AHIP – FINAL EXAMINATION ACTUAL QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS) PLUS RATIONALES
2026 Q&A | INSTANT DOWNLOAD PDF
Core Domains
Medicare Fee-For-Service Eligibility and Benefits
Medicare Advantage and Part D Prescription Drug Plans
Eligibility, Coverage, Nondiscrimination, Marketing, and Enrollment Requirements
Fraud, Waste, and Abuse Identification and Detection
General Compliance, Legal Tools, Reporting, Obligations, and FWA Costs
Introduction
The AHIP (America's Health Insurance Plans) Final Examination is a comprehensive certification assessment designed for insurance agents and
brokers who sell Medicare Advantage (MA) and Medicare Part D prescription drug plans. This exam evaluates critical knowledge and skills
necessary for regulatory compliance, including Medicare eligibility rules, plan types, enrollment periods, CMS marketing guidelines,
nondiscrimination requirements, and Fraud, Waste, and Abuse (FWA) prevention. The assessment consists of multiple-choice and scenario-based
questions that emphasize real-world application, critical thinking, and professional decision-making. Agents must demonstrate mastery of
Centers for Medicare & Medicaid Services (CMS) compliance requirements to ensure ethical, lawful, and beneficiary-centered practices in the
Medicare marketplace.
Section One: Questions 1–100
Question 1
Which Medicare part covers inpatient hospital care, skilled nursing facility care, hospice, and some home health services?
A. Medicare Part B
B. Medicare Part C
C. Medicare Part A
D. Medicare Part D
🟢 C. Medicare Part A
,🔴 RATIONALE: Medicare Part A is known as "hospital insurance" and covers inpatient hospital care, skilled nursing facility care, hospice care, and
some home health services. Part B covers outpatient/medical insurance, Part C is Medicare Advantage, and Part D covers prescription drugs.
Question 2
An agent is conducting a sales presentation with Ms. Duarte, who has cognitive impairment. Her son has power of attorney for financial decisions.
Can the agent enroll Ms. Duarte in a Medicare Advantage plan without the son's consent?
A. Yes, if Ms. Duarte verbally agrees during the presentation
B. No, the agent must obtain consent from the son with power of attorney
C. Yes, but only if Ms. Duarte signs the enrollment form independently
D. No, enrollment is prohibited for individuals with cognitive impairment
🟢 B. No, the agent must obtain consent from the son with power of attorney
🔴 RATIONALE: When an individual has a legally appointed representative (such as someone with power of attorney), the agent must obtain
consent from that representative for enrollment. The son with power of attorney has the legal authority to make financial and healthcare decisions
for Ms. Duarte.
Question 3
What is the minimum score required to pass the AHIP final examination?
A. 80%
B. 85%
C. 90%
D. 95%
🟢 C. 90%
🔴 RATIONALE: The AHIP test requires a score of 90% or higher to pass. This means an agent must answer at least 45 out of 50 questions correctly.
This high threshold reflects the critical nature of Medicare compliance information.
,Question 4
Which enrollment period occurs annually from October 15 to December 7?
A. Medicare Open Enrollment Period (OEP)
B. Annual Enrollment Period (AEP)
C. Initial Enrollment Period (IEP)
D. Special Enrollment Period (SEP)
🟢 B. Annual Enrollment Period (AEP)
🔴 RATIONALE: The Annual Enrollment Period (AEP) runs from October 15 to December 7 each year, during which Medicare beneficiaries can
make changes to their Medicare Advantage and Part D plans. The effective date for changes is January 1.
Question 5
What is the primary purpose of Fraud, Waste, and Abuse (FWA) training in the AHIP certification?
A. To increase agent commission rates
B. To educate agents on detecting, preventing, and reporting Medicare fraud
C. To reduce the number of Medicare enrollments
D. To simplify the enrollment process for beneficiaries
🟢 B. To educate agents on detecting, preventing, and reporting Medicare fraud
🔴 RATIONALE: FWA training covers the cost of Medicare fraud, efforts and tools utilized to detect fraud, how to properly report fraud, and the
legal obligations of agents. This protects beneficiaries and ensures integrity in the Medicare program.
Question 6
How many attempts are allowed to pass the AHIP final examination?
, A. One attempt
B. Two attempts
C. Three attempts
D. Five attempts
🟢 C. Three attempts
🔴 RATIONALE: Agents are given up to three attempts to pass the AHIP exam. If an agent fails all three attempts, most carriers will not contract
that agent for the year, as multiple failures are considered a red flag.
Question 7
Which type of Medicare Advantage plan typically has the lowest premiums but requires members to use only network providers?
A. Medicare Advantage PPO
B. Medicare Advantage HMO
C. Medicare Advantage PFFS
D. Medicare Advantage SNP
🟢 B. Medicare Advantage HMO
🔴 RATIONALE: Medicare Advantage HMOs (Health Maintenance Organizations) typically have lower premiums but require members to use only
network providers (except for emergencies). PPOs offer some out-of-network coverage at higher costs, PFFS is a point-of-service plan, and SNPs
serve specific groups.
