[STUDY GUIDE] • HIGH-YIELD PRACTICE & REVIEW EDITION
AHIP Final Exam 2026/2027 Updated
Solved Exam Questions with Verified
Solutions and Complete Answers
Comprehensive Examination Question Bank • Concept Mapping
TOTAL QUESTIONS EXAM TOPICS ANSWERS
169 Questions 12 Modules 100% Verified
DOCUMENT OVERVIEW
This document contains 169 verified questions with correct answers related to Medicare Advantage and
related topics. Each item provides a comprehensive overview of the principles and regulations governing
Medicare, ensuring it is suitable for exam preparation, review, and certification for professionals in the
healthcare insurance field.
EXAM BLUEPRINT & TOPIC DISTRIBUTION
Systematic breakdown of subject domains and exam coverage.
Topic Module Scope & Core Focus Questions Share (%)
This topic covers the basics of Medicare Advantage, its
Medicare Advantage Plans benefits, and eligibility requirements. 15 Qs 8.9%
Concepts related to various enrollment periods including
Enrollment Periods Initial, Annual, and Special Election Periods. 14 Qs 8.3%
Questions regarding Part D coverage, low-income subsidies,
Prescription Drug Coverage and prescription drug plans. 14 Qs 8.3%
Understanding the different components of Medicare and their
Medicare Parts A, B, C, and D functionalities. 14 Qs 8.3%
Exploring compliance with Medicare marketing and fraud,
Compliance and Regulations waste, and abuse regulations. 14 Qs 8.3%
Guidelines and best practices for marketing Medicare plans
Marketing Practices and services. 14 Qs 8.3%
Confidential • Student Study Edition • Practice & Review Guide Page 1 of 46
,STUDENT STUDY & MASTERY EDITION PRACTICE & REVIEW GUIDE
Dual Eligibility and Special Focus on beneficiaries who are dually eligible for Medicare
Cases and Medicaid and their specific needs. 14 Qs 8.3%
Duties and responsibilities of agents in the Medicare and
Agent Responsibilities insurance space. 14 Qs 8.3%
Programs to assist low-income beneficiaries with Medicare
Financial Assistance Programs costs and related subsidies. 14 Qs 8.3%
Service Quality and Grievance Understanding the processes for addressing service quality
Procedures and filing grievances. 14 Qs 8.3%
Exploration of coverage provided under various Medicare
Healthcare Services Coverage plans, including hospice and specialty services. 14 Qs 8.3%
Examination of ethical considerations and standards in
Ethics in Medicare Practices Medicare sales and marketing. 14 Qs 8.3%
Total Exam Coverage 12 Integrated Topic Modules 169 Qs 100.0%
TOPIC 1: MEDICARE ADVANTAGE PLANS
15 Questions • 8.9% of Exam • This topic covers the basics of Medicare Advantage, its benefits, and eligibility requirements.
QUESTION 1
Mr. Sinclair has diabetes and heart trouble and is generally satisfied with the care he
has received under Original Medicare, but he would like to know more about Medicare
Advantage Special Needs Plans (SNPs). What could you tell him?
Answer: SNPs have special programs for enrollees with chronic conditions, like Mr. Sinclair, and they
provide prescription drug coverage that could be very helpful as well.
QUESTION 2
Mrs. Burton is a retiree with substantial income. She is enrolled in an MA-PD plan and
was disappointed with the service she received from her primary care physician
because she was told she would have to wait five weeks to get an appointment when
she was feeling ill. She called you to ask what she could do so she would not have to
put up with such poor access to care. What could you tell her?
Answer: She could file a grievance with her plan to complain about the lack of timeliness in getting an
appointment.
Confidential • Student Study Edition • Practice & Review Guide Page 2 of 46
,STUDENT STUDY & MASTERY EDITION PRACTICE & REVIEW GUIDE
QUESTION 3
Mr. Wells is trying to understand the difference between Original Medicare and
Medicare Advantage. What would be the correct description?
Answer: Medicare Advantage is a way of covering all the Original Medicare benefits through private health
insurance companies.
QUESTION 4
Ms. Gates has recently become dually eligible for Medicare and Medicaid. She is very
concerned about how this will affect her prescription drug coverage. What should you
tell her?
Answer: As a dual eligible beneficiary, her Part D drugs will be covered by Medicare once she is enrolled in a
Part D plan. If she doesn't select a plan, Medicare will select a plan for her.
QUESTION 5
Mr. Moy's wife has a Medicare Advantage plan, but he wants to understand what
coverage Medicare Supplemental Insurance provides since his health care needs are
different from his wife's needs. What could you tell Mr. Moy?
