America's Health Insurance Plans
LANIF • PIHA
AHIP Medicare + Fraud, Waste & Abuse Training
G U I D I N G G R E A T E R H E A LT H
EST. 1956
AHIP Final Exam — Medicare Training
CO M P R E H E N S I V E M E D I C A R E A D VA N TA G E & PA RT D K N O W L E D G E A SS E SS M E N T
INSTITUTION America's Health Insurance Plans (AHIP) EXAM CODE AHIP-MED-FINAL-2026
PROGRAM Medicare + Fraud, Waste & Abuse Training ACADEMIC YEAR
EXAM TITLE AHIP Final Exam — Medicare Advantage & TOTAL QUESTIONS 47 Questions
Part D
COURSE TITLE AHIP Medicare Training Final Examination FORMAT Multiple Choice — Select the Single Best
Answer
EXAMINATION INSTRUCTIONS
▸ Select the single best answer for each question.
▸ Questions cover Medicare coverage rules, enrollment periods, marketing compliance, Part D drug coverage, and Medicare
Advantage plan regulations.
▸ Distinguish carefully between Original Medicare, Medicare Advantage, Part D, and Medigap coverage rules.
▸ Correct answers and detailed rationales appear below each question for comprehensive review.
▸ All content is derived from the AHIP Medicare Training Final Exam question bank.
SECTION I — MEDICARE COVERAGE, COMPLIANCE & ENROLLMENT Questions 1 – 47
1. Mrs. West wears glasses and dentures and has enjoyed considerable pain relief from arthritis through acupuncture.
She is concerned about whether or not Medicare will cover these items and services. What should you tell her?
A. Medicare covers all of these items and services as long as they are deemed medically necessary.
B. Medicare covers acupuncture and dentures but not glasses.
C. Medicare covers glasses and dentures but not acupuncture.
D. Medicare does not cover acupuncture, or, in general, glasses or dentures.
CORRECT ANSWER D — Medicare does not cover acupuncture, or, in general, glasses or dentures.
RATIONALE Original Medicare generally excludes routine dental care (dentures), routine vision care (eyeglasses), and
acupuncture from coverage. While some Medicare Advantage plans may offer supplemental benefits for these
items, under Original Medicare they are standard exclusions.
,2. Mr. Bickford did not quite qualify for the extra help low-income subsidy under the Medicare Part D Prescription
Drug program and he is wondering if there is any other option he has for obtaining help with his considerable drug
costs. What should you tell him?
A. There are no other options available; he must pay all costs out-of-pocket.
B. He could check with the manufacturers of his medications to see if they offer an assistance program or check
whether his state has a pharmacy assistance program.
C. He can automatically qualify for Medicaid to cover his drug costs.
D. He should switch to a Medicare Advantage plan that covers all drugs with no cost-sharing.
CORRECT ANSWER B — He could check with the manufacturers of his medications to see if they offer an assistance
program or check whether his state has a pharmacy assistance program.
RATIONALE When a beneficiary does not qualify for the Part D low-income subsidy, alternative sources of financial
assistance exist. Pharmaceutical manufacturer patient assistance programs (PAPs) and state pharmacy
assistance programs (SPAPs) can help offset prescription drug costs for those with limited means.
3. Mr. Lombardi is interested in a Medicare Advantage (MA) PPO plan that you represent. The MA PPO plan does not
include drug coverage, but the other two plans do. Mr. Lombardi intends to obtain his drug coverage through a
stand-alone Medicare prescription drug plan. What should you tell him?
A. He can enroll in the MA-only PPO plan and a stand-alone prescription drug plan without any issues.
B. He cannot enroll in the MA-only PPO plan and a stand-alone prescription drug plan; he must choose an MA plan that
includes drug coverage or a Medigap plan with a stand-alone drug plan.
C. He can enroll in any combination of plans regardless of drug coverage.
D. He must enroll in Original Medicare to get a stand-alone drug plan.
CORRECT ANSWER B — He cannot enroll in the MA-only PPO plan and a stand-alone prescription drug plan; he must
choose an MA plan that includes drug coverage or a Medigap plan with a stand-alone drug plan.
RATIONALE CMS rules prohibit enrollment in an MA plan that does not include Part D drug coverage (MA-only plan)
concurrently with a stand-alone Part D plan. Beneficiaries who want drug coverage must either enroll in an
MA-PD plan or remain in Original Medicare with a stand-alone Part D plan (and optionally a Medigap plan).
4. Mr. Torres would like to pay for his monthly Part D premiums with an automatic monthly withdrawal from his
savings account until it is exhausted, and then have his premiums withheld from his Social Security check. What
should you tell him?
A. He can switch payment methods at any time during the year.
B. In general, he must select a single Part D premium payment mechanism that will be used throughout the year.
C. He can set up both payment methods and the plan will automatically switch when the account is empty.
D. Part D premiums can only be paid via Social Security withholding.
CORRECT ANSWER B — In general, he must select a single Part D premium payment mechanism that will be used
throughout the year.
RATIONALE CMS requires beneficiaries to select one consistent premium payment method for the plan year. Switching
payment mechanisms mid-year is generally not permitted, and plans are not required to accommodate
sequential payment methods.
