AHIP Certification Exam 2025 | 100
Questions and Explained Answers
Melissa Meadows is a marketing representative for Best Care which has recently introduced a
Medicare Advantage plan offering comprehensive dental benefits for $15 per month. Best Care
has not submitted any potential posts to CMS for approval. Melissa would like to use the power
of social media to reach potential prospects. What advice would you give her? -ANSWER:
As soon as CMS approves Best Care's social media posts, Agent Meadows could post a tweet
stating that "Best Care offers an array of Medicare Advantage benefit packages. One might be
right for you. Call me to find out more!"
Correct: Best Care must submit marketing materials, including social media posts to CMS for
approval before the plan or its agents may begin posting such marketing content.
You will be holding a sales event soon, at which you would like to offer door prizes to attendees.
Under guidelines from the Medicare agency, what types of gifts or prizes would not be allowed
in this situation? -ANSWER: Gifts of nominal retail value ($15 or less)
Incorrect: This statement is incorrect because marketing representatives may offer gifts to sales
event attendees provided they are of nominal value and are worth $15 or less.
You have approached a hospital administrator about marketing in her facility. The administrator
is uncomfortable with the suggestion. How could you address her concerns? -ANSWER: Tell her
that Medicare guidelines allow you to conduct marketing activities in common areas of a
provider's facility.
Correct: Marketing representatives may engage in marketing activities in common areas of
health care settings. This includes a cafeteria, community or recreational room as well as a
conference room.
Agent Martinez wishes to solicit Medicare Advantage prospects through e-mail and asks you for
advice as to whether this is possible. What should you tell her? -ANSWER: Marketing
representatives may initiate electronic contact through e-mail but an opt-out process must be
provided.
Correct: A marketing representative may initiate electronic contact through e-mail since that is
now considered general audience marketing similar to print media. Rules regarding unsolicited
contact do not apply to marketing through these materials. However, use of electronic media
must provide an opt-out process.
Your friend's mother just moved to an assisted living facility and he asked if you could present a
program for the residents about the MA-PD plans you market. What could you tell him? -
ANSWER: You appreciate the opportunity and would be happy to schedule an appointment with
anyone at their request.
Correct: Marketing representatives may schedule an appointment with a beneficiary in a long-
term care facility only upon their request.
,You are working several plans and community organizations to sponsor an educational event.
When putting together advertisements for this event, what should you do? -ANSWER: You must
ensure that the advertisements indicate it is an educational event, otherwise it will be considered
a marketing event.
Correct. Educational events must be explicitly advertised as educational
ABC is a Medicare Advantage (MA) plan sponsor. It would like to use its enrollees' information
to market non-health related products such as life insurance and annuities. Which statement best
describes ABC's obligation to its enrollees regarding marketing such products? -ANSWER: It
must obtain a HIPAA compliant authorization from an enrollee that indicates the plan or plan
sponsor may use their information for marketing purposes.
Correct: A plan sponsor must obtain HIPAA authorization from an enrollee before using or
disclosing the enrollee's information to market non-health related items such as life insurance.
Therefore, this answer is the best description of ABC's obligation to its enrollees in these
circumstances.
Another agent you know has engaged in misconduct that has been verified by the plan she
represented. What sort of penalty might the plan impose on this individual? -ANSWER: The
plan may withhold commission, require retraining, report the misconduct to a state department of
insurance or terminate the contract.
Correct: Plans must take corrective action in the event of verified misconduct by a marketing
representative. Such disciplinary action might include withholding or withdrawing commissions,
retraining, termination, and reporting agent termination to a state department of insurance.
You are seeking to represent an individual Medicare Advantage plan and an individual Part D
plan in your state. You have completed the required training for each plan, but you did not
achieve a passing score on the tests that came after the training. What can you do in this
situation? -ANSWER: You will not be able to represent any Medicare Advantage or Part D plan
until you complete the training and achieve an adequate score. However, you will not have to
take a test if you exclusively market employer/union group plans and the companies do not
require testing.
Correct: You are required to pass the test in order to represent any Medicare Advantage or Part D
plans. There is no testing requirement for agents/brokers that only market employer/union group
plans.
Incorrect: You are required to pass the test in order to represent any Medicare Advantage or Part
D plans. However, your name will not be registered with CMS due to your failing score.
Miguel Sanchez is a relatively new agent who has come to you for advice as to what he can do
during the Medicare Advantage Open Enrollment Period (MA-OEP). What advice should you
give Miguel? -ANSWER: During the MA-OEP, Miguel can have one-on-one meetings with
beneficiaries who have requested such meetings.
, Correct: During the MA-OEP, those enrolled in a Medicare Advantage plan have the opportunity
to change plans or enroll in Original Medicare. Marketing representatives may respond to
beneficiary requests for one-on-one meetings.
