell her?
A) She is not eligible for Part A because she was not born in the United States
B) She must have been a U.S. resident for at least 20 years to qualify for Part A
C) Most individuals who are citizens and over age 65 are covered under Part A by
virtue of having paid Medicare taxes while working
D) She must enroll in Part A and pay a monthly premium regardless of her work
history
Correct Answer: C
Rationale: Medicare Part A eligibility is based on work history and payment
of Medicare taxes, not citizenship at birth. Individuals who are citizens and age
65+ generally qualify for premium-free Part A if they or their spouse have
worked at least 40 quarters (10 years) in Medicare-covered employment .
2. Which of the following services is covered under Medicare Part A?
A) Outpatient physician visits
B) Preventive care screenings
C) Inpatient hospital stays and skilled nursing facility care
D) Durable medical equipment
Correct Answer: C
Rationale: Medicare Part A specifically covers inpatient hospital stays,
skilled nursing facility care (not custodial care), hospice, and some home health
care. Part B covers outpatient services including physician visits, preventive
care, and durable medical equipment .
,3. Mr. Bauer is a 49-year-old individual with a disability. He has been receiving
Social Security Disability Insurance (SSDI) benefits for 18 months. Is he eligible
for Medicare?
A) No, Medicare is only available to individuals age 65 and older
B) Yes, but only if he also qualifies for Medicaid
C) Yes, individuals under 65 who have received SSDI benefits for 24 months are
eligible for Medicare
D) No, he must wait until age 65 to enroll in Medicare
Correct Answer: C
Rationale: Individuals under age 65 who have received SSDI benefits for 24
months become eligible for Medicare. This is an important exception to the
general age-65 rule .
4. How many quarters of Medicare-covered employment must an individual
have to qualify for premium-free Part A?
A) 20 quarters
B) 30 quarters
C) 40 quarters
D) 50 quarters
Correct Answer: C
Rationale: Individuals who have worked at least 40 quarters (10 years) in
Medicare-covered employment qualify for premium-free Part A. This standard
applies to both the individual and their spouse .
5. What is the standard Medicare Part B premium based upon?
A) The beneficiary's zip code
B) The beneficiary's Modified Adjusted Gross Income (MAGI)
C) The beneficiary's health status
D) The number of years the beneficiary has been retired
, Correct Answer: B
Rationale: Medicare Part B premiums are income-related. Higher-income
beneficiaries pay a higher premium through the Income-Related Monthly
Adjustment Amount (IRMAA), which is based on their Modified Adjusted Gross
Income (MAGI) from two years prior .
6. What percentage of the Medicare-approved amount does a beneficiary
typically pay for Part B covered services after meeting the annual deductible?
A) 10%
B) 20%
C) 30%
D) 50%
Correct Answer: B
Rationale: Under Original Medicare Part B, after the annual deductible is
satisfied, the beneficiary is responsible for 20% coinsurance of the Medicare-
approved amount for most covered services. Medicare pays the remaining 80% .
7. Medicare Part C is also known as:
A) Medicare Supplement Insurance
B) Medicare Advantage
C) Standalone Prescription Drug Plans
D) Medicaid
Correct Answer: B
Rationale: Medicare Part C is officially known as the Medicare Advantage
program. Private insurance companies approved by CMS deliver Part A and Part
B benefits through these plans, often including additional benefits like
prescription drug coverage, dental, vision, and hearing .
8. What is the primary purpose of Medicare Part D?
, A) To cover extended hospitalizations
B) To provide optional outpatient prescription drug coverage
C) To cover dental, vision, and hearing services
D) To offer international travel medical insurance
Correct Answer: B
Rationale: Medicare Part D is the optional outpatient prescription drug
coverage program administered by private insurance companies that have
contracted with the federal government. It helps beneficiaries pay for their
prescription medications .
9. Which type of plan is a standalone option that adds drug coverage to Original
Medicare?
A) MA-PD (Medicare Advantage Prescription Drug Plan)
B) PDP (Prescription Drug Plan)
C) PPO (Preferred Provider Organization)
D) Medigap
Correct Answer: B
Rationale: A Prescription Drug Plan (PDP) is a standalone plan that provides
Part D prescription benefits for beneficiaries enrolled in Original Medicare or
certain other plan types that don't include drug coverage .
10. A beneficiary enrolled in a Medicare Advantage plan must still pay which
premium?
A) The Medicare Part A premium
B) The Medicare Part B premium
C) The Medicare Part D premium
D) No premiums are required
Correct Answer: B
Rationale: Beneficiaries enrolled in Medicare Advantage plans must
continue to pay their Medicare Part B premium to the federal government.
