2026 AHIP EXAM PREPARATION PACKAGE – 300 COMPLETE STUDY GUIDE WITH EXAM
QUESTIONS, COMPLIANCE SCENARIOS, AND VERIFIED SOLUTIONS FOR AHIP CERTIFICATION
| GRADED A+
Core Domains
Module 1: Medicare Basics (Parts A, B, C, D) – Exam Weight 20%
Module 2: Medicare Advantage Plans – Exam Weight 20%
Module 3: Part D Prescription Drug Coverage – Exam Weight 15%
Module 4: Marketing & Sales Compliance – Exam Weight 25%
Module 5: Fraud, Waste & Abuse and General Compliance – Exam Weight 20%
Introduction
This comprehensive 300-question AHIP certification preparation package assesses the knowledge
required of health insurance agents and brokers selling Medicare Advantage (MA) and Part D
prescription drug plans. It evaluates understanding of Medicare basics, plan types, enrollment
periods, Part D structure including the 2026 redesign, marketing and sales compliance rules, and
fraud, waste, and abuse (FWA) prevention. The questions combine foundational doctrine with
compliance scenarios emphasizing real-world application and critical decision-making. Candidates
must demonstrate the ability to apply CMS regulations to complex sales situations, protect
beneficiaries from misleading marketing practices, and maintain the integrity of federal healthcare
,programs. The AHIP certification exam consists of 50 questions, requires a 90% passing score
(45/50 correct), and allows a maximum of three attempts. A realistic 15-hour study budget
allocates roughly 3 hours each to Medicare Basics and Medicare Advantage, 2.5 to Part D, 4 to
Marketing & Sales Compliance, and 2 to FWA.
SECTION ONE: MEDICARE BASICS (PARTS A, B, C, D) – Q1–Q60
Question 1
Margaret, age 68, is admitted to the hospital for a hip replacement. She has Original Medicare
Part A and Part B. During her first hospital stay, she is inpatient for 5 days. How much will
Margaret pay out-of-pocket for her hospital stay under Part A?
A) Nothing; Part A covers all inpatient hospital costs after the deductible is met
B) The Part A deductible for the benefit period plus daily coinsurance for each day
C) Only the Part A deductible for the benefit period
D) 20% coinsurance of the total hospital bill
🟢 C) Only the Part A deductible for the benefit period
🔴 RATIONALE: For hospital inpatient stays, Medicare Part A covers days 1–60 after the
beneficiary pays the single deductible for the benefit period. Since Margaret stayed only 5 days,
she pays only the Part A deductible. Option A is incorrect because it omits the deductible. Option
B is incorrect because daily coinsurance does not apply until day 61. Option D is incorrect
because 20% coinsurance applies to Part B services, not Part A inpatient hospital stays.
,Question 2
Robert, age 72, has Original Medicare and is discharged from the hospital to a skilled nursing
facility (SNF) for rehabilitation after a stroke. He has already used 5 days of his SNF benefit
during a prior hospitalization this year. How many SNF days remain fully covered by Medicare
Part A before a daily copayment is required?
A) 15 days
B) 20 days
C) 25 days
D) 100 days
🟢 A) 15 days
🔴 RATIONALE: Medicare Part A covers up to 100 days in a SNF per benefit period, with days 1–
20 fully covered. Since Robert used 5 days previously, 15 fully covered days remain before the
daily copayment begins on day 21. Option B is incorrect because it ignores the 5 days already
used. Option C is incorrect because it miscalculates the remaining benefit. Option D is incorrect
because it represents the total benefit period rather than the remaining fully covered days.
Question 3
Helen, age 70, visits her primary care physician for an annual wellness visit and a flu shot. She
also receives a diagnostic colonoscopy where a polyp is removed. Which service is NOT covered
under Medicare Part B?
A) Annual wellness visit
B) Flu shot
, C) Diagnostic colonoscopy with polyp removal
D) Routine dental cleaning
🟢 D) Routine dental cleaning
🔴 RATIONALE: Original Medicare does not cover routine dental services, including cleanings,
fillings, or dentures. Option A is incorrect because annual wellness visits are covered under Part B
preventive services. Option B is incorrect because flu shots are covered under Part B preventive
services. Option C is incorrect because diagnostic colonoscopies with polyp removal are covered
under Part B.
Question 4
George, age 66, enrolls in Medicare Part B. His annual income is $120,000 (individual tax return).
Which statement about his Part B premium is accurate?