Question 8
What is the time limit for completing the AHIP final examination?
2026 Q&A | INSTANT DOWNLOAD PDF
Core Domains
Medicare Fee-For-Service Eligibility and Benefits
Medicare Advantage and Part D Prescription Drug Plans
Eligibility, Coverage, Nondiscrimination, Marketing, and Enrollment Requirements
Fraud, Waste, and Abuse Identification and Detection
General Compliance, Legal Tools, Reporting, Obligations, and FWA Costs
Introduction
The AHIP (America's Health Insurance Plans) Final Examination is a comprehensive certification assessment designed for insurance agents and
brokers who sell Medicare Advantage (MA) and Medicare Part D prescription drug plans. This exam evaluates critical knowledge and skills
necessary for regulatory compliance, including Medicare eligibility rules, plan types, enrollment periods, CMS marketing guidelines,
nondiscrimination requirements, and Fraud, Waste, and Abuse (FWA) prevention. The assessment consists of multiple-choice and scenario-based
questions that emphasize real-world application, critical thinking, and professional decision-making. Agents must demonstrate mastery of
Centers for Medicare & Medicaid Services (CMS) compliance requirements to ensure ethical, lawful, and beneficiary-centered practices in the
Medicare marketplace.
Section One: Questions 1–100
Question 1
Which Medicare part covers inpatient hospital care, skilled nursing facility care, hospice, and some home health services?
A. Medicare Part B
B. Medicare Part C
C. Medicare Part A
D. Medicare Part D
🟢 C. Medicare Part A
,🔴 RATIONALE: Medicare Part A is known as "hospital insurance" and covers inpatient hospital care, skilled nursing facility care, hospice care, and
some home health services. Part B covers outpatient/medical insurance, Part C is Medicare Advantage, and Part D covers prescription drugs.
Question 2
An agent is conducting a sales presentation with Ms. Duarte, who has cognitive impairment. Her son has power of attorney for financial decisions.
Can the agent enroll Ms. Duarte in a Medicare Advantage plan without the son's consent?
A. Yes, if Ms. Duarte verbally agrees during the presentation
B. No, the agent must obtain consent from the son with power of attorney
C. Yes, but only if Ms. Duarte signs the enrollment form independently
D. No, enrollment is prohibited for individuals with cognitive impairment
🟢 B. No, the agent must obtain consent from the son with power of attorney
🔴 RATIONALE: When an individual has a legally appointed representative (such as someone with power of attorney), the agent must obtain
consent from that representative for enrollment. The son with power of attorney has the legal authority to make financial and healthcare decisions
for Ms. Duarte.
Question 3
What is the minimum score required to pass the AHIP final examination?
A. 80%
B. 85%
C. 90%
D. 95%
🟢 C. 90%
🔴 RATIONALE: The AHIP test requires a score of 90% or higher to pass. This means an agent must answer at least 45 out of 50 questions correctly.
This high threshold reflects the critical nature of Medicare compliance information.
,Question 4
Which enrollment period occurs annually from October 15 to December 7?
A. Medicare Open Enrollment Period (OEP)
B. Annual Enrollment Period (AEP)
C. Initial Enrollment Period (IEP)
D. Special Enrollment Period (SEP)
🟢 B. Annual Enrollment Period (AEP)
🔴 RATIONALE: The Annual Enrollment Period (AEP) runs from October 15 to December 7 each year, during which Medicare beneficiaries can
make changes to their Medicare Advantage and Part D plans. The effective date for changes is January 1.
Question 5
What is the primary purpose of Fraud, Waste, and Abuse (FWA) training in the AHIP certification?
A. To increase agent commission rates
B. To educate agents on detecting, preventing, and reporting Medicare fraud
C. To reduce the number of Medicare enrollments
D. To simplify the enrollment process for beneficiaries
🟢 B. To educate agents on detecting, preventing, and reporting Medicare fraud
🔴 RATIONALE: FWA training covers the cost of Medicare fraud, efforts and tools utilized to detect fraud, how to properly report fraud, and the
legal obligations of agents. This protects beneficiaries and ensures integrity in the Medicare program.
Question 6
How many attempts are allowed to pass the AHIP final examination?
, A. One attempt
B. Two attempts
C. Three attempts
D. Five attempts
🟢 C. Three attempts
🔴 RATIONALE: Agents are given up to three attempts to pass the AHIP exam. If an agent fails all three attempts, most carriers will not contract
that agent for the year, as multiple failures are considered a red flag.
Question 7
Which type of Medicare Advantage plan typically has the lowest premiums but requires members to use only network providers?
A. Medicare Advantage PPO
B. Medicare Advantage HMO
C. Medicare Advantage PFFS
D. Medicare Advantage SNP
🟢 B. Medicare Advantage HMO
🔴 RATIONALE: Medicare Advantage HMOs (Health Maintenance Organizations) typically have lower premiums but require members to use only
network providers (except for emergencies). PPOs offer some out-of-network coverage at higher costs, PFFS is a point-of-service plan, and SNPs
serve specific groups.
Question 8
What is the time limit for completing the AHIP final examination?
