1|Page
# AHIP EXAM REVIEW## (AMERICA'S HEALTH
INSURANCE PLANS) CERTIFICATION
EXAM**2026-2027 EDITION | 200+ QUESTIONS |
DETAILED RATIONALES** **GRADED A+ |
MEDICARE COMPLIANCE & SALES
CERTIFICATION**
TABLE OF CONTENTS
| Section | Topic Area | Questions |
| I | Medicare Basics (Parts A, B, C, D, Medigap) | 1-25 |
| II | Enrollment Periods & Eligibility | 26-45 |
| III | Medicare Advantage (Part C) Plans | 46-60 |
| IV | Medicare Part D Prescription Drug Plans | 61-75 |
| V | Medigap (Supplemental Insurance) | 76-85 |
| VI | Medicaid & Dual Eligibility | 86-95 |
| VII | Marketing & Sales Compliance (CMS Rules) | 96-115 |
| VIII | Fraud, Waste, & Abuse (FWA) Prevention | 116-125 |
| IX | Agent/Broker Compensation & Training | 126-135 |
| X | Special Enrollment Periods (SEPs) | 136-150 |
| XI | Scope of Appointment & SOA Requirements | 151-160 |
| XII | Comprehensive Case Scenarios | 161-180 |
| XIII | Final Exam Practice Set | 181-200 |
,2|Page
# SECTION I: MEDICARE BASICS (PARTS A, B, C, D, MEDIGAP)
(Questions 1-25)
**1. Mr. Schmidt would like to plan for retirement and has asked you
what is covered under Original Fee-for-Service (FFS) Medicare. What
could you tell him?**
A) Only inpatient hospital services are covered
B) Part A covers hospital, skilled nursing facility (SNF), hospice, and
home health services; Part B covers professional services such as those
provided by a physician
C) All vision and dental care are covered without limits
D) Prescription drugs are always covered under Original Medicare
**Correct Answer: B**
**Rationale:** Original Medicare consists of Part A (hospital, SNF,
hospice, home health) and Part B (physician services, outpatient care,
preventive services). It does NOT cover routine dental, vision, hearing
aids, or most outpatient prescription drugs (Part D is separate).
---
,3|Page
**2. Ms. Henderson believes that she will qualify for Medicare coverage
when she turns 65, without paying any premiums, because she has been
working for 40 years and paying Medicare taxes. What should you tell
her?**
A) She will qualify for premium-free Part A but must pay a standard
monthly premium for Part B
B) She will have to pay premiums for both Part A and Part B
C) All Medicare coverage is free regardless of work history
D) She does not qualify for Medicare at age 65 because she is still
working
**Correct Answer: A**
**Rationale:** Individuals who have worked and paid Medicare taxes
for at least 40 quarters (10 years) qualify for premium-free Part A. Part
B requires payment of a standard monthly premium (higher for
individuals with higher incomes – IRMAA).
---
**3. Mr. Vasquez is in good health and is preparing a budget in
anticipation of his retirement when he turns 66. He wants to understand
the health care costs he might be exposed to under Medicare if he were
to require hospitalization because of an illness. In general terms, what
, 4|Page
could you tell him about his costs for inpatient hospital services under
Original Medicare?**
A) There are no costs for inpatient hospitalization
B) He pays a deductible for the first 60 days, then daily coinsurance
rates apply for days 61-90
C) He pays a flat rate regardless of length of stay
D) He pays a premium for each hospital stay
**Correct Answer: B**
**Rationale:** Under Part A, Original Medicare requires payment of a
deductible for each benefit period (covering days 1-60). Days 61-90
require daily coinsurance. Days 91-150 (lifetime reserve days) also
require higher coinsurance. After that, all costs are the patient's
responsibility.
