2026 AHIP MODULE 4 PRACTICE EXAM COMMUNICATIONS
AND MARKETING RULES FOR MEDICARE ADVANTAGE
AND PART D PLANS
1. Regarding Marketing vs communications, Which option best reflects Medicare rules?
A. Marketing rules never apply to agents
B. Marketing is a subset of communications that is intended to draw attention to a plan or influence an enrollment
decision and meets CMS content/intent standards
C. All communications are automatically marketing
D. Only television ads can be marketing
Correct Answer: B. Marketing is a subset of communications that is intended to draw attention to a plan or
influence an enrollment decision and meets CMS content/intent standards
Rationale: CMS distinguishes general communications from marketing based on content and intent; marketing is
more specifically regulated.
2. A compliance reviewer is comparing several Medicare marketing statements involving
Misrepresentation. Which statement is accurate?
A. Exaggeration is acceptable if verbally corrected later
B. Agents may omit important limitations
C. A plan may imply government endorsement
D. Marketing may not contain materially inaccurate, misleading, or confusing claims about Medicare or plan
benefits
Correct Answer: D. Marketing may not contain materially inaccurate, misleading, or confusing claims about
Medicare or plan benefits
Rationale: CMS requires Medicare marketing to be accurate and not misleading.
3. George, a licensed Medicare agent, is while comparing next-year coverage. The discussion turns to Sales
event meals. Which conduct is compliant?
A. Plans and agents may provide light snacks or refreshments at sales/marketing events but may not provide or
subsidize meals
B. No food of any kind is permitted
C. Meals are required for seminars over one hour
D. Full meals are permitted if under $50
Correct Answer: A. Plans and agents may provide light snacks or refreshments at sales/marketing events but
may not provide or subsidize meals
Rationale: CMS prohibits meals at sales/marketing events but permits light snacks and refreshments consistent
with guidance.
4. During a compliance review, an agent must give an accurate explanation of Beneficiary needs without
overstating or omitting a key rule. Which explanation should the agent use?
A. Agents should avoid asking about prescriptions
B. Provider networks are irrelevant
C. Before enrollment, agents should discuss relevant beneficiary needs such as providers, prescriptions,
health-care costs, premiums, benefits, and specific care needs
D. Only premium may be discussed
Correct Answer: C. Before enrollment, agents should discuss relevant beneficiary needs such as providers,
prescriptions, health-care costs, premiums, benefits, and specific care needs
Rationale: CMS expects a meaningful needs review before enrollment so beneficiaries understand how a plan fits
their providers, drugs, costs, and care needs.
5. Regarding Nominal gifts, What should the beneficiary be told?
A. Gift value has no restriction
B. Cash gifts are preferred
C. Promotional gifts offered to prospective enrollees must comply with CMS nominal-value and
nondiscrimination rules and may not be cash or cash equivalents
D. Gifts may be conditioned on enrollment
,Correct Answer: C. Promotional gifts offered to prospective enrollees must comply with CMS nominal-value
and nondiscrimination rules and may not be cash or cash equivalents
Rationale: CMS restricts promotional gifts to protect beneficiaries from inducements and prohibits cash or
cash-equivalent enrollment incentives.
6. A compliance reviewer is comparing several Medicare marketing statements involving Marketing vs
communications. Which statement is accurate?
A. Marketing is a subset of communications that is intended to draw attention to a plan or influence an enrollment
decision and meets CMS content/intent standards
B. All communications are automatically marketing
C. Marketing rules never apply to agents
D. Only television ads can be marketing
Correct Answer: A. Marketing is a subset of communications that is intended to draw attention to a plan or
influence an enrollment decision and meets CMS content/intent standards
Rationale: CMS distinguishes general communications from marketing based on content and intent; marketing is
more specifically regulated.
7. Olivia, a licensed Medicare agent, is during an annual coverage review. The discussion turns to
Compensation neutrality. Which conduct is compliant?
A. Compensation is unregulated
B. Higher commissions justify withholding lower-commission options
C. Agents may receive unlimited plan-specific bonuses for steering
D. Compensation structures must comply with CMS rules designed to reduce incentives for inappropriate steering
Correct Answer: D. Compensation structures must comply with CMS rules designed to reduce incentives for
inappropriate steering
Rationale: CMS regulates agent/broker compensation and certain TPMO contract terms to reduce financial
incentives that could distort plan recommendations.