, 5. Agent Jennings makes a presentation on Medicare advertised as an educational event. She gives a brief
presentation that mentions plan-specific premiums. Is this a prohibited activity at an event that has been
advertised as educational?
A. No, as long as the majority of the content remains educational.
B. Yes. When an event has been advertised as "educational," discussing plan-specific premiums is impermissible.
C. No, agents can discuss any plan details at any event.
D. Yes, but only if someone specifically asks about premiums.
CORRECT ANSWER B — Yes. When an event has been advertised as "educational," discussing plan-specific premiums is
impermissible.
RATIONALE CMS marketing guidelines strictly separate educational events from sales/marketing events. Educational
events must remain purely informational. Mentioning plan-specific details such as premiums converts the
event into a marketing/sales event, which would be a violation if advertised as educational.
6. Mrs. Mulcahy is concerned that she may not qualify for enrollment in a Medicare prescription drug plan because,
although she is entitled to Part A, she is not enrolled under Medicare Part B. What should you tell her?
A. She must enroll in Part B before she can enroll in a Part D plan.
B. Everyone who is entitled to Part A or enrolled under Part B is eligible to enroll in a Medicare prescription drug plan.
C. She cannot enroll in Part D unless she has both Part A and Part B.
D. Only those enrolled in Part B are eligible for Part D.
CORRECT ANSWER B — Everyone who is entitled to Part A or enrolled under Part B is eligible to enroll in a Medicare
prescription drug plan.
RATIONALE Part D eligibility requires either entitlement to Part A or enrollment in Part B — not both. As long as Mrs.
Mulcahy is entitled to Part A, she satisfies the eligibility requirement for Part D enrollment regardless of her
Part B status.
7. Mr. Jacob sees a wide range in what various Part D plans charge for deductibles, premiums and cost sharing. How
can you explain this to him?
A. All Part D plans must have identical benefit structures.
B. Medicare Part D drug plans may have different benefit structures, but on average, they must all be at least as good as
the standard model established by the government.
C. Plans can charge whatever they want without any government oversight.
D. The variation is due to plans covering completely different drugs.
CORRECT ANSWER B — Medicare Part D drug plans may have different benefit structures, but on average, they must all be
at least as good as the standard model established by the government.
RATIONALE CMS defines a standard Part D benefit model. Plans can vary their deductibles, premiums, cost-sharing tiers,
and formulary structures, but their overall actuarial value must be at least equivalent to the standard benefit.
This allows competition while maintaining minimum coverage standards.
LANIF • PIHA
AHIP Medicare + Fraud, Waste & Abuse Training
G U I D I N G G R E A T E R H E A LT H
EST. 1956
AHIP Final Exam — Medicare Training
CO M P R E H E N S I V E M E D I C A R E A D VA N TA G E & PA RT D K N O W L E D G E A SS E SS M E N T
INSTITUTION America's Health Insurance Plans (AHIP) EXAM CODE AHIP-MED-FINAL-2026
PROGRAM Medicare + Fraud, Waste & Abuse Training ACADEMIC YEAR
EXAM TITLE AHIP Final Exam — Medicare Advantage & TOTAL QUESTIONS 47 Questions
Part D
COURSE TITLE AHIP Medicare Training Final Examination FORMAT Multiple Choice — Select the Single Best
Answer
EXAMINATION INSTRUCTIONS
▸ Select the single best answer for each question.
▸ Questions cover Medicare coverage rules, enrollment periods, marketing compliance, Part D drug coverage, and Medicare
Advantage plan regulations.
▸ Distinguish carefully between Original Medicare, Medicare Advantage, Part D, and Medigap coverage rules.
▸ Correct answers and detailed rationales appear below each question for comprehensive review.
▸ All content is derived from the AHIP Medicare Training Final Exam question bank.
SECTION I — MEDICARE COVERAGE, COMPLIANCE & ENROLLMENT Questions 1 – 47
1. Mrs. West wears glasses and dentures and has enjoyed considerable pain relief from arthritis through acupuncture.
She is concerned about whether or not Medicare will cover these items and services. What should you tell her?
A. Medicare covers all of these items and services as long as they are deemed medically necessary.
B. Medicare covers acupuncture and dentures but not glasses.
C. Medicare covers glasses and dentures but not acupuncture.
D. Medicare does not cover acupuncture, or, in general, glasses or dentures.
CORRECT ANSWER D — Medicare does not cover acupuncture, or, in general, glasses or dentures.
RATIONALE Original Medicare generally excludes routine dental care (dentures), routine vision care (eyeglasses), and
acupuncture from coverage. While some Medicare Advantage plans may offer supplemental benefits for these
items, under Original Medicare they are standard exclusions.
,2. Mr. Bickford did not quite qualify for the extra help low-income subsidy under the Medicare Part D Prescription
Drug program and he is wondering if there is any other option he has for obtaining help with his considerable drug
costs. What should you tell him?
A. There are no other options available; he must pay all costs out-of-pocket.
B. He could check with the manufacturers of his medications to see if they offer an assistance program or check
whether his state has a pharmacy assistance program.