---
**4. Mrs. Foster is covered by Original Medicare. She sustained a hip
fracture and is being successfully treated for that condition. However,
she and her physicians feel that after her lengthy hospital stay, she will
need a month or two of nursing and rehabilitative care. What should you
tell them about Original Medicare's coverage of care in a skilled nursing
facility?**
# AHIP EXAM REVIEW## (AMERICA'S HEALTH
INSURANCE PLANS) CERTIFICATION
EXAM**2026-2027 EDITION | 200+ QUESTIONS |
DETAILED RATIONALES** **GRADED A+ |
MEDICARE COMPLIANCE & SALES
CERTIFICATION**
TABLE OF CONTENTS
| Section | Topic Area | Questions |
| I | Medicare Basics (Parts A, B, C, D, Medigap) | 1-25 |
| II | Enrollment Periods & Eligibility | 26-45 |
| III | Medicare Advantage (Part C) Plans | 46-60 |
| IV | Medicare Part D Prescription Drug Plans | 61-75 |
| V | Medigap (Supplemental Insurance) | 76-85 |
| VI | Medicaid & Dual Eligibility | 86-95 |
| VII | Marketing & Sales Compliance (CMS Rules) | 96-115 |
| VIII | Fraud, Waste, & Abuse (FWA) Prevention | 116-125 |
| IX | Agent/Broker Compensation & Training | 126-135 |
| X | Special Enrollment Periods (SEPs) | 136-150 |
| XI | Scope of Appointment & SOA Requirements | 151-160 |
| XII | Comprehensive Case Scenarios | 161-180 |
| XIII | Final Exam Practice Set | 181-200 |
,2|Page
# SECTION I: MEDICARE BASICS (PARTS A, B, C, D, MEDIGAP)
(Questions 1-25)
**1. Mr. Schmidt would like to plan for retirement and has asked you
what is covered under Original Fee-for-Service (FFS) Medicare. What
could you tell him?**
A) Only inpatient hospital services are covered
B) Part A covers hospital, skilled nursing facility (SNF), hospice, and
home health services; Part B covers professional services such as those
provided by a physician
C) All vision and dental care are covered without limits
D) Prescription drugs are always covered under Original Medicare
**Correct Answer: B**
**Rationale:** Original Medicare consists of Part A (hospital, SNF,
hospice, home health) and Part B (physician services, outpatient care,
preventive services). It does NOT cover routine dental, vision, hearing
aids, or most outpatient prescription drugs (Part D is separate).
---
,3|Page
**2. Ms. Henderson believes that she will qualify for Medicare coverage
when she turns 65, without paying any premiums, because she has been
working for 40 years and paying Medicare taxes. What should you tell
her?**
A) She will qualify for premium-free Part A but must pay a standard
monthly premium for Part B
B) She will have to pay premiums for both Part A and Part B
C) All Medicare coverage is free regardless of work history
D) She does not qualify for Medicare at age 65 because she is still
working
**Correct Answer: A**
**Rationale:** Individuals who have worked and paid Medicare taxes
for at least 40 quarters (10 years) qualify for premium-free Part A. Part
B requires payment of a standard monthly premium (higher for
individuals with higher incomes – IRMAA).
---
**3. Mr. Vasquez is in good health and is preparing a budget in
anticipation of his retirement when he turns 66. He wants to understand
the health care costs he might be exposed to under Medicare if he were
to require hospitalization because of an illness. In general terms, what
, 4|Page
could you tell him about his costs for inpatient hospital services under
Original Medicare?**
A) There are no costs for inpatient hospitalization
B) He pays a deductible for the first 60 days, then daily coinsurance
rates apply for days 61-90
C) He pays a flat rate regardless of length of stay
D) He pays a premium for each hospital stay
**Correct Answer: B**
**Rationale:** Under Part A, Original Medicare requires payment of a
deductible for each benefit period (covering days 1-60). Days 61-90
require daily coinsurance. Days 91-150 (lifetime reserve days) also
require higher coinsurance. After that, all costs are the patient's
responsibility.
---
**4. Mrs. Foster is covered by Original Medicare. She sustained a hip
fracture and is being successfully treated for that condition. However,
she and her physicians feel that after her lengthy hospital stay, she will
need a month or two of nursing and rehabilitative care. What should you
tell them about Original Medicare's coverage of care in a skilled nursing
facility?**