Answer: Medicare Supplemental Insurance would help cover his Part A and Part B deductibles or
coinsurance in Original Fee-forService (FFS) Medicare as well as possibly some services that Medicare does
not cover.
QUESTION 6
Mr. Polanski likes the cost of an HMO plan available in his area but would like to be able
to visit one or two doctors who aren't participating providers. He wants to know if the
Point of Service (POS) option available with some HMOs will be of any help in this
situation. What should you tell him?
Answer: The POS option might be a good solution for him as it will allow him to visit out-of-network
providers, generally without prior approval. However, he should be aware that it is likely he will have to pay
higher cost-sharing for services from out-ofnetwork providers.
Confidential • Student Study Edition • Practice & Review Guide Page 3 of 46
, STUDENT STUDY & MASTERY EDITION PRACTICE & REVIEW GUIDE
QUESTION 7
What is the policy of non-retaliation?
Answer: Protects employees, who in good faith report suspected non-compliance.
QUESTION 8
Under Section 1557, the 2020 Final Rule issued during the Trump Administration sex
was initially defined____________
Answer: As biologic sex only, meaning whether a person was determined to be male or female at birth.
QUESTION 9
Mrs. Ramos is considering a Medicare Advantage PPO and has questions about which
providers she can go to for her health care.
What should you tell her?
Answer: Mrs. Ramos can obtain care from any provider who participates in Original Medicare, but generally
will have a higher costsharing amount if she sees a provider who/that is not a part of the PPO network.
QUESTION 10
Sal D'Angelo is new to the Medicare marketplace having previously been focused on
life insurance and disability income protection products. He intends to conduct an
educational seminar during the AEP at a local hotel and then invite those who attend to
a subsequent marketing meeting to discuss the benefits of next year's plans. How
would you advise Sal?
Answer: Sal should conduct the education seminar as an early morning meeting and the marketing meeting
on the following day in the late afternoon so that there are at least 12 hours between the two meetings.
QUESTION 11
Mr. Kumar is considering a Medicare Advantage HMO and has questions about his
ability to access providers. What should you tell him?
Answer: In most Medicare Advantage HMOs, Mr. Kumar must generally obtain his services only from
providers within the plan's network (except in an emergency or where care is unavailable within the network).
Confidential • Student Study Edition • Practice & Review Guide Page 4 of 46
AHIP Final Exam 2026/2027 Updated
Solved Exam Questions with Verified
Solutions and Complete Answers
Comprehensive Examination Question Bank • Concept Mapping
TOTAL QUESTIONS EXAM TOPICS ANSWERS
169 Questions 12 Modules 100% Verified
DOCUMENT OVERVIEW
This document contains 169 verified questions with correct answers related to Medicare Advantage and
related topics. Each item provides a comprehensive overview of the principles and regulations governing
Medicare, ensuring it is suitable for exam preparation, review, and certification for professionals in the
healthcare insurance field.
EXAM BLUEPRINT & TOPIC DISTRIBUTION
Systematic breakdown of subject domains and exam coverage.
Topic Module Scope & Core Focus Questions Share (%)
This topic covers the basics of Medicare Advantage, its
Medicare Advantage Plans benefits, and eligibility requirements. 15 Qs 8.9%
Concepts related to various enrollment periods including
Enrollment Periods Initial, Annual, and Special Election Periods. 14 Qs 8.3%
Questions regarding Part D coverage, low-income subsidies,
Prescription Drug Coverage and prescription drug plans. 14 Qs 8.3%
Understanding the different components of Medicare and their
Medicare Parts A, B, C, and D functionalities. 14 Qs 8.3%
Exploring compliance with Medicare marketing and fraud,
Compliance and Regulations waste, and abuse regulations. 14 Qs 8.3%
Guidelines and best practices for marketing Medicare plans
Marketing Practices and services. 14 Qs 8.3%
Confidential • Student Study Edition • Practice & Review Guide Page 1 of 46
,STUDENT STUDY & MASTERY EDITION PRACTICE & REVIEW GUIDE
Dual Eligibility and Special Focus on beneficiaries who are dually eligible for Medicare
Cases and Medicaid and their specific needs. 14 Qs 8.3%
Duties and responsibilities of agents in the Medicare and
Agent Responsibilities insurance space. 14 Qs 8.3%
Programs to assist low-income beneficiaries with Medicare
Financial Assistance Programs costs and related subsidies. 14 Qs 8.3%
Service Quality and Grievance Understanding the processes for addressing service quality
Procedures and filing grievances. 14 Qs 8.3%
Exploration of coverage provided under various Medicare
Healthcare Services Coverage plans, including hospice and specialty services. 14 Qs 8.3%
Examination of ethical considerations and standards in
Ethics in Medicare Practices Medicare sales and marketing. 14 Qs 8.3%
Total Exam Coverage 12 Integrated Topic Modules 169 Qs 100.0%
TOPIC 1: MEDICARE ADVANTAGE PLANS
15 Questions • 8.9% of Exam • This topic covers the basics of Medicare Advantage, its benefits, and eligibility requirements.
