Free 2027 Medicare Agent Readiness Test — 25 Practice Questions (Instant Score)

This is an independent practice diagnostic written from official CMS and Medicare.gov guidance. It is not the AHIP or NABIP exam, it contains no actual or recalled certification exam questions, it does not predict your score, and it does not guarantee a passing result. TemplateTitanHQ is an independent business and is not affiliated with or endorsed by CMS, Medicare, AHIP, NABIP, any health plan, or any government agency.

1. In November, Rochelle wants to leave her current PDP and choose a different drug plan for the coming plan year. Which election period ordinarily supports that change?

Enrollment periods, elections, SEPs, disenrollment

A. The MA Open Enrollment Period, even though she is not enrolled in MA.

B. The Annual Election Period for a generally January 1 effective date.

C. The institutional SEP, even though she has never lived in a qualifying facility.

D. The 5-star SEP, regardless of the destination plan's rating.

2. Nadia's employment at a company that provided her group health coverage ends in March. She wants to enroll in Part B using the enrollment right tied to that employment. What should the agent confirm about her timing?

Enrollment periods, elections, SEPs, disenrollment

A. That she waits exactly one full year after her coverage ends before applying.

B. That she can only use this right during the fall Annual Election Period.

C. That the opportunity is available only to beneficiaries who never worked past age 65.

D. That she enrolls while covered by the group plan or within the period after the employment or coverage ends, whichever comes first.

3. Felix relocates to a different neighborhood that stays within his MA plan's overall service area, but the move newly exposes several plans that were not available at his old address. What should the agent conclude about his enrollment rights?

Enrollment periods, elections, SEPs, disenrollment

A. No SEP applies because he technically remained inside the same broad service area.

B. He must wait for the next Annual Election Period regardless of the new options.

C. The new options only matter if he first disenrolls from his current plan.

D. A special enrollment period is available because new plan options opened up as a result of the move.

4. Yusuf's plan believes he may regain his qualifying status soon and instead of disenrolling him immediately, keeps him enrolled for a period first. What is this temporary continuation generally called, and how long can it run?

Enrollment periods, elections, SEPs, disenrollment

A. A grievance extension, which always lasts exactly one year.

B. A hardship waiver, which has no defined time limit.

C. An appeal stay, which only applies after a final adverse decision.

D. Deemed continued eligibility, which can run from 30 days up to six months.

5. An agent marks a July application as tied to an SEP the beneficiary never actually experienced, just to avoid holding it until AEP. Is that handling acceptable?

Enrollment periods, elections, SEPs, disenrollment

A. No; an application must reflect the beneficiary's actual, documented qualifying event.

B. Yes; any reasonable-sounding SEP label keeps the application moving.

C. Yes; the effective date can be corrected later without consequence.

D. No; but only because July applications are always automatically rejected.

6. A plan sends members a neutral notice listing new customer-service hours and contact information, with no benefits, costs, ratings, comparisons, or enrollment appeal. How should the piece be classified?

Marketing, communications, SOA, events

A. Marketing, because every message from a plan tries to retain members.

B. A communication that does not satisfy both marketing prongs.

C. An enrollment mechanism because it contains a telephone number.

D. A sales event invitation because it describes service hours.

7. Yusuf sends a compliant marketing email with a working opt-out. A beneficiary replies asking for more details rather than opting out. May Yusuf now call her to continue the conversation?

Marketing, communications, SOA, events

A. Yes, once she has replied, but he still needs a signed SOA before discussing specific plan details.

B. No, because the original email was already an unsolicited contact.

C. Yes, and her reply also serves as a valid Scope of Appointment.

D. No, unless he waits 48 hours from the date of the original email.

8. Felix's TPMO wants to share its full list of beneficiary leads with a partner TPMO to expand outreach. What must happen before that data can be shared for MA or Part D marketing purposes?

Marketing, communications, SOA, events

A. The beneficiary must give prior express written consent naming each receiving TPMO.

B. Nothing further, because one-to-one consent requirements no longer apply to TPMOs.

C. The partner TPMO must simply agree to follow the same disclaimer language.

D. The data may be shared freely once both TPMOs are licensed in the same state.

9. A user publicly comments on Winona's social media post asking what Medicare plans she sells. Winona replies with a direct message answering the question. Has Winona engaged in a prohibited unsolicited contact?