8. During a compliance review, an agent must give an accurate explanation of PHI without overstating or
omitting a key rule. Which explanation should the agent use?
A. Only paper records are protected
B. Agents handling protected health information must comply with HIPAA and applicable
plan/business-associate privacy obligations
C. PHI may be freely reused for any marketing
D. HIPAA never applies to plan representatives
Correct Answer: B. Agents handling protected health information must comply with HIPAA and applicable
plan/business-associate privacy obligations
Rationale: Beneficiary health and coverage information is protected and may be used or disclosed only as
permitted by law and applicable agreements.
9. Regarding Call recording, Which statement is most accurate?
A. TPMOs operating on behalf of plans must record marketing, sales, and enrollment calls in their entirety,
including audio portions of web-based calls
B. Recording is prohibited
C. Only calls ending in enrollment are recorded
D. Only complaints must be recorded
Correct Answer: A. TPMOs operating on behalf of plans must record marketing, sales, and enrollment calls in
their entirety, including audio portions of web-based calls
Rationale: CMS requires organizations to ensure applicable TPMO marketing, sales, and enrollment calls are
recorded in their entirety.
10. A compliance reviewer is comparing several Medicare marketing statements involving Medicare
name/logo. Which statement is accurate?
A. Government-looking mailers need no disclaimer
B. Marketing must not misleadingly imply that a private plan or agent is Medicare, CMS, or another government
entity
C. Private plans may freely present themselves as Medicare
D. Agents may use official seals to increase response
, Correct Answer: B. Marketing must not misleadingly imply that a private plan or agent is Medicare, CMS, or
another government entity
Rationale: CMS rules protect beneficiaries from confusion about private plan status versus the federal Medicare
program.
11. Linda, a licensed Medicare agent, is during a scheduled phone consultation. The discussion turns to
Scope of Appointment. Which conduct is compliant?
A. It is the beneficiary Medicare card
B. It is the agent state license
C. It is the enrollment application
D. A Scope of Appointment documents the Medicare products the beneficiary agrees may be discussed at an
individual marketing appointment
Correct Answer: D. A Scope of Appointment documents the Medicare products the beneficiary agrees may be
discussed at an individual marketing appointment
Rationale: The SOA sets the permitted scope of an individual sales/marketing appointment and is a beneficiary
protection.
12. During a compliance review, an agent must give an accurate explanation of Permission to contact
without overstating or omitting a key rule. Which explanation should the agent use?
A. Permission authorizes unlimited unrelated product sales
B. Permission is never needed
C. A beneficiary can provide permission for an agent or plan to contact them about Medicare plan options, subject
to CMS rules
D. A family member can always give blanket permission without authority
Correct Answer: C. A beneficiary can provide permission for an agent or plan to contact them about Medicare
plan options, subject to CMS rules
Rationale: Permission to contact supports compliant follow-up but does not erase limits on scope, privacy, or
other marketing rules.
13. Regarding Star rating claims, Which action or explanation is most appropriate?
A. Star ratings apply only to Medigap
B. Any single 5-star measure can be advertised as a 5-star overall plan
C. Star ratings may be fabricated
D. When discussing Star Ratings, agents must accurately identify the applicable rating and avoid implying that an
isolated measure represents the overall rating
Correct Answer: D. When discussing Star Ratings, agents must accurately identify the applicable rating and
avoid implying that an isolated measure represents the overall rating
Rationale: CMS has specific rules for presenting Star Ratings so beneficiaries are not misled about overall plan
quality.
14. A compliance reviewer is comparing several Medicare marketing statements involving Unsolicited
contact. Which statement is accurate?
A. Parking-lot solicitation is permitted
B. Door-to-door solicitation is allowed during AEP
C. Agents and plans generally may not make unsolicited door-to-door visits or other prohibited direct sales
contacts to prospective enrollees
D. Cold calling is always allowed if no enrollment occurs
Correct Answer: C. Agents and plans generally may not make unsolicited door-to-door visits or other prohibited
direct sales contacts to prospective enrollees
Rationale: Medicare marketing rules restrict unsolicited direct contact and require beneficiary permission or
another permitted basis for individual marketing contact.
15. Samuel, a licensed Medicare agent, is while comparing next-year coverage. The discussion turns to Call
recording. Which conduct is compliant?
