America's Health Insurance Plans
LANIF • PIHA
✦ AHIP ✦
MEDICARE Medicare + Fraud, Waste & Abuse Training
G U I D I N G T H E F U T U R E O F H E A LT H C A R E
CERTIFICATION
AHIP Final Exam Questions
M E D I C A R E A D VA N TA G E · PA RT D · M E D I G A P · E N R O L L M E N T P E R I O D S · E L I G I B I L I TY
ORGANIZATION America's Health Insurance Plans (AHIP) CERTIFICATION Medicare + Fraud, Waste & Abuse Training
EXAM TYPE Final Examination ACADEMIC YEAR
TOTAL QUESTIONS 35 Questions SUBJECT AREAS Medicare Parts A–D · MA Plans · Medigap ·
Enrollment · LIS
FORMAT Multiple Choice — Select the Single Best
Answer
FINAL EXAMINATION INSTRUCTIONS
▸ Select the single best answer for each question based on current Medicare regulations and AHIP curriculum.
▸ Content covers Medicare Parts A–D, Medicare Advantage plan types, Medigap, enrollment periods, eligibility, and Low-Income
Subsidy.
▸ Each question includes a detailed rationale explaining the correct answer and why distractors are incorrect.
SECTION I — MEDICARE PARTS A–D, MA PLANS & ENROLLMENT Questions 1 – 35
1. Which of the following are types of Medicare Advantage Plans?
A. PPO, HMO, MSA, Cost Plan, PFFS
B. PPO, HMO, PDP, Cost Plan, MSA
C. HMO, PPO, Medigap, PFFS, MSA
D. Cost Plan, PDP, HMO, PPO, SNP
CORRECT ANSWER A — PPO, HMO, MSA, Cost Plan, PFFS
RATIONALE The five types of Medicare Advantage (Part C) plans are: Health Maintenance Organization (HMO), Preferred
Provider Organization (PPO), Private Fee-for-Service (PFFS), Medical Savings Account (MSA), and Medicare
Cost Plans. PDP (Prescription Drug Plan) is a stand-alone Part D plan, not an MA plan type. Medigap is
Medicare Supplement Insurance, separate from Medicare Advantage. SNP (Special Needs Plan) is a subtype of
MA coordinated care plan, not a distinct plan category in this context.
, 2. Medicare-Medicaid plans serve which population and include what coverage?
A. Only Medicaid beneficiaries; include Part A coverage
B. Both Medicare and Medicaid individuals; include Part D coverage
C. Only Medicare beneficiaries; include Part B coverage
D. Individuals under 65 only; include Part C coverage
CORRECT ANSWER B — Both Medicare and Medicaid individuals; include Part D coverage
RATIONALE Medicare-Medicaid plans (also called Dual Eligible Special Needs Plans or D-SNPs) serve individuals who are
entitled to both Medicare and Medicaid — sometimes referred to as "dual eligibles." These plans must include
Part D prescription drug coverage. They coordinate benefits between the two programs to provide
comprehensive coverage for low-income beneficiaries with significant health needs.
3. Which of the following is true regarding Medicare Cost Plans?
A. They require only Part A to enroll
B. They can be joined anytime the plan is accepting new members
C. Non-network providers must charge the same as network providers
D. They are not permitted to offer Part D coverage
CORRECT ANSWER B — They can be joined anytime the plan is accepting new members
RATIONALE Medicare Cost Plans offer flexible enrollment — beneficiaries can join anytime the plan is accepting new
members, unlike MA plans which have specific enrollment periods. They require Part B to enroll (not just Part
A). Non-network providers can charge higher coinsurances and deductibles. Cost Plans may offer Part D drug
coverage but are not required to do so. Different enrollment and disenrollment periods apply. Beneficiaries
can also enroll in a stand-alone PDP if the Cost Plan does not offer drug benefits.
4. Individuals with ESRD may sign up for Medicare Part A and Part B at what time?
A. Only during the Annual Enrollment Period
B. At any time; coverage begins the fourth month after dialysis begins
C. Only during a Special Enrollment Period
D. Only after receiving a kidney transplant
CORRECT ANSWER B — At any time; coverage begins the fourth month after dialysis begins
RATIONALE Individuals with End-Stage Renal Disease (ESRD) have special enrollment rights — they may sign up for
Medicare at any time. Coverage begins on the fourth month after dialysis treatment begins. This is an
exception to standard enrollment periods. However, once enrolled in Medicare, ESRD patients generally
cannot enroll in most Medicare Advantage plans (except SNPs designed for ESRD patients or if they developed
ESRD after already enrolling in an MA plan).