Questions & Answers (AHIP)
SECTION I: MEDICARE PROGRAM BASICS
1. Mrs. Chen, a 65-year-old U.S. citizen who has been a U.S. resident for 12
years, is concerned she won't qualify for Part A coverage because she wasn't
born in the U.S. What should you tell her?
A) She is not eligible for Part A because she was not born in the United States
B) She must have been a U.S. resident for at least 20 years to qualify for Part A
C) Most individuals who are citizens and over age 65 are covered under Part A by
virtue of having paid Medicare taxes while working
D) She must enroll in Part A and pay a monthly premium regardless of her work
history
Correct Answer: C
Rationale: Medicare Part A eligibility is based on work history and payment
of Medicare taxes, not citizenship at birth. Individuals who are citizens and age
65+ generally qualify for premium-free Part A if they or their spouse have
worked at least 40 quarters (10 years) in Medicare-covered employment .
2. Which of the following services is covered under Medicare Part A?
A) Outpatient physician visits
B) Preventive care screenings
C) Inpatient hospital stays and skilled nursing facility care
D) Durable medical equipment
Correct Answer: C
Rationale: Medicare Part A specifically covers inpatient hospital stays,
skilled nursing facility care (not custodial care), hospice, and some home health
care. Part B covers outpatient services including physician visits, preventive
care, and durable medical equipment .
,3. Mr. Bauer is a 49-year-old individual with a disability. He has been receiving
Social Security Disability Insurance (SSDI) benefits for 18 months. Is he eligible
for Medicare?
A) No, Medicare is only available to individuals age 65 and older
B) Yes, but only if he also qualifies for Medicaid
C) Yes, individuals under 65 who have received SSDI benefits for 24 months are
eligible for Medicare
D) No, he must wait until age 65 to enroll in Medicare
Correct Answer: C
Rationale: Individuals under age 65 who have received SSDI benefits for 24
months become eligible for Medicare. This is an important exception to the
general age-65 rule .
4. How many quarters of Medicare-covered employment must an individual
have to qualify for premium-free Part A?
A) 20 quarters
B) 30 quarters
C) 40 quarters
D) 50 quarters
Correct Answer: C
Rationale: Individuals who have worked at least 40 quarters (10 years) in
Medicare-covered employment qualify for premium-free Part A. This standard
applies to both the individual and their spouse .
5. What is the standard Medicare Part B premium based upon?
A) The beneficiary's zip code
B) The beneficiary's Modified Adjusted Gross Income (MAGI)
C) The beneficiary's health status
D) The number of years the beneficiary has been retired
, Correct Answer: B
Rationale: Medicare Part B premiums are income-related. Higher-income
beneficiaries pay a higher premium through the Income-Related Monthly
Adjustment Amount (IRMAA), which is based on their Modified Adjusted Gross
Income (MAGI) from two years prior .
6. What percentage of the Medicare-approved amount does a beneficiary
typically pay for Part B covered services after meeting the annual deductible?
A) 10%
B) 20%
C) 30%
D) 50%
Correct Answer: B
Rationale: Under Original Medicare Part B, after the annual deductible is
satisfied, the beneficiary is responsible for 20% coinsurance of the Medicare-
approved amount for most covered services. Medicare pays the remaining 80% .
7. Medicare Part C is also known as:
A) Medicare Supplement Insurance
B) Medicare Advantage
C) Standalone Prescription Drug Plans
D) Medicaid
Correct Answer: B
Rationale: Medicare Part C is officially known as the Medicare Advantage
program. Private insurance companies approved by CMS deliver Part A and Part
B benefits through these plans, often including additional benefits like
prescription drug coverage, dental, vision, and hearing .
8. What is the primary purpose of Medicare Part D?
, A) To cover extended hospitalizations
B) To provide optional outpatient prescription drug coverage
C) To cover dental, vision, and hearing services
D) To offer international travel medical insurance
Correct Answer: B
Rationale: Medicare Part D is the optional outpatient prescription drug
coverage program administered by private insurance companies that have
contracted with the federal government. It helps beneficiaries pay for their
prescription medications .
9. Which type of plan is a standalone option that adds drug coverage to Original
Medicare?
A) MA-PD (Medicare Advantage Prescription Drug Plan)
B) PDP (Prescription Drug Plan)
C) PPO (Preferred Provider Organization)
D) Medigap
Correct Answer: B
Rationale: A Prescription Drug Plan (PDP) is a standalone plan that provides
Part D prescription benefits for beneficiaries enrolled in Original Medicare or
certain other plan types that don't include drug coverage .
10. A beneficiary enrolled in a Medicare Advantage plan must still pay which
premium?
A) The Medicare Part A premium
B) The Medicare Part B premium
C) The Medicare Part D premium
D) No premiums are required
Correct Answer: B
Rationale: Beneficiaries enrolled in Medicare Advantage plans must
continue to pay their Medicare Part B premium to the federal government.
