AHIP CERTIFICATION EXAMINATION
AHIP 2026/2027
Modules 1-5
Medicare Certification Examination
Actual Questions & Answers | Guarantee Pass Edition
Aligned with 2026-2027 CMS and AHIP Medicare Training Standards
Updated with Inflation Reduction Act Provisions & Part D Changes
150 5 70%
Total Questions Modules Covered Scenario-Based
Comprehensive Coverage of:
Medicare Basics | Medicare Advantage (Part C) | Part D Prescription Drugs | Medigap | CMS Marketing & FWA
Compliance
For AHIP Medicare Certification Candidates
Updated 2026-2027 Edition
,AHIP 2026/2027 Modules 1-5 - Medicare Certification Exam 150 Questions | Updated CMS Guidelines
Examination Overview
This examination is designed to comprehensively assess your mastery of the AHIP Medicare Certification Modules 1-5,
aligned with 2026-2027 CMS and AHIP Medicare Training Standards. The exam contains exactly 150 multiple-choice
questions distributed across five modules: Medicare Basics (Q1-30), Medicare Advantage Part C (Q31-55), Part D
Prescription Drug Plans (Q56-80), Medigap (Q81-95), and CMS Marketing, Compliance, and Fraud/Waste/Abuse
Guidelines (Q96-150). Each question presents four options (A-D) with exactly one correct answer, followed by a detailed
rationale grounded in CMS guidelines, enrollment rules, compliance requirements, and beneficiary protections.
The exam is structured as 70% scenario-based, 20% application/analysis, and 10% recall, reflecting the cognitive
distribution of the AHIP exam blueprint. Distractors are designed to reflect common AHIP exam pitfalls, including
enrollment period confusion, Medigap/MA coordination errors, Part D coverage gap misunderstanding, marketing
compliance violations, and FWA identification errors. Successful completion of this exam - achieving approximately
90% or higher - provides strong preparation for the actual AHIP Medicare Certification examination administered
annually to agents and brokers selling Medicare Advantage and Part D plans.
Examination Structure
Se Module Questions Focus Areas
cti
on
1 Module 1 Q1-Q30 Original Medicare Parts A & B, Eligibility, Enrollment
(30 Q) Periods (IEP, GEP, AEP, OEP, SEP), Late Enrollment
Penalties, and...
2 Module 2 Q31-Q55 Plan Types (HMO, PPO, PFFS, SNPs, MSAs), Enrollment
(25 Q) Rules, Risk Adjustment, Star Ratings, and MA Open
Enrollment Period...
3 Module 3 Q56-Q80 Formularies, Protected Classes, Coverage Gap, Creditable
(25 Q) Coverage, Late Enrollment Penalty, and Low-Income
Subsidy (Extr...
4 Module 4 Q81-Q95 Standardized Plans, Open Enrollment Period, Guaranteed
(15 Q) Issue Rights, and Coordination with MA Plans...
5 Module 5 Q96-Q150 Scope of Appointment, Marketing vs. Educational Events,
(55 Q) Nominal Gifts, Prohibited Practices, CMS Oversight,
Upcoding, Un...
AHIP Medicare Certification - Guarantee Pass Edition Page 2
,AHIP 2026/2027 Modules 1-5 - Medicare Certification Exam 150 Questions | Updated CMS Guidelines
Key Topics Assessed
Module 1 - Medicare Part A & Part B benefits; premium-free Part A eligibility (40 quarters); Part B IRMAA; IEP
(7-month window); GEP (Jan 1 - Mar 31); AEP (Oct 15 - Dec 7); MA OEP (Jan 1 - Mar 31); SEPs for qualifying life
events; Part B late enrollment penalty (10% per 12 months); Part A benefit periods and lifetime reserve days; MSP rules
for working-aged beneficiaries with employer coverage.
Module 2 - MA plan types (HMO, PPO, PFFS, SNP, MSA, HMO-POS); MA-PD integration; Part B premium
obligation; CMS risk adjustment using HCCs; Star Ratings and Quality Bonus Payments; MA OEP rules; network
adequacy; prior authorization and appeals; maximum out-of-pocket (MOOP) limits; ANOC and EOC disclosures; 5-star
SEP.
Module 3 - PDP vs. MA-PD; formularies and tiers; six protected classes; coverage gap closure and the $2,000 annual
out-of-pocket cap (2025 Inflation Reduction Act); TrOOP; creditable coverage and the 63-day SEP; Part D late
enrollment penalty (1% per month); Low-Income Subsidy (Extra Help); formulary exceptions and appeals; Drug
Management Programs (lock-in).
