AHIP 2027 FINAL EXAM – MEDICARE
CERTIFICATION EXAM QUESTIONS
AND ANSWERS . VERIFIED
1. Mrs. Anderson is turning 65 in July. She is already receiving Social Security benefits. How
will she be enrolled in Medicare?
A. She must visit a Social Security office to apply manually.
B. She must wait until the General Enrollment Period to sign up.
C. She will be automatically enrolled in Part A, but must apply for Part B.
D. She will be automatically enrolled in Part A and Part B.
Answer: D
Conceptual Explanation: Individuals already receiving Social Security benefits are
automatically enrolled in Medicare Parts A and B starting the first day of the month they
turn 65.
2. Under the 2027 CMS guidelines, what is the ‘48-hour rule’ regarding the Scope of
Appointment (SOA)?
A. Agents must wait 48 hours after a sale to submit an application.
,B. Agents have 48 hours to upload a signed SOA to the carrier portal.
C. An SOA must be signed at least 48 hours prior to a personal marketing appointment,
with specific exceptions.
D. Beneficiaries have 48 hours to rescind an SOA after signing.
Answer: C
Conceptual Explanation: CMS requires a 48-hour buffer between the signing of the Scope
of Appointment and the actual sales meeting, unless it is the end of an enrollment period or
a walk-in.
3. Which of the following describes the Medicare Part D ‘Initial Coverage Limit’ (ICL)?
A. The amount the beneficiary pays before the plan starts to pay.
B. The maximum amount a plan will pay for drugs in a calendar year.
C. The threshold where the beneficiary enters the ‘donut hole’ or coverage gap.
D. The maximum out-of-pocket limit for all Part D drugs.
Answer: C
Conceptual Explanation: The ICL is the point where the total drug costs (paid by both the
plan and the member) reach a limit, moving the member into the next coverage phase.
, 4. Mr. Davies is enrolled in a Medicare Advantage (MA) plan. He wants to switch to a
different MA plan during the Medicare Advantage Open Enrollment Period (MA OEP). Is this
allowed?
A. Yes, he can make one change to another MA plan or return to Original Medicare.
B. No, he can only switch during the Annual Election Period (AEP).
C. Yes, but only if he has a qualifying life event.
D. No, the OEP is only for new Medicare beneficiaries.
Answer: A
Conceptual Explanation: The MA OEP (Jan 1 – Mar 31) allows individuals enrolled in an
MA plan to make one change to another MA plan or return to Original Medicare and enroll
in a Part D plan.
5. Which of these is a ‘Prohibited’ marketing practice for Medicare Advantage plans?
A. Conducting a sales presentation in a public library.
B. Approaching a beneficiary in a common area like a grocery store parking lot.
C. Offering a $15 gift card as an incentive to attend a seminar.
D. Sending a direct mail piece to a lead who requested information.
Answer: B
Conceptual Explanation: Unsolicited direct contact, such as ‘door-knocking’ or
approaching people in parking lots or common areas, is strictly prohibited by CMS.
CERTIFICATION EXAM QUESTIONS
AND ANSWERS . VERIFIED
1. Mrs. Anderson is turning 65 in July. She is already receiving Social Security benefits. How
will she be enrolled in Medicare?
A. She must visit a Social Security office to apply manually.
B. She must wait until the General Enrollment Period to sign up.
C. She will be automatically enrolled in Part A, but must apply for Part B.
D. She will be automatically enrolled in Part A and Part B.
Answer: D
Conceptual Explanation: Individuals already receiving Social Security benefits are
automatically enrolled in Medicare Parts A and B starting the first day of the month they
turn 65.
2. Under the 2027 CMS guidelines, what is the ‘48-hour rule’ regarding the Scope of
Appointment (SOA)?
A. Agents must wait 48 hours after a sale to submit an application.
,B. Agents have 48 hours to upload a signed SOA to the carrier portal.
C. An SOA must be signed at least 48 hours prior to a personal marketing appointment,
with specific exceptions.
D. Beneficiaries have 48 hours to rescind an SOA after signing.
Answer: C
Conceptual Explanation: CMS requires a 48-hour buffer between the signing of the Scope
of Appointment and the actual sales meeting, unless it is the end of an enrollment period or
a walk-in.
3. Which of the following describes the Medicare Part D ‘Initial Coverage Limit’ (ICL)?
A. The amount the beneficiary pays before the plan starts to pay.
B. The maximum amount a plan will pay for drugs in a calendar year.
C. The threshold where the beneficiary enters the ‘donut hole’ or coverage gap.
D. The maximum out-of-pocket limit for all Part D drugs.
Answer: C
Conceptual Explanation: The ICL is the point where the total drug costs (paid by both the
plan and the member) reach a limit, moving the member into the next coverage phase.
, 4. Mr. Davies is enrolled in a Medicare Advantage (MA) plan. He wants to switch to a
different MA plan during the Medicare Advantage Open Enrollment Period (MA OEP). Is this
allowed?
A. Yes, he can make one change to another MA plan or return to Original Medicare.
B. No, he can only switch during the Annual Election Period (AEP).
C. Yes, but only if he has a qualifying life event.
D. No, the OEP is only for new Medicare beneficiaries.
Answer: A
Conceptual Explanation: The MA OEP (Jan 1 – Mar 31) allows individuals enrolled in an
MA plan to make one change to another MA plan or return to Original Medicare and enroll
in a Part D plan.
5. Which of these is a ‘Prohibited’ marketing practice for Medicare Advantage plans?
A. Conducting a sales presentation in a public library.
B. Approaching a beneficiary in a common area like a grocery store parking lot.
C. Offering a $15 gift card as an incentive to attend a seminar.
D. Sending a direct mail piece to a lead who requested information.
Answer: B
Conceptual Explanation: Unsolicited direct contact, such as ‘door-knocking’ or
approaching people in parking lots or common areas, is strictly prohibited by CMS.