Marketing, communications, SOA, events

A. No; replying to the user's own public question is a response to beneficiary-initiated contact.

B. Yes; any direct message sent by an agent is treated as unsolicited outreach.

C. Yes; social media replies are banned regardless of who spoke first.

D. No; but only because the platform is not covered by the unsolicited-contact rule.

10. After an outpatient visit, Lena sees separate charges for her physician's services and assumes Part A is the primary source of coverage. Which Medicare part generally addresses the professional services in this setting?

Parts A/B/C/D, eligibility, plan types

A. Part B generally covers the physician's outpatient services.

B. Part A generally covers every service delivered on a hospital campus.

C. Part C pays the claim even when Lena has not joined Medicare Advantage.

D. Part D generally covers the physician's evaluation and treatment.

11. Simone was recently diagnosed with amyotrophic lateral sclerosis and asks whether she must wait through a standard disability qualifying period before Medicare begins.

Parts A/B/C/D, eligibility, plan types

A. A diagnosis of ALS generally establishes Medicare entitlement without waiting through the standard disability qualifying period.

B. She must complete the same lengthy SSDI qualifying period required for other disabling conditions.

C. Only beneficiaries who are already sixty-five can use a disability-based diagnosis for entitlement.

D. Medicare entitlement for ALS depends on enrolling in a specific Medicare Advantage plan first.

12. Perpetua lives in a rural county with few participating providers and is considering a longtime non-network Private Fee-for-Service plan there. She asks about the practical risk of that choice.

Parts A/B/C/D, eligibility, plan types

A. PFFS plans guarantee the same continuity-of-care protections as an HMO network contract.

B. Provider participation in a non-network PFFS plan is locked in for the full plan year once agreed to.

C. Rural location has no bearing on the practical access risk of a non-network PFFS plan.

D. Because non-network PFFS relies on individual providers agreeing to the plan's terms visit by visit, a scarce-provider county could see several providers stop accepting the plan at once.

13. Solomon's card shows his name, Medicare Beneficiary Identifier, and effective dates, and the agent wants to know what specifically to verify from it before submitting an enrollment.

Parts A/B/C/D, eligibility, plan types

A. The agent should verify that the name, MBI, and current Part A and/or Part B effective dates on the card match the application before submitting it.

B. Only the beneficiary's name needs to be checked against the application.

C. The card's issue date is the only detail relevant to enrollment accuracy.

D. Card details do not need to be checked once the beneficiary verbally confirms them.

14. Tanya wants some coverage when she chooses physicians outside a plan's preferred network and accepts higher cost sharing for that flexibility. Which plan type most directly matches her priority?

MA, MA-PD, PDP, HMO, PPO, PFFS, MSA, SNPs

A. An HMO that excludes routine non-network care except under limited protections.

B. An MSA chosen solely because it deposits funds into an account.

C. A PPO with an out-of-network benefit subject to the plan's terms.

D. A D-SNP for which no Medicaid eligibility has been established.

15. Naomi is comparing an HMO with embedded Part D against a Medicare MSA and is confused about why the MSA quote never lists a drug benefit. What should she be told?

MA, MA-PD, PDP, HMO, PPO, PFFS, MSA, SNPs

A. The MSA quote is incomplete, and Part D will be added automatically before enrollment.

B. Medicare MSA plans do not include Part D, so drug coverage must come from a separate stand-alone PDP if wanted.

C. MSA plans include Part D only for enrollees who also have Medicaid.

D. The absence of a drug benefit means Naomi cannot select an MSA at all.

16. Selena, an HMO member, sees an out-of-network dermatologist for a routine skin check without an emergency, urgent, or dialysis-related reason. What is the likely coverage outcome?

MA, MA-PD, PDP, HMO, PPO, PFFS, MSA, SNPs

A. The visit is automatically covered because Selena has Medicare Part B.

B. The visit is likely not covered because it falls outside the plan's network without a qualifying exception.

C. The visit converts her HMO into a PPO for that claim only.

D. The visit must be billed to Original Medicare instead of the HMO.

17. Kendra has diabetes but no Medicaid or institutional care need, and she asks which SNP category, if any, might fit her situation. What should she be told?