Module 4 - Standardized Medigap plans (A, B, C, D, F, G, K, L, M, N); prohibition on Plans C & F for new
beneficiaries (post Jan 1, 2020); high-deductible Plans F & G; 6-month Medigap Open Enrollment Period; guaranteed
issue rights; federal prohibition on selling Medigap to MA enrollees; Plan G and Plan N features; Plan N copays for
office and ER visits.
Module 5 - Scope of Appointment (SOA) and 10-year retention; educational vs. marketing events; $15 nominal-value
gift threshold; prohibited practices (door-to-door, cold calling, government endorsement claims, free meals); third-party
marketing organizations (TPMOs); Medical Loss Ratio (MLR); upcoding; unbundling; phantom billing; Anti-Kickback
Statute; Stark Law; False Claims Act and qui tam; HHS OIG exclusions; FWA reporting channels (1-800-MEDICARE,
OIG hotline); Medicare identity theft response.
Section 1 - Module 1: Medicare Basics
Original Medicare Parts A & B, Eligibility, Enrollment Periods (IEP, GEP, AEP, OEP, SEP), Late Enrollment Penalties, and
Medicare Secondary Payer Rules
Q1: Mrs. Alvarez is turning 65 in two months and has worked at a private employer for 32 years, paying
Medicare payroll taxes throughout. She asks her agent whether she will need to pay a monthly premium for
Medicare Part A. Which response is MOST accurate under 2026 CMS rules?
A. She must pay the standard Part A premium because she has not yet reached 40 quarters of coverage.
B. She is entitled to premium-free Part A because she has accumulated more than 40 quarters (10 years) of
Medicare-covered employment. [CORRECT]
C. She is only entitled to premium-free Part A after she also enrolls in Part B and pays that premium.
D. Premium-free Part A is available only to individuals who are also receiving Social Security retirement benefits.
Correct Answer: B - She is entitled to premium-free Part A because she has accumulated more than 40 quarters
(10 years) of Medicare-covered employment.
AHIP Medicare Certification - Guarantee Pass Edition Page 3
, AHIP 2026/2027 Modules 1-5 - Medicare Certification Exam 150 Questions | Updated CMS Guidelines
Rationale: Premium-free Part A requires 40 quarters (10 years) of Medicare-covered employment, which Mrs. Alvarez
satisfies with 32 years of payroll-tax-paying work. The other options confuse the requirement: Part A eligibility is independent
of Part B enrollment, and although many beneficiaries also draw Social Security, retirement benefits are not a prerequisite for
premium-free Part A.
Q2: A 67-year-old beneficiary is confused about when his Initial Enrollment Period (IEP) began. He was born on
March 15, 1960. Under CMS rules, which month did his IEP START?
A. December 2024 (three months before his birthday month). [CORRECT]
B. January 2025 (the month immediately preceding his birth month).
C. February 2025 (the birth month itself, counted first).
D. March 2025 (the birth month itself).
Correct Answer: A - December 2024 (three months before his birthday month).
Rationale: The IEP is a 7-month window that begins 3 months before the month the beneficiary turns 65, includes the birth
month, and ends 3 months after. For a March 15 birthday, the IEP begins in December (3 months before March) and runs
through the end of June. Option B reflects a common off-by-one error and Option C/D incorrectly anchor the window to the
birth month.
Q3: Mr. Tanaka delayed enrollment in Medicare Part B because he was covered under his wife's active employer
group health plan. He is now 68 and his wife is retiring, causing him to lose that coverage. Which enrollment
opportunity applies to him?
A. General Enrollment Period (GEP) running January 1 through March 31 only.
B. Special Enrollment Period (SEP) triggered by loss of current employer coverage, with no late enrollment
penalty. [CORRECT]
C. Annual Enrollment Period (AEP) running October 15 through December 7 only.
D. Medicare Advantage Open Enrollment Period (OEP) running January 1 through March 31 only.
Correct Answer: B - Special Enrollment Period (SEP) triggered by loss of current employer coverage, with no
late enrollment penalty.
Rationale: Loss of active employer group health plan coverage is a qualifying life event that triggers a Special Enrollment
Period (SEP) for Part B without the late enrollment penalty. The GEP applies only to individuals who lacked any other
qualifying coverage, and AEP/OEP rules govern Part C/Part D changes rather than initial Part B enrollment triggered by
employer loss.