A. Only complaints must be recorded
B. TPMOs operating on behalf of plans must record marketing, sales, and enrollment calls in their entirety,
including audio portions of web-based calls
C. Recording is prohibited
D. Only calls ending in enrollment are recorded
AND MARKETING RULES FOR MEDICARE ADVANTAGE
AND PART D PLANS
1. Regarding Marketing vs communications, Which option best reflects Medicare rules?
A. Marketing rules never apply to agents
B. Marketing is a subset of communications that is intended to draw attention to a plan or influence an enrollment
decision and meets CMS content/intent standards
C. All communications are automatically marketing
D. Only television ads can be marketing
Correct Answer: B. Marketing is a subset of communications that is intended to draw attention to a plan or
influence an enrollment decision and meets CMS content/intent standards
Rationale: CMS distinguishes general communications from marketing based on content and intent; marketing is
more specifically regulated.
2. A compliance reviewer is comparing several Medicare marketing statements involving
Misrepresentation. Which statement is accurate?
A. Exaggeration is acceptable if verbally corrected later
B. Agents may omit important limitations
C. A plan may imply government endorsement
D. Marketing may not contain materially inaccurate, misleading, or confusing claims about Medicare or plan
benefits
Correct Answer: D. Marketing may not contain materially inaccurate, misleading, or confusing claims about
Medicare or plan benefits
Rationale: CMS requires Medicare marketing to be accurate and not misleading.
3. George, a licensed Medicare agent, is while comparing next-year coverage. The discussion turns to Sales
event meals. Which conduct is compliant?
A. Plans and agents may provide light snacks or refreshments at sales/marketing events but may not provide or
subsidize meals
B. No food of any kind is permitted
C. Meals are required for seminars over one hour
D. Full meals are permitted if under $50
Correct Answer: A. Plans and agents may provide light snacks or refreshments at sales/marketing events but
may not provide or subsidize meals
Rationale: CMS prohibits meals at sales/marketing events but permits light snacks and refreshments consistent
with guidance.
4. During a compliance review, an agent must give an accurate explanation of Beneficiary needs without
overstating or omitting a key rule. Which explanation should the agent use?
A. Agents should avoid asking about prescriptions
B. Provider networks are irrelevant
C. Before enrollment, agents should discuss relevant beneficiary needs such as providers, prescriptions,
health-care costs, premiums, benefits, and specific care needs
D. Only premium may be discussed
Correct Answer: C. Before enrollment, agents should discuss relevant beneficiary needs such as providers,
prescriptions, health-care costs, premiums, benefits, and specific care needs
Rationale: CMS expects a meaningful needs review before enrollment so beneficiaries understand how a plan fits
their providers, drugs, costs, and care needs.
5. Regarding Nominal gifts, What should the beneficiary be told?
A. Gift value has no restriction
B. Cash gifts are preferred
C. Promotional gifts offered to prospective enrollees must comply with CMS nominal-value and
nondiscrimination rules and may not be cash or cash equivalents
D. Gifts may be conditioned on enrollment
,Correct Answer: C. Promotional gifts offered to prospective enrollees must comply with CMS nominal-value
and nondiscrimination rules and may not be cash or cash equivalents
Rationale: CMS restricts promotional gifts to protect beneficiaries from inducements and prohibits cash or
cash-equivalent enrollment incentives.
6. A compliance reviewer is comparing several Medicare marketing statements involving Marketing vs
communications. Which statement is accurate?
A. Marketing is a subset of communications that is intended to draw attention to a plan or influence an enrollment
decision and meets CMS content/intent standards
B. All communications are automatically marketing
C. Marketing rules never apply to agents
D. Only television ads can be marketing
Correct Answer: A. Marketing is a subset of communications that is intended to draw attention to a plan or
influence an enrollment decision and meets CMS content/intent standards
Rationale: CMS distinguishes general communications from marketing based on content and intent; marketing is
more specifically regulated.
7. Olivia, a licensed Medicare agent, is during an annual coverage review. The discussion turns to
Compensation neutrality. Which conduct is compliant?
A. Compensation is unregulated
B. Higher commissions justify withholding lower-commission options
C. Agents may receive unlimited plan-specific bonuses for steering
D. Compensation structures must comply with CMS rules designed to reduce incentives for inappropriate steering
Correct Answer: D. Compensation structures must comply with CMS rules designed to reduce incentives for
inappropriate steering
Rationale: CMS regulates agent/broker compensation and certain TPMO contract terms to reduce financial
incentives that could distort plan recommendations.
8. During a compliance review, an agent must give an accurate explanation of PHI without overstating or
omitting a key rule. Which explanation should the agent use?