Agent Jennings makes a presentation on Medicare advertised as an educational event. Agent
Jennings distributes materials that are solely educational. However, she gives a brief presentation
that mentions plan-specific premiums. Is this a prohibited activity at an event that has been
advertised as educational? -ANSWER: Yes. When an event has been advertised as "educational,"
discussing plan-specific premiums is impermissible.
Correct: Discussion or distribution of plan-specific information is prohibited at any educational
event.
Next week you will be participating in your first "educational event" for prospective enrollees.
To be sure that you do not violate any of the applicable guidelines, in what activities should you
plan to engage? -ANSWER: You should plan to ensure that the educational event is an
informative event and must not conduct a sales presentation or distribute or accept enrollment
forms at the event.
Correct: Sales presentations and distribution or acceptance of enrollment forms are prohibited
when an event is advertised as educational.
During a sales presentation, your client asks you whether the Medicare agency recommends that
she sign up for your plan or stay in Original Medicare. What should you tell her? -ANSWER:
Tell her that the Medicare agency does not endorse or recommend any plan.
Correct: Centers for Medicare and Medicaid Services (CMS), the government agency
responsible for Medicare, does not endorse or recommend any of the Medicare Advantage (MA)
plans it approves. Medicare beneficiaries should choose either Original Medicare or a MA plan
based on their particular needs and circumstances.
Plan sponsors may undertake the following marketing activities with current Medicare
Advantage plan members? -ANSWER: Market non-health related items or services such as life
insurance or annuities policies to current members as permitted following HIPAA Privacy Rules.
Correct: Plan sponsors must obtain HIPAA compliant authorization forms from enrollees before
the Plan sponsor may use (or may request a marketing representative to use on their behalf)
information about the enrollee to market non-health related items or services such as life
insurance or annuity policies.
Mrs. Lu is turning 65 in November and called to ask for your help deciding on a Medicare
Advantage plan. She agreed to sign a scope of appointment form and meet with you on October
15. During the appointment, what are you permitted to do? -ANSWER: You may provide her
with the required enrollment materials and take her completed enrollment application.
Correct: Because you are meeting for an individual marketing appointment, you are permitted to
distribute plan materials and accept enrollment forms.
Mrs. Kumar would like her daughter, who lives in another state, to meet with you during the
Annual Election Period to help her complete her enrollment in a Part D plan. She asked you
Questions and Explained Answers
Melissa Meadows is a marketing representative for Best Care which has recently introduced a
Medicare Advantage plan offering comprehensive dental benefits for $15 per month. Best Care
has not submitted any potential posts to CMS for approval. Melissa would like to use the power
of social media to reach potential prospects. What advice would you give her? -ANSWER:
As soon as CMS approves Best Care's social media posts, Agent Meadows could post a tweet
stating that "Best Care offers an array of Medicare Advantage benefit packages. One might be
right for you. Call me to find out more!"
Correct: Best Care must submit marketing materials, including social media posts to CMS for
approval before the plan or its agents may begin posting such marketing content.
You will be holding a sales event soon, at which you would like to offer door prizes to attendees.
Under guidelines from the Medicare agency, what types of gifts or prizes would not be allowed
in this situation? -ANSWER: Gifts of nominal retail value ($15 or less)
Incorrect: This statement is incorrect because marketing representatives may offer gifts to sales
event attendees provided they are of nominal value and are worth $15 or less.
You have approached a hospital administrator about marketing in her facility. The administrator
is uncomfortable with the suggestion. How could you address her concerns? -ANSWER: Tell her
that Medicare guidelines allow you to conduct marketing activities in common areas of a
provider's facility.
Correct: Marketing representatives may engage in marketing activities in common areas of
health care settings. This includes a cafeteria, community or recreational room as well as a
conference room.
Agent Martinez wishes to solicit Medicare Advantage prospects through e-mail and asks you for
advice as to whether this is possible. What should you tell her? -ANSWER: Marketing
representatives may initiate electronic contact through e-mail but an opt-out process must be
provided.
Correct: A marketing representative may initiate electronic contact through e-mail since that is
now considered general audience marketing similar to print media. Rules regarding unsolicited
contact do not apply to marketing through these materials. However, use of electronic media
must provide an opt-out process.
Your friend's mother just moved to an assisted living facility and he asked if you could present a
program for the residents about the MA-PD plans you market. What could you tell him? -
ANSWER: You appreciate the opportunity and would be happy to schedule an appointment with
anyone at their request.
Correct: Marketing representatives may schedule an appointment with a beneficiary in a long-
term care facility only upon their request.
,You are working several plans and community organizations to sponsor an educational event.