AHIP Medicare Certification - Guarantee Pass Edition Page 4
AHIP 2026/2027
Modules 1-5
Medicare Certification Examination
Actual Questions & Answers | Guarantee Pass Edition
Aligned with 2026-2027 CMS and AHIP Medicare Training Standards
Updated with Inflation Reduction Act Provisions & Part D Changes
150 5 70%
Total Questions Modules Covered Scenario-Based
Comprehensive Coverage of:
Medicare Basics | Medicare Advantage (Part C) | Part D Prescription Drugs | Medigap | CMS Marketing & FWA
Compliance
For AHIP Medicare Certification Candidates
Updated 2026-2027 Edition
,AHIP 2026/2027 Modules 1-5 - Medicare Certification Exam 150 Questions | Updated CMS Guidelines
Examination Overview
This examination is designed to comprehensively assess your mastery of the AHIP Medicare Certification Modules 1-5,
aligned with 2026-2027 CMS and AHIP Medicare Training Standards. The exam contains exactly 150 multiple-choice
questions distributed across five modules: Medicare Basics (Q1-30), Medicare Advantage Part C (Q31-55), Part D
Prescription Drug Plans (Q56-80), Medigap (Q81-95), and CMS Marketing, Compliance, and Fraud/Waste/Abuse
Guidelines (Q96-150). Each question presents four options (A-D) with exactly one correct answer, followed by a detailed
rationale grounded in CMS guidelines, enrollment rules, compliance requirements, and beneficiary protections.
The exam is structured as 70% scenario-based, 20% application/analysis, and 10% recall, reflecting the cognitive
distribution of the AHIP exam blueprint. Distractors are designed to reflect common AHIP exam pitfalls, including
enrollment period confusion, Medigap/MA coordination errors, Part D coverage gap misunderstanding, marketing
compliance violations, and FWA identification errors. Successful completion of this exam - achieving approximately
90% or higher - provides strong preparation for the actual AHIP Medicare Certification examination administered
annually to agents and brokers selling Medicare Advantage and Part D plans.
Examination Structure
Se Module Questions Focus Areas
cti
on
1 Module 1 Q1-Q30 Original Medicare Parts A & B, Eligibility, Enrollment
(30 Q) Periods (IEP, GEP, AEP, OEP, SEP), Late Enrollment
Penalties, and...
2 Module 2 Q31-Q55 Plan Types (HMO, PPO, PFFS, SNPs, MSAs), Enrollment
(25 Q) Rules, Risk Adjustment, Star Ratings, and MA Open
Enrollment Period...
3 Module 3 Q56-Q80 Formularies, Protected Classes, Coverage Gap, Creditable
(25 Q) Coverage, Late Enrollment Penalty, and Low-Income
Subsidy (Extr...
4 Module 4 Q81-Q95 Standardized Plans, Open Enrollment Period, Guaranteed
(15 Q) Issue Rights, and Coordination with MA Plans...
5 Module 5 Q96-Q150 Scope of Appointment, Marketing vs. Educational Events,
(55 Q) Nominal Gifts, Prohibited Practices, CMS Oversight,
Upcoding, Un...
AHIP Medicare Certification - Guarantee Pass Edition Page 2
,AHIP 2026/2027 Modules 1-5 - Medicare Certification Exam 150 Questions | Updated CMS Guidelines
Key Topics Assessed
Module 1 - Medicare Part A & Part B benefits; premium-free Part A eligibility (40 quarters); Part B IRMAA; IEP
(7-month window); GEP (Jan 1 - Mar 31); AEP (Oct 15 - Dec 7); MA OEP (Jan 1 - Mar 31); SEPs for qualifying life
events; Part B late enrollment penalty (10% per 12 months); Part A benefit periods and lifetime reserve days; MSP rules
for working-aged beneficiaries with employer coverage.
Module 2 - MA plan types (HMO, PPO, PFFS, SNP, MSA, HMO-POS); MA-PD integration; Part B premium
obligation; CMS risk adjustment using HCCs; Star Ratings and Quality Bonus Payments; MA OEP rules; network
adequacy; prior authorization and appeals; maximum out-of-pocket (MOOP) limits; ANOC and EOC disclosures; 5-star
SEP.
Module 3 - PDP vs. MA-PD; formularies and tiers; six protected classes; coverage gap closure and the $2,000 annual
out-of-pocket cap (2025 Inflation Reduction Act); TrOOP; creditable coverage and the 63-day SEP; Part D late
enrollment penalty (1% per month); Low-Income Subsidy (Extra Help); formulary exceptions and appeals; Drug
Management Programs (lock-in).