A. Only paper records are protected
B. Agents handling protected health information must comply with HIPAA and applicable
plan/business-associate privacy obligations
C. PHI may be freely reused for any marketing
D. HIPAA never applies to plan representatives
Correct Answer: B. Agents handling protected health information must comply with HIPAA and applicable
plan/business-associate privacy obligations
Rationale: Beneficiary health and coverage information is protected and may be used or disclosed only as
permitted by law and applicable agreements.
9. Regarding Call recording, Which statement is most accurate?
A. TPMOs operating on behalf of plans must record marketing, sales, and enrollment calls in their entirety,
including audio portions of web-based calls
B. Recording is prohibited
C. Only calls ending in enrollment are recorded
D. Only complaints must be recorded
Correct Answer: A. TPMOs operating on behalf of plans must record marketing, sales, and enrollment calls in
their entirety, including audio portions of web-based calls
Rationale: CMS requires organizations to ensure applicable TPMO marketing, sales, and enrollment calls are
recorded in their entirety.
10. A compliance reviewer is comparing several Medicare marketing statements involving Medicare
name/logo. Which statement is accurate?
A. Government-looking mailers need no disclaimer
B. Marketing must not misleadingly imply that a private plan or agent is Medicare, CMS, or another government
entity
C. Private plans may freely present themselves as Medicare
D. Agents may use official seals to increase response
, Correct Answer: B. Marketing must not misleadingly imply that a private plan or agent is Medicare, CMS, or
another government entity
Rationale: CMS rules protect beneficiaries from confusion about private plan status versus the federal Medicare
program.
11. Linda, a licensed Medicare agent, is during a scheduled phone consultation. The discussion turns to
Scope of Appointment. Which conduct is compliant?
A. It is the beneficiary Medicare card
B. It is the agent state license
C. It is the enrollment application
D. A Scope of Appointment documents the Medicare products the beneficiary agrees may be discussed at an
individual marketing appointment
Correct Answer: D. A Scope of Appointment documents the Medicare products the beneficiary agrees may be
discussed at an individual marketing appointment
Rationale: The SOA sets the permitted scope of an individual sales/marketing appointment and is a beneficiary
protection.
12. During a compliance review, an agent must give an accurate explanation of Permission to contact
without overstating or omitting a key rule. Which explanation should the agent use?
A. Permission authorizes unlimited unrelated product sales
B. Permission is never needed
C. A beneficiary can provide permission for an agent or plan to contact them about Medicare plan options, subject
to CMS rules
D. A family member can always give blanket permission without authority
Correct Answer: C. A beneficiary can provide permission for an agent or plan to contact them about Medicare
plan options, subject to CMS rules
Rationale: Permission to contact supports compliant follow-up but does not erase limits on scope, privacy, or
other marketing rules.
13. Regarding Star rating claims, Which action or explanation is most appropriate?
A. Star ratings apply only to Medigap
B. Any single 5-star measure can be advertised as a 5-star overall plan
C. Star ratings may be fabricated
D. When discussing Star Ratings, agents must accurately identify the applicable rating and avoid implying that an
isolated measure represents the overall rating
Correct Answer: D. When discussing Star Ratings, agents must accurately identify the applicable rating and
avoid implying that an isolated measure represents the overall rating
Rationale: CMS has specific rules for presenting Star Ratings so beneficiaries are not misled about overall plan
quality.
14. A compliance reviewer is comparing several Medicare marketing statements involving Unsolicited
contact. Which statement is accurate?
A. Parking-lot solicitation is permitted
B. Door-to-door solicitation is allowed during AEP
C. Agents and plans generally may not make unsolicited door-to-door visits or other prohibited direct sales
contacts to prospective enrollees
D. Cold calling is always allowed if no enrollment occurs
Correct Answer: C. Agents and plans generally may not make unsolicited door-to-door visits or other prohibited
direct sales contacts to prospective enrollees
Rationale: Medicare marketing rules restrict unsolicited direct contact and require beneficiary permission or
another permitted basis for individual marketing contact.
15. Samuel, a licensed Medicare agent, is while comparing next-year coverage. The discussion turns to Call
recording. Which conduct is compliant?
A. Only complaints must be recorded
B. TPMOs operating on behalf of plans must record marketing, sales, and enrollment calls in their entirety,
including audio portions of web-based calls
C. Recording is prohibited
D. Only calls ending in enrollment are recorded