MA, MA-PD, PDP, HMO, PPO, PFFS, MSA, SNPs

A. She should pursue a D-SNP because diabetes is treated as a dual-eligible condition.

B. No SNP category can ever serve someone without Medicaid or institutional status.

C. She should pursue an I-SNP because chronic conditions default to institutional classification.

D. A C-SNP may fit if diabetes is on CMS's approved chronic-condition list and is verified through the plan's process.

18. A prescription appears on the plan's formulary, yet the price differs sharply between the beneficiary's neighborhood pharmacy and a preferred pharmacy. What explains the possible difference?

Part D, formularies, tiers, Extra Help, TrOOP

A. Formulary inclusion makes the price identical at every pharmacy.

B. Network and preferred-pharmacy status can affect access and cost sharing.

C. The drug becomes non-covered whenever a pharmacy charges more.

D. Part B sets one retail price for all Part D prescriptions.

19. Felix has modest income and resources but has no Medicaid, Medicare Savings Program, or SSI status on file. What step allows him to be considered for Extra Help?

Part D, formularies, tiers, Extra Help, TrOOP

A. Waiting for automatic deeming, since every low-income beneficiary is deemed eventually.

B. Enrolling in a zero-premium Medicare Advantage plan.

C. Asking his pharmacy to self-certify his income level.

D. Filing an Extra Help application for CMS to make a subsidy-eligibility determination.

20. Corazon's plan wants to move her current maintenance drug to a higher cost-sharing tier before the next plan year. What must generally happen before that change affects her?

Part D, formularies, tiers, Extra Help, TrOOP

A. Nothing, because tier placement can change for current users without any notice.

B. The change takes effect immediately once the plan's board approves it internally.

C. She must first file a grievance to delay the change.

D. Affected enrollees generally receive advance notice before such formulary changes take effect.

21. A TPMO agent discusses two plans' premiums and networks during a web meeting with audio enabled. The agent proposes recording only the enrollment portion if the beneficiary applies. What is required?

TPMOs, call recording, permission to contact

A. Only the final signature screen must be retained.

B. Recording is optional because the call used a web platform.

C. The marketing and sales audio must be recorded in its entirety.

D. The call may be reconstructed later from the agent's notes.

22. An agency offers every attendee at a marketing event a small tote bag regardless of whether they enroll, while a separate raffle prize is a gift card that can be redeemed for cash at any retailer. Which part of this plan is not compliant?

TPMOs, call recording, permission to contact

A. The cash-redeemable gift card, because gifts may never function as cash equivalents.

B. The tote bag, because gifts must never be offered to non-enrollees.

C. The tote bag, because gifts require a written waiver signed in advance.

D. The raffle format itself, because prize drawings are entirely prohibited at marketing events.

23. An employee accidentally transposes two digits on one enrollment record, promptly reports the mistake, and corrects it. There is no evidence of deception or a pattern. How should the conduct be characterized?

Fraud, waste and abuse; privacy; reporting

A. Fraud because every inaccurate field proves intent to deceive.

B. Abuse because an isolated typo always violates accepted medical standards.

C. An error that requires correction but lacks the intent element of fraud.

D. Waste because a data-entry mistake is automatically inefficient utilization.

24. A carrier's internal audit finds that a batch of claims was systematically overpaid due to a configuration error, and leadership debates whether to wait for CMS to discover it or report it first. Which approach better reflects sound compliance practice?

Fraud, waste and abuse; privacy; reporting

A. Wait silently, since voluntary disclosure could draw unwanted attention.

B. Report the overpayment proactively through the applicable self-disclosure process.

C. Quietly correct future claims without addressing the past overpayment.

D. Delay any action until a formal audit notice arrives.

25. A member is upset about repeated long hold times and a rude customer-service representative, but no benefit or payment decision is disputed. Which process fits the complaint?

Beneficiary protections, appeals, grievances

A. A Part D formulary exception for a non-covered drug.

B. An expedited appeal based on urgent medical jeopardy.

C. An organization determination on a requested MA service.

D. A grievance addressing dissatisfaction with plan service and operations.