Module 4 - Standardized Medigap plans (A, B, C, D, F, G, K, L, M, N); prohibition on Plans C & F for new
beneficiaries (post Jan 1, 2020); high-deductible Plans F & G; 6-month Medigap Open Enrollment Period; guaranteed
issue rights; federal prohibition on selling Medigap to MA enrollees; Plan G and Plan N features; Plan N copays for
office and ER visits.
Module 5 - Scope of Appointment (SOA) and 10-year retention; educational vs. marketing events; $15 nominal-value
gift threshold; prohibited practices (door-to-door, cold calling, government endorsement claims, free meals); third-party
marketing organizations (TPMOs); Medical Loss Ratio (MLR); upcoding; unbundling; phantom billing; Anti-Kickback
Statute; Stark Law; False Claims Act and qui tam; HHS OIG exclusions; FWA reporting channels (1-800-MEDICARE,
OIG hotline); Medicare identity theft response.
Section 1 - Module 1: Medicare Basics
Original Medicare Parts A & B, Eligibility, Enrollment Periods (IEP, GEP, AEP, OEP, SEP), Late Enrollment Penalties, and
Medicare Secondary Payer Rules
Q1: Mrs. Alvarez is turning 65 in two months and has worked at a private employer for 32 years, paying
Medicare payroll taxes throughout. She asks her agent whether she will need to pay a monthly premium for
Medicare Part A. Which response is MOST accurate under 2026 CMS rules?
A. She must pay the standard Part A premium because she has not yet reached 40 quarters of coverage.
B. She is entitled to premium-free Part A because she has accumulated more than 40 quarters (10 years) of
Medicare-covered employment. [CORRECT]
C. She is only entitled to premium-free Part A after she also enrolls in Part B and pays that premium.
D. Premium-free Part A is available only to individuals who are also receiving Social Security retirement benefits.
Correct Answer: B - She is entitled to premium-free Part A because she has accumulated more than 40 quarters
(10 years) of Medicare-covered employment.
AHIP Medicare Certification - Guarantee Pass Edition Page 3
, AHIP 2026/2027 Modules 1-5 - Medicare Certification Exam 150 Questions | Updated CMS Guidelines
Rationale: Premium-free Part A requires 40 quarters (10 years) of Medicare-covered employment, which Mrs. Alvarez
satisfies with 32 years of payroll-tax-paying work. The other options confuse the requirement: Part A eligibility is independent
of Part B enrollment, and although many beneficiaries also draw Social Security, retirement benefits are not a prerequisite for
premium-free Part A.
Q2: A 67-year-old beneficiary is confused about when his Initial Enrollment Period (IEP) began. He was born on
March 15, 1960. Under CMS rules, which month did his IEP START?
A. December 2024 (three months before his birthday month). [CORRECT]
B. January 2025 (the month immediately preceding his birth month).
C. February 2025 (the birth month itself, counted first).
D. March 2025 (the birth month itself).
Correct Answer: A - December 2024 (three months before his birthday month).
Rationale: The IEP is a 7-month window that begins 3 months before the month the beneficiary turns 65, includes the birth
month, and ends 3 months after. For a March 15 birthday, the IEP begins in December (3 months before March) and runs
through the end of June. Option B reflects a common off-by-one error and Option C/D incorrectly anchor the window to the
birth month.
Q3: Mr. Tanaka delayed enrollment in Medicare Part B because he was covered under his wife's active employer
group health plan. He is now 68 and his wife is retiring, causing him to lose that coverage. Which enrollment
opportunity applies to him?
A. General Enrollment Period (GEP) running January 1 through March 31 only.
B. Special Enrollment Period (SEP) triggered by loss of current employer coverage, with no late enrollment
penalty. [CORRECT]
C. Annual Enrollment Period (AEP) running October 15 through December 7 only.
D. Medicare Advantage Open Enrollment Period (OEP) running January 1 through March 31 only.
Correct Answer: B - Special Enrollment Period (SEP) triggered by loss of current employer coverage, with no
late enrollment penalty.
Rationale: Loss of active employer group health plan coverage is a qualifying life event that triggers a Special Enrollment
Period (SEP) for Part B without the late enrollment penalty. The GEP applies only to individuals who lacked any other
qualifying coverage, and AEP/OEP rules govern Part C/Part D changes rather than initial Part B enrollment triggered by
employer loss.
AHIP Medicare Certification - Guarantee Pass Edition Page 4