QUESTION 1
Mr. Sinclair has diabetes and heart trouble and is generally satisfied with the care he
has received under Original Medicare, but he would like to know more about Medicare
Advantage Special Needs Plans (SNPs). What could you tell him?
Answer: SNPs have special programs for enrollees with chronic conditions, like Mr. Sinclair, and they
provide prescription drug coverage that could be very helpful as well.
QUESTION 2
Mrs. Burton is a retiree with substantial income. She is enrolled in an MA-PD plan and
was disappointed with the service she received from her primary care physician
because she was told she would have to wait five weeks to get an appointment when
she was feeling ill. She called you to ask what she could do so she would not have to
put up with such poor access to care. What could you tell her?
Answer: She could file a grievance with her plan to complain about the lack of timeliness in getting an
appointment.
Confidential • Student Study Edition • Practice & Review Guide Page 2 of 46
,STUDENT STUDY & MASTERY EDITION PRACTICE & REVIEW GUIDE
QUESTION 3
Mr. Wells is trying to understand the difference between Original Medicare and
Medicare Advantage. What would be the correct description?
Answer: Medicare Advantage is a way of covering all the Original Medicare benefits through private health
insurance companies.
QUESTION 4
Ms. Gates has recently become dually eligible for Medicare and Medicaid. She is very
concerned about how this will affect her prescription drug coverage. What should you
tell her?
Answer: As a dual eligible beneficiary, her Part D drugs will be covered by Medicare once she is enrolled in a
Part D plan. If she doesn't select a plan, Medicare will select a plan for her.
QUESTION 5
Mr. Moy's wife has a Medicare Advantage plan, but he wants to understand what
coverage Medicare Supplemental Insurance provides since his health care needs are
different from his wife's needs. What could you tell Mr. Moy?
Answer: Medicare Supplemental Insurance would help cover his Part A and Part B deductibles or
coinsurance in Original Fee-forService (FFS) Medicare as well as possibly some services that Medicare does
not cover.
QUESTION 6
Mr. Polanski likes the cost of an HMO plan available in his area but would like to be able
to visit one or two doctors who aren't participating providers. He wants to know if the
Point of Service (POS) option available with some HMOs will be of any help in this
situation. What should you tell him?
Answer: The POS option might be a good solution for him as it will allow him to visit out-of-network
providers, generally without prior approval. However, he should be aware that it is likely he will have to pay
higher cost-sharing for services from out-ofnetwork providers.
Confidential • Student Study Edition • Practice & Review Guide Page 3 of 46
, STUDENT STUDY & MASTERY EDITION PRACTICE & REVIEW GUIDE
QUESTION 7
What is the policy of non-retaliation?
Answer: Protects employees, who in good faith report suspected non-compliance.
QUESTION 8
Under Section 1557, the 2020 Final Rule issued during the Trump Administration sex
was initially defined____________
Answer: As biologic sex only, meaning whether a person was determined to be male or female at birth.
QUESTION 9
Mrs. Ramos is considering a Medicare Advantage PPO and has questions about which
providers she can go to for her health care.
What should you tell her?
Answer: Mrs. Ramos can obtain care from any provider who participates in Original Medicare, but generally
will have a higher costsharing amount if she sees a provider who/that is not a part of the PPO network.
QUESTION 10
Sal D'Angelo is new to the Medicare marketplace having previously been focused on
life insurance and disability income protection products. He intends to conduct an
educational seminar during the AEP at a local hotel and then invite those who attend to
a subsequent marketing meeting to discuss the benefits of next year's plans. How
would you advise Sal?
Answer: Sal should conduct the education seminar as an early morning meeting and the marketing meeting
on the following day in the late afternoon so that there are at least 12 hours between the two meetings.
QUESTION 11
Mr. Kumar is considering a Medicare Advantage HMO and has questions about his
ability to access providers. What should you tell him?
Answer: In most Medicare Advantage HMOs, Mr. Kumar must generally obtain his services only from
providers within the plan's network (except in an emergency or where care is unavailable within the network).
Confidential • Student Study Edition • Practice & Review Guide Page 4 of 46
