Spring 2026 AHIP Annual Recertification Exam
Study Guide PDF | Complete Medicare Compliance
Training & FWA Certification Prep for Healthcare
Professionals | Verified Practice Questions with
Detailed Rationales | Updated 2026 CMS
Guidelines, Medicare Advantage, Part D, Fraud
Waste & Abuse (FWA) Requirements | Step-by-Step
AHIP Recertification Test Preparation for Agents,
Brokers, Nurses & Healthcare Staff | Pass with
Confidence, Improve Scores & Stay Compliant
,Question 1:
What is the primary purpose of the Affordable Care Act (ACA)?
• A) To increase insurance premiums
• B) To expand access to affordable health insurance
• C) To eliminate all private health insurance
• D) To tax individuals for not having insurance
Correct Option: B) To expand access to affordable health insurance
Rationale:
The primary goal of the Affordable Care Act is to enhance access to affordable health
insurance for Americans. This was achieved by creating marketplaces for health plans,
expanding Medicaid eligibility, and implementing consumer protections against
insurance discrimination.
Question 2:
Which of the following is a key requirement for Medicare Advantage plans?
• A) They must cover all services provided by Medicare.
• B) They can choose which Medicare services to cover.
• C) They must offer services outside the US.
• D) They only cover prescription drugs.
Correct Option: A) They must cover all services provided by Medicare.
Rationale:
Medicare Advantage plans, also known as Part C, are required to cover all Medicare
services, excluding hospice care, which remains covered under Medicare Part A. Plans
may offer additional benefits beyond standard Medicare services but cannot omit any
covered services.
Question 3:
Which of the following is true about Medicare Part D?
• A) It is a federal program providing healthcare services.
• B) It offers prescription drug coverage to those eligible for Medicare.
• C) It requires all Medicare beneficiaries to enroll.
• D) It pays for all prescription drug costs without a premium.
, Correct Option: B) It offers prescription drug coverage to those eligible for
Medicare.
Rationale:
Medicare Part D is specifically designed to provide prescription drug coverage for
individuals who are eligible for Medicare. While enrollment is optional, beneficiaries are
encouraged to join to help manage costs associated with medications. Part D involves
premiums, deductibles, and co-pays, which vary by plan.
Question 4:
What is the role of the marketplace in the ACA?
• A) To eliminate Medicaid.
• B) To provide a venue for individuals to compare and purchase health insurance
plans.
• C) To impose fees on larger employers.
• D) To directly provide care to patients.
Correct Option: B) To provide a venue for individuals to compare and purchase
health insurance plans.
Rationale:
The ACA established marketplaces (or exchanges) where individuals and families can
compare and purchase health insurance plans. These marketplaces help consumers
understand their options and assist in finding coverage that meets their needs while
potentially providing subsidies based on income.
Question 5:
What is one significant change introduced by the ACA regarding pre-existing conditions?
• A) Insurers can deny coverage to people with pre-existing conditions.
• B) Insurers must provide coverage regardless of pre-existing conditions.
• C) People with pre-existing conditions must pay higher premiums.
• D) Coverage for pre-existing conditions is limited to emergencies.
Correct Option: B) Insurers must provide coverage regardless of pre-existing
conditions.
Rationale:
One of the most transformative aspects of the ACA is the requirement that insurance
companies cannot deny coverage or charge higher premiums based on pre-existing
Study Guide PDF | Complete Medicare Compliance
Training & FWA Certification Prep for Healthcare
Professionals | Verified Practice Questions with
Detailed Rationales | Updated 2026 CMS
Guidelines, Medicare Advantage, Part D, Fraud
Waste & Abuse (FWA) Requirements | Step-by-Step
AHIP Recertification Test Preparation for Agents,
Brokers, Nurses & Healthcare Staff | Pass with
Confidence, Improve Scores & Stay Compliant
,Question 1:
What is the primary purpose of the Affordable Care Act (ACA)?
• A) To increase insurance premiums
• B) To expand access to affordable health insurance
• C) To eliminate all private health insurance
• D) To tax individuals for not having insurance
Correct Option: B) To expand access to affordable health insurance
Rationale:
The primary goal of the Affordable Care Act is to enhance access to affordable health
insurance for Americans. This was achieved by creating marketplaces for health plans,
expanding Medicaid eligibility, and implementing consumer protections against
insurance discrimination.
Question 2:
Which of the following is a key requirement for Medicare Advantage plans?
• A) They must cover all services provided by Medicare.
• B) They can choose which Medicare services to cover.
• C) They must offer services outside the US.
• D) They only cover prescription drugs.
Correct Option: A) They must cover all services provided by Medicare.
Rationale:
Medicare Advantage plans, also known as Part C, are required to cover all Medicare
services, excluding hospice care, which remains covered under Medicare Part A. Plans
may offer additional benefits beyond standard Medicare services but cannot omit any
covered services.
Question 3:
Which of the following is true about Medicare Part D?
• A) It is a federal program providing healthcare services.
• B) It offers prescription drug coverage to those eligible for Medicare.
• C) It requires all Medicare beneficiaries to enroll.
• D) It pays for all prescription drug costs without a premium.
, Correct Option: B) It offers prescription drug coverage to those eligible for
Medicare.
Rationale:
Medicare Part D is specifically designed to provide prescription drug coverage for
individuals who are eligible for Medicare. While enrollment is optional, beneficiaries are
encouraged to join to help manage costs associated with medications. Part D involves
premiums, deductibles, and co-pays, which vary by plan.
Question 4:
What is the role of the marketplace in the ACA?
• A) To eliminate Medicaid.
• B) To provide a venue for individuals to compare and purchase health insurance
plans.
• C) To impose fees on larger employers.
• D) To directly provide care to patients.
Correct Option: B) To provide a venue for individuals to compare and purchase
health insurance plans.
Rationale:
The ACA established marketplaces (or exchanges) where individuals and families can
compare and purchase health insurance plans. These marketplaces help consumers
understand their options and assist in finding coverage that meets their needs while
potentially providing subsidies based on income.
Question 5:
What is one significant change introduced by the ACA regarding pre-existing conditions?
• A) Insurers can deny coverage to people with pre-existing conditions.
• B) Insurers must provide coverage regardless of pre-existing conditions.
• C) People with pre-existing conditions must pay higher premiums.
• D) Coverage for pre-existing conditions is limited to emergencies.
Correct Option: B) Insurers must provide coverage regardless of pre-existing
conditions.
Rationale:
One of the most transformative aspects of the ACA is the requirement that insurance
companies cannot deny coverage or charge higher premiums based on pre-existing