A) George will pay the standard Part B premium with no adjustments because he is newly
enrolled
B) George will pay an income-related monthly adjustment amount (IRMAA) in addition to the
standard premium
C) George is exempt from Part B premiums because he has 40 quarters of Medicare-covered
employment
D) George will pay only the Part B deductible and no premium
🟢 B) George will pay an income-related monthly adjustment amount (IRMAA) in addition to the
standard premium
QUESTIONS, COMPLIANCE SCENARIOS, AND VERIFIED SOLUTIONS FOR AHIP CERTIFICATION
| GRADED A+
Core Domains
Module 1: Medicare Basics (Parts A, B, C, D) – Exam Weight 20%
Module 2: Medicare Advantage Plans – Exam Weight 20%
Module 3: Part D Prescription Drug Coverage – Exam Weight 15%
Module 4: Marketing & Sales Compliance – Exam Weight 25%
Module 5: Fraud, Waste & Abuse and General Compliance – Exam Weight 20%
Introduction
This comprehensive 300-question AHIP certification preparation package assesses the knowledge
required of health insurance agents and brokers selling Medicare Advantage (MA) and Part D
prescription drug plans. It evaluates understanding of Medicare basics, plan types, enrollment
periods, Part D structure including the 2026 redesign, marketing and sales compliance rules, and
fraud, waste, and abuse (FWA) prevention. The questions combine foundational doctrine with
compliance scenarios emphasizing real-world application and critical decision-making. Candidates
must demonstrate the ability to apply CMS regulations to complex sales situations, protect
beneficiaries from misleading marketing practices, and maintain the integrity of federal healthcare
,programs. The AHIP certification exam consists of 50 questions, requires a 90% passing score
(45/50 correct), and allows a maximum of three attempts. A realistic 15-hour study budget
allocates roughly 3 hours each to Medicare Basics and Medicare Advantage, 2.5 to Part D, 4 to
Marketing & Sales Compliance, and 2 to FWA.
SECTION ONE: MEDICARE BASICS (PARTS A, B, C, D) – Q1–Q60
Question 1
Margaret, age 68, is admitted to the hospital for a hip replacement. She has Original Medicare
Part A and Part B. During her first hospital stay, she is inpatient for 5 days. How much will
Margaret pay out-of-pocket for her hospital stay under Part A?
A) Nothing; Part A covers all inpatient hospital costs after the deductible is met
B) The Part A deductible for the benefit period plus daily coinsurance for each day
C) Only the Part A deductible for the benefit period
D) 20% coinsurance of the total hospital bill
🟢 C) Only the Part A deductible for the benefit period
🔴 RATIONALE: For hospital inpatient stays, Medicare Part A covers days 1–60 after the
beneficiary pays the single deductible for the benefit period. Since Margaret stayed only 5 days,
she pays only the Part A deductible. Option A is incorrect because it omits the deductible. Option
B is incorrect because daily coinsurance does not apply until day 61. Option D is incorrect
because 20% coinsurance applies to Part B services, not Part A inpatient hospital stays.
,Question 2
Robert, age 72, has Original Medicare and is discharged from the hospital to a skilled nursing
facility (SNF) for rehabilitation after a stroke. He has already used 5 days of his SNF benefit
during a prior hospitalization this year. How many SNF days remain fully covered by Medicare
Part A before a daily copayment is required?
A) 15 days
B) 20 days
C) 25 days
D) 100 days
🟢 A) 15 days
🔴 RATIONALE: Medicare Part A covers up to 100 days in a SNF per benefit period, with days 1–
20 fully covered. Since Robert used 5 days previously, 15 fully covered days remain before the
daily copayment begins on day 21. Option B is incorrect because it ignores the 5 days already
used. Option C is incorrect because it miscalculates the remaining benefit. Option D is incorrect
because it represents the total benefit period rather than the remaining fully covered days.
Question 3
Helen, age 70, visits her primary care physician for an annual wellness visit and a flu shot. She
also receives a diagnostic colonoscopy where a polyp is removed. Which service is NOT covered
under Medicare Part B?
A) Annual wellness visit
B) Flu shot
, C) Diagnostic colonoscopy with polyp removal
D) Routine dental cleaning
🟢 D) Routine dental cleaning
🔴 RATIONALE: Original Medicare does not cover routine dental services, including cleanings,
fillings, or dentures. Option A is incorrect because annual wellness visits are covered under Part B
preventive services. Option B is incorrect because flu shots are covered under Part B preventive
services. Option C is incorrect because diagnostic colonoscopies with polyp removal are covered
under Part B.
Question 4
George, age 66, enrolls in Medicare Part B. His annual income is $120,000 (individual tax return).
Which statement about his Part B premium is accurate?
A) George will pay the standard Part B premium with no adjustments because he is newly
enrolled
B) George will pay an income-related monthly adjustment amount (IRMAA) in addition to the
standard premium
C) George is exempt from Part B premiums because he has 40 quarters of Medicare-covered
employment
D) George will pay only the Part B deductible and no premium
🟢 B) George will pay an income-related monthly adjustment amount (IRMAA) in addition to the
standard premium