C. He can automatically qualify for Medicaid to cover his drug costs.
D. He should switch to a Medicare Advantage plan that covers all drugs with no cost-sharing.
CORRECT ANSWER B — He could check with the manufacturers of his medications to see if they offer an assistance
program or check whether his state has a pharmacy assistance program.
RATIONALE When a beneficiary does not qualify for the Part D low-income subsidy, alternative sources of financial
assistance exist. Pharmaceutical manufacturer patient assistance programs (PAPs) and state pharmacy
assistance programs (SPAPs) can help offset prescription drug costs for those with limited means.
3. Mr. Lombardi is interested in a Medicare Advantage (MA) PPO plan that you represent. The MA PPO plan does not
include drug coverage, but the other two plans do. Mr. Lombardi intends to obtain his drug coverage through a
stand-alone Medicare prescription drug plan. What should you tell him?
A. He can enroll in the MA-only PPO plan and a stand-alone prescription drug plan without any issues.
B. He cannot enroll in the MA-only PPO plan and a stand-alone prescription drug plan; he must choose an MA plan that
includes drug coverage or a Medigap plan with a stand-alone drug plan.
C. He can enroll in any combination of plans regardless of drug coverage.
D. He must enroll in Original Medicare to get a stand-alone drug plan.
CORRECT ANSWER B — He cannot enroll in the MA-only PPO plan and a stand-alone prescription drug plan; he must
choose an MA plan that includes drug coverage or a Medigap plan with a stand-alone drug plan.
RATIONALE CMS rules prohibit enrollment in an MA plan that does not include Part D drug coverage (MA-only plan)
concurrently with a stand-alone Part D plan. Beneficiaries who want drug coverage must either enroll in an
MA-PD plan or remain in Original Medicare with a stand-alone Part D plan (and optionally a Medigap plan).
4. Mr. Torres would like to pay for his monthly Part D premiums with an automatic monthly withdrawal from his
savings account until it is exhausted, and then have his premiums withheld from his Social Security check. What
should you tell him?
A. He can switch payment methods at any time during the year.
B. In general, he must select a single Part D premium payment mechanism that will be used throughout the year.
C. He can set up both payment methods and the plan will automatically switch when the account is empty.
D. Part D premiums can only be paid via Social Security withholding.
CORRECT ANSWER B — In general, he must select a single Part D premium payment mechanism that will be used
throughout the year.
RATIONALE CMS requires beneficiaries to select one consistent premium payment method for the plan year. Switching
payment mechanisms mid-year is generally not permitted, and plans are not required to accommodate
sequential payment methods.
, 5. Agent Jennings makes a presentation on Medicare advertised as an educational event. She gives a brief
presentation that mentions plan-specific premiums. Is this a prohibited activity at an event that has been
advertised as educational?
A. No, as long as the majority of the content remains educational.
B. Yes. When an event has been advertised as "educational," discussing plan-specific premiums is impermissible.
C. No, agents can discuss any plan details at any event.
D. Yes, but only if someone specifically asks about premiums.
CORRECT ANSWER B — Yes. When an event has been advertised as "educational," discussing plan-specific premiums is
impermissible.
RATIONALE CMS marketing guidelines strictly separate educational events from sales/marketing events. Educational
events must remain purely informational. Mentioning plan-specific details such as premiums converts the
event into a marketing/sales event, which would be a violation if advertised as educational.
6. Mrs. Mulcahy is concerned that she may not qualify for enrollment in a Medicare prescription drug plan because,
although she is entitled to Part A, she is not enrolled under Medicare Part B. What should you tell her?
A. She must enroll in Part B before she can enroll in a Part D plan.
B. Everyone who is entitled to Part A or enrolled under Part B is eligible to enroll in a Medicare prescription drug plan.
C. She cannot enroll in Part D unless she has both Part A and Part B.
D. Only those enrolled in Part B are eligible for Part D.
CORRECT ANSWER B — Everyone who is entitled to Part A or enrolled under Part B is eligible to enroll in a Medicare
prescription drug plan.
RATIONALE Part D eligibility requires either entitlement to Part A or enrollment in Part B — not both. As long as Mrs.
Mulcahy is entitled to Part A, she satisfies the eligibility requirement for Part D enrollment regardless of her
Part B status.
7. Mr. Jacob sees a wide range in what various Part D plans charge for deductibles, premiums and cost sharing. How
can you explain this to him?
A. All Part D plans must have identical benefit structures.
B. Medicare Part D drug plans may have different benefit structures, but on average, they must all be at least as good as
the standard model established by the government.
C. Plans can charge whatever they want without any government oversight.
D. The variation is due to plans covering completely different drugs.
CORRECT ANSWER B — Medicare Part D drug plans may have different benefit structures, but on average, they must all be
at least as good as the standard model established by the government.
RATIONALE CMS defines a standard Part D benefit model. Plans can vary their deductibles, premiums, cost-sharing tiers,
and formulary structures, but their overall actuarial value must be at least equivalent to the standard benefit.
This allows competition while maintaining minimum coverage standards.