When putting together advertisements for this event, what should you do? -ANSWER: You must
ensure that the advertisements indicate it is an educational event, otherwise it will be considered
a marketing event.
Correct. Educational events must be explicitly advertised as educational
ABC is a Medicare Advantage (MA) plan sponsor. It would like to use its enrollees' information
to market non-health related products such as life insurance and annuities. Which statement best
describes ABC's obligation to its enrollees regarding marketing such products? -ANSWER: It
must obtain a HIPAA compliant authorization from an enrollee that indicates the plan or plan
sponsor may use their information for marketing purposes.
Correct: A plan sponsor must obtain HIPAA authorization from an enrollee before using or
disclosing the enrollee's information to market non-health related items such as life insurance.
Therefore, this answer is the best description of ABC's obligation to its enrollees in these
circumstances.
Another agent you know has engaged in misconduct that has been verified by the plan she
represented. What sort of penalty might the plan impose on this individual? -ANSWER: The
plan may withhold commission, require retraining, report the misconduct to a state department of
insurance or terminate the contract.
Correct: Plans must take corrective action in the event of verified misconduct by a marketing
representative. Such disciplinary action might include withholding or withdrawing commissions,
retraining, termination, and reporting agent termination to a state department of insurance.
You are seeking to represent an individual Medicare Advantage plan and an individual Part D
plan in your state. You have completed the required training for each plan, but you did not
achieve a passing score on the tests that came after the training. What can you do in this
situation? -ANSWER: You will not be able to represent any Medicare Advantage or Part D plan
until you complete the training and achieve an adequate score. However, you will not have to
take a test if you exclusively market employer/union group plans and the companies do not
require testing.
Correct: You are required to pass the test in order to represent any Medicare Advantage or Part D
plans. There is no testing requirement for agents/brokers that only market employer/union group
plans.
Incorrect: You are required to pass the test in order to represent any Medicare Advantage or Part
D plans. However, your name will not be registered with CMS due to your failing score.
Miguel Sanchez is a relatively new agent who has come to you for advice as to what he can do
during the Medicare Advantage Open Enrollment Period (MA-OEP). What advice should you
give Miguel? -ANSWER: During the MA-OEP, Miguel can have one-on-one meetings with
beneficiaries who have requested such meetings.
, Correct: During the MA-OEP, those enrolled in a Medicare Advantage plan have the opportunity
to change plans or enroll in Original Medicare. Marketing representatives may respond to
beneficiary requests for one-on-one meetings.
Agent Jennings makes a presentation on Medicare advertised as an educational event. Agent
Jennings distributes materials that are solely educational. However, she gives a brief presentation
that mentions plan-specific premiums. Is this a prohibited activity at an event that has been
advertised as educational? -ANSWER: Yes. When an event has been advertised as "educational,"
discussing plan-specific premiums is impermissible.
Correct: Discussion or distribution of plan-specific information is prohibited at any educational
event.
Next week you will be participating in your first "educational event" for prospective enrollees.
To be sure that you do not violate any of the applicable guidelines, in what activities should you
plan to engage? -ANSWER: You should plan to ensure that the educational event is an
informative event and must not conduct a sales presentation or distribute or accept enrollment
forms at the event.
Correct: Sales presentations and distribution or acceptance of enrollment forms are prohibited
when an event is advertised as educational.
During a sales presentation, your client asks you whether the Medicare agency recommends that
she sign up for your plan or stay in Original Medicare. What should you tell her? -ANSWER:
Tell her that the Medicare agency does not endorse or recommend any plan.
Correct: Centers for Medicare and Medicaid Services (CMS), the government agency
responsible for Medicare, does not endorse or recommend any of the Medicare Advantage (MA)
plans it approves. Medicare beneficiaries should choose either Original Medicare or a MA plan
based on their particular needs and circumstances.
Plan sponsors may undertake the following marketing activities with current Medicare
Advantage plan members? -ANSWER: Market non-health related items or services such as life
insurance or annuities policies to current members as permitted following HIPAA Privacy Rules.
Correct: Plan sponsors must obtain HIPAA compliant authorization forms from enrollees before
the Plan sponsor may use (or may request a marketing representative to use on their behalf)
information about the enrollee to market non-health related items or services such as life
insurance or annuity policies.
Mrs. Lu is turning 65 in November and called to ask for your help deciding on a Medicare
Advantage plan. She agreed to sign a scope of appointment form and meet with you on October
15. During the appointment, what are you permitted to do? -ANSWER: You may provide her
with the required enrollment materials and take her completed enrollment application.
Correct: Because you are meeting for an individual marketing appointment, you are permitted to
distribute plan materials and accept enrollment forms.
Mrs. Kumar would like her daughter, who lives in another state, to meet with you during the
Annual Election Period to help her complete her enrollment in a Part D plan. She asked you