LANIF • PIHA
✦ AHIP ✦
MEDICARE Medicare + Fraud, Waste & Abuse Training
G U I D I N G T H E F U T U R E O F H E A LT H C A R E
CERTIFICATION
AHIP Final Exam Questions
M E D I C A R E A D VA N TA G E · PA RT D · M E D I G A P · E N R O L L M E N T P E R I O D S · E L I G I B I L I TY
ORGANIZATION America's Health Insurance Plans (AHIP) CERTIFICATION Medicare + Fraud, Waste & Abuse Training
EXAM TYPE Final Examination ACADEMIC YEAR
TOTAL QUESTIONS 35 Questions SUBJECT AREAS Medicare Parts A–D · MA Plans · Medigap ·
Enrollment · LIS
FORMAT Multiple Choice — Select the Single Best
Answer
FINAL EXAMINATION INSTRUCTIONS
▸ Select the single best answer for each question based on current Medicare regulations and AHIP curriculum.
▸ Content covers Medicare Parts A–D, Medicare Advantage plan types, Medigap, enrollment periods, eligibility, and Low-Income
Subsidy.
▸ Each question includes a detailed rationale explaining the correct answer and why distractors are incorrect.
SECTION I — MEDICARE PARTS A–D, MA PLANS & ENROLLMENT Questions 1 – 35
1. Which of the following are types of Medicare Advantage Plans?
A. PPO, HMO, MSA, Cost Plan, PFFS
B. PPO, HMO, PDP, Cost Plan, MSA
C. HMO, PPO, Medigap, PFFS, MSA
D. Cost Plan, PDP, HMO, PPO, SNP
CORRECT ANSWER A — PPO, HMO, MSA, Cost Plan, PFFS
RATIONALE The five types of Medicare Advantage (Part C) plans are: Health Maintenance Organization (HMO), Preferred
Provider Organization (PPO), Private Fee-for-Service (PFFS), Medical Savings Account (MSA), and Medicare
Cost Plans. PDP (Prescription Drug Plan) is a stand-alone Part D plan, not an MA plan type. Medigap is
Medicare Supplement Insurance, separate from Medicare Advantage. SNP (Special Needs Plan) is a subtype of
MA coordinated care plan, not a distinct plan category in this context.
, 2. Medicare-Medicaid plans serve which population and include what coverage?
A. Only Medicaid beneficiaries; include Part A coverage
B. Both Medicare and Medicaid individuals; include Part D coverage
C. Only Medicare beneficiaries; include Part B coverage
D. Individuals under 65 only; include Part C coverage
CORRECT ANSWER B — Both Medicare and Medicaid individuals; include Part D coverage
RATIONALE Medicare-Medicaid plans (also called Dual Eligible Special Needs Plans or D-SNPs) serve individuals who are
entitled to both Medicare and Medicaid — sometimes referred to as "dual eligibles." These plans must include
Part D prescription drug coverage. They coordinate benefits between the two programs to provide
comprehensive coverage for low-income beneficiaries with significant health needs.
3. Which of the following is true regarding Medicare Cost Plans?
A. They require only Part A to enroll
B. They can be joined anytime the plan is accepting new members
C. Non-network providers must charge the same as network providers
D. They are not permitted to offer Part D coverage
CORRECT ANSWER B — They can be joined anytime the plan is accepting new members
RATIONALE Medicare Cost Plans offer flexible enrollment — beneficiaries can join anytime the plan is accepting new
members, unlike MA plans which have specific enrollment periods. They require Part B to enroll (not just Part
A). Non-network providers can charge higher coinsurances and deductibles. Cost Plans may offer Part D drug
coverage but are not required to do so. Different enrollment and disenrollment periods apply. Beneficiaries
can also enroll in a stand-alone PDP if the Cost Plan does not offer drug benefits.
4. Individuals with ESRD may sign up for Medicare Part A and Part B at what time?
A. Only during the Annual Enrollment Period
B. At any time; coverage begins the fourth month after dialysis begins
C. Only during a Special Enrollment Period
D. Only after receiving a kidney transplant
CORRECT ANSWER B — At any time; coverage begins the fourth month after dialysis begins
RATIONALE Individuals with End-Stage Renal Disease (ESRD) have special enrollment rights — they may sign up for
Medicare at any time. Coverage begins on the fourth month after dialysis treatment begins. This is an
exception to standard enrollment periods. However, once enrolled in Medicare, ESRD patients generally
cannot enroll in most Medicare Advantage plans (except SNPs designed for ESRD patients or if they developed
ESRD after already enrolling in an MA plan).
