AHIP Final Exam Latest (2025/2026) | 50
Verified Questions and Correct Answers |
A+ Graded
1. Which.part.of.Medicare.covers.inpatient.hospital.services?
.CORRECT.ANSWER:.Part.A
Rationale:.Medicare.Part.A.pays.for.inpatient.stays,.skilled.nursing.facility.care,.hospice,.and.s
ome.home.health.
2. A.beneficiary.turning.65.and.already.receiving.Social.Security.benefits.is
.automatically.enrolled.in:
.CORRECT.ANSWER:.Part.A.and.Part.B
Rationale:.Automatic.enrollment.occurs.when.receiving.SSA.benefits.prior.to.65.
3. The.penalty.for.delaying.Medicare.Part.B.enrollment.without.creditable
.coverage.is:
.CORRECT.ANSWER:.10%.for.every.12.months.delayed
Rationale:.CMS.applies.a.10%.surcharge.for.each.full.uncovered.year.
4. Medicare.Advantage.plans.must.cover:
.CORRECT.ANSWER:.All.services.covered.by.Original.Medicare
Rationale:.MA.plans.are.required.to.provide.equal.or.greater.coverage.than.Parts.A.and.B.
,5. What.is.the.main.requirement.to.join.a.Medicare.Advantage.plan?
.CORRECT.ANSWER:.Must.have.both.Part.A.and.Part.B
Rationale:.Enrollment.in.both.parts.is.mandatory.for.MA.
6. The.six.protected.drug.classes.under.Part.D.ensure:
.CORRECT.ANSWER:.Broad.access.to.critical.medications
Rationale:.Plans.must.cover.all.or.nearly.all.drugs.in.these.categories.
7. An.agent.must.obtain.a.Scope.of.Appointment.(SOA):
.CORRECT.ANSWER:.Before.discussing.specific.plan.benefits
Rationale:.CMS.requires.SOA.to.document.beneficiary.permission.
8. LIS.(Low-Income.Subsidy).helps.beneficiaries.with:
.CORRECT.ANSWER:.Part.D.premium,.deductible,.and.cost-sharing
Rationale:.LIS.reduces.or.eliminates.drug.plan.costs.for.low-income.enrollees.
9. What.is.considered.marketing?
.CORRECT.ANSWER:.Materials.intended.to.steer.beneficiaries.toward.enrollment
Rationale:.CMS.defines.marketing.by.intent.and.content.
10. Medicare.Part.B.covers:
.CORRECT.ANSWER:.Outpatient.services.and.preventive.care
Rationale:.Part.B.includes.doctor.visits,.screenings,.DME,.and.outpatient.services.
11. A.Special.Enrollment.Period.(SEP).for.Part.B.exists.when:
,.CORRECT.ANSWER:.A.beneficiary.has.creditable.employer.coverage.and.delays.enrollment
Rationale:.SEP.avoids.penalties.when.credible.employer.insurance.exists.
12. Medicare.Advantage.plans.receive.payment.from.CMS.through:
.CORRECT.ANSWER:.Monthly.capitated.payments
Rationale:.Plans.get.a.fixed.per-member.amount.regardless.of.service.use.
13. Upcoding.by.a.provider.is.an.example.of:
.CORRECT.ANSWER:.Fraud
Rationale:.Intentionally.coding.higher.levels.of.service.is.deceptive.and.illegal.
14. Waste.refers.to:
.CORRECT.ANSWER:.Over-utilization.of.services
Rationale:.Waste.does.not.require.intent.to.break.rules.
15. Which.program.helps.pay.Medicare.costs.for.individuals.with.limited
.income?
.CORRECT.ANSWER:.Medicare.Savings.Programs.(MSPs)
Rationale:.MSPs.cover.Part.A/B.premiums.and.sometimes.cost-sharing.
16. A.marketing.event.allows.an.agent.to:
.CORRECT.ANSWER:.Present.plan-specific.information
Rationale:.Unlike.educational.events,.marketing.events.permit.discussing.benefits.
17. A.PPO.Medicare.Advantage.plan.allows.members.to:
.CORRECT.ANSWER:.See.out-of-network.providers.at.higher.cost
Rationale:.PPOs.offer.flexibility,.but.at.increased.OOP.costs.
, 18. Which.plan.type.restricts.members.to.their.network.for.all
.non-emergency.care?
.CORRECT.ANSWER:.HMO
Rationale:.HMOs.generally.require.in-network.providers.
19. Which.of.the.following.is.required.for.enrollment.in.a.Special.Needs
.Plan.(SNP)?
.CORRECT.ANSWER:.Must.meet.the.SNP’s.eligibility.criteria
Rationale:.SNPs.require.chronic.conditions,.institutional.status,.or.dual.eligibility.
20. The.Medicare.Part.D.coverage.gap.(“donut.hole”).occurs.after:
.CORRECT.ANSWER:.The.initial.coverage.limit.is.reached
Rationale:.After.the.limit,.members.pay.a.percentage.of.drug.costs.until.catastrophic.coverage.
21. A.permissible.activity.at.an.educational.event.is:
.CORRECT.ANSWER:.Giving.out.general.Medicare.information
Rationale:.No.plan-specific.info.or.enrollment.forms.allowed.
22. Which.statement.is.true.about.MA.plans.and.emergency.care?
.CORRECT.ANSWER:.Emergency.care.must.be.covered.everywhere.in.the.U.S.
Rationale:.CMS.requires.universal.emergency.coverage.
23. A.drug.formulary.is:
.CORRECT.ANSWER:.The.list.of.drugs.a.Part.D.plan.covers
Rationale:.Formularies.categorize.drugs.by.tiers.and.coverage.rules.
Verified Questions and Correct Answers |
A+ Graded
1. Which.part.of.Medicare.covers.inpatient.hospital.services?
.CORRECT.ANSWER:.Part.A
Rationale:.Medicare.Part.A.pays.for.inpatient.stays,.skilled.nursing.facility.care,.hospice,.and.s
ome.home.health.
2. A.beneficiary.turning.65.and.already.receiving.Social.Security.benefits.is
.automatically.enrolled.in:
.CORRECT.ANSWER:.Part.A.and.Part.B
Rationale:.Automatic.enrollment.occurs.when.receiving.SSA.benefits.prior.to.65.
3. The.penalty.for.delaying.Medicare.Part.B.enrollment.without.creditable
.coverage.is:
.CORRECT.ANSWER:.10%.for.every.12.months.delayed
Rationale:.CMS.applies.a.10%.surcharge.for.each.full.uncovered.year.
4. Medicare.Advantage.plans.must.cover:
.CORRECT.ANSWER:.All.services.covered.by.Original.Medicare
Rationale:.MA.plans.are.required.to.provide.equal.or.greater.coverage.than.Parts.A.and.B.
,5. What.is.the.main.requirement.to.join.a.Medicare.Advantage.plan?
.CORRECT.ANSWER:.Must.have.both.Part.A.and.Part.B
Rationale:.Enrollment.in.both.parts.is.mandatory.for.MA.
6. The.six.protected.drug.classes.under.Part.D.ensure:
.CORRECT.ANSWER:.Broad.access.to.critical.medications
Rationale:.Plans.must.cover.all.or.nearly.all.drugs.in.these.categories.
7. An.agent.must.obtain.a.Scope.of.Appointment.(SOA):
.CORRECT.ANSWER:.Before.discussing.specific.plan.benefits
Rationale:.CMS.requires.SOA.to.document.beneficiary.permission.
8. LIS.(Low-Income.Subsidy).helps.beneficiaries.with:
.CORRECT.ANSWER:.Part.D.premium,.deductible,.and.cost-sharing
Rationale:.LIS.reduces.or.eliminates.drug.plan.costs.for.low-income.enrollees.
9. What.is.considered.marketing?
.CORRECT.ANSWER:.Materials.intended.to.steer.beneficiaries.toward.enrollment
Rationale:.CMS.defines.marketing.by.intent.and.content.
10. Medicare.Part.B.covers:
.CORRECT.ANSWER:.Outpatient.services.and.preventive.care
Rationale:.Part.B.includes.doctor.visits,.screenings,.DME,.and.outpatient.services.
11. A.Special.Enrollment.Period.(SEP).for.Part.B.exists.when:
,.CORRECT.ANSWER:.A.beneficiary.has.creditable.employer.coverage.and.delays.enrollment
Rationale:.SEP.avoids.penalties.when.credible.employer.insurance.exists.
12. Medicare.Advantage.plans.receive.payment.from.CMS.through:
.CORRECT.ANSWER:.Monthly.capitated.payments
Rationale:.Plans.get.a.fixed.per-member.amount.regardless.of.service.use.
13. Upcoding.by.a.provider.is.an.example.of:
.CORRECT.ANSWER:.Fraud
Rationale:.Intentionally.coding.higher.levels.of.service.is.deceptive.and.illegal.
14. Waste.refers.to:
.CORRECT.ANSWER:.Over-utilization.of.services
Rationale:.Waste.does.not.require.intent.to.break.rules.
15. Which.program.helps.pay.Medicare.costs.for.individuals.with.limited
.income?
.CORRECT.ANSWER:.Medicare.Savings.Programs.(MSPs)
Rationale:.MSPs.cover.Part.A/B.premiums.and.sometimes.cost-sharing.
16. A.marketing.event.allows.an.agent.to:
.CORRECT.ANSWER:.Present.plan-specific.information
Rationale:.Unlike.educational.events,.marketing.events.permit.discussing.benefits.
17. A.PPO.Medicare.Advantage.plan.allows.members.to:
.CORRECT.ANSWER:.See.out-of-network.providers.at.higher.cost
Rationale:.PPOs.offer.flexibility,.but.at.increased.OOP.costs.
, 18. Which.plan.type.restricts.members.to.their.network.for.all
.non-emergency.care?
.CORRECT.ANSWER:.HMO
Rationale:.HMOs.generally.require.in-network.providers.
19. Which.of.the.following.is.required.for.enrollment.in.a.Special.Needs
.Plan.(SNP)?
.CORRECT.ANSWER:.Must.meet.the.SNP’s.eligibility.criteria
Rationale:.SNPs.require.chronic.conditions,.institutional.status,.or.dual.eligibility.
20. The.Medicare.Part.D.coverage.gap.(“donut.hole”).occurs.after:
.CORRECT.ANSWER:.The.initial.coverage.limit.is.reached
Rationale:.After.the.limit,.members.pay.a.percentage.of.drug.costs.until.catastrophic.coverage.
21. A.permissible.activity.at.an.educational.event.is:
.CORRECT.ANSWER:.Giving.out.general.Medicare.information
Rationale:.No.plan-specific.info.or.enrollment.forms.allowed.
22. Which.statement.is.true.about.MA.plans.and.emergency.care?
.CORRECT.ANSWER:.Emergency.care.must.be.covered.everywhere.in.the.U.S.
Rationale:.CMS.requires.universal.emergency.coverage.
23. A.drug.formulary.is:
.CORRECT.ANSWER:.The.list.of.drugs.a.Part.D.plan.covers
Rationale:.Formularies.categorize.drugs.by.tiers.and.coverage.rules.
