AHIP Certification Exam 2024/2025 – Updated Scenarios with 100% Correct and Verified Answers

AHIP Certification Exam 2024/2025 – Updated Scenarios
with 100% Correct and Verified Answers

AHIP 2024/2025 Practice Scenarios
Question 1
Mrs. Thompson, a 66-year-old Medicare beneficiary, asks if she can enroll in a Medicare Ad-
vantage (MA) plan during the Annual Enrollment Period (AEP). She is currently enrolled in
Original Medicare. What should you tell her?
a. She can only enroll in a Medigap plan during AEP.
b. She can enroll in an MA plan from October 15 to December 7.
c. She must wait until the General Enrollment Period.
d. She is ineligible for MA plans due to her age.
Answer: b. She can enroll in an MA plan from October 15 to December 7.
Explanation: The AEP (October 15–December 7) allows Medicare beneficiaries to enroll in
or switch MA plans, effective January 1, per CMS guidelines.

Question 2
Mr. Rivera, a 62-year-old with end-stage renal disease (ESRD), asks if he qualifies for Medicare
coverage. What should you advise?
a. He must wait until age 65 to enroll.
b. He qualifies, with coverage starting the fourth month after dialysis begins.
c. He is ineligible due to his ESRD diagnosis.
d. He must enroll in a Medicare Advantage plan first.
Answer: b. He qualifies, with coverage starting the fourth month after dialysis begins.
Explanation: CMS allows individuals with ESRD to enroll in Medicare regardless of age, with
coverage typically starting the fourth month after dialysis initiation.

Question 3
During a sales seminar, an attendee asks if Medicare covers routine dental cleanings. What is
the correct response?
a. Original Medicare covers routine dental cleanings.
b. Some Medicare Advantage plans may cover dental services.
c. All Part D plans include dental coverage.
d. Medicare excludes all dental services.




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,Answer: b. Some Medicare Advantage plans may cover dental services.
Explanation: Original Medicare does not cover routine dental care, but some MA plans offer
supplemental dental benefits, per CMS.

Question 4
Mrs. Carter, a low-income beneficiary, asks about help with her Medicare Part B premiums.
What should you tell her?
a. She should contact her state Medicaid agency for Medicare Savings Programs.
b. She must purchase a Medigap plan for assistance.
c. No programs exist to help with Part B premiums.
d. She automatically qualifies for a premium waiver.
Answer: a. She should contact her state Medicaid agency for Medicare Savings Programs.
Explanation: Medicare Savings Programs, administered through state Medicaid agencies, can
help low-income beneficiaries cover Part B premiums, per CMS.

Question 5
Mr. Lee attends a marketing event and receives a $20 gift card for attending. Is this permissible
under CMS rules?
a. Yes, gifts up to $25 are allowed.
b. No, gifts must be valued under $15.
c. Yes, there are no limits on gift values.
d. No, gifts are prohibited at marketing events.
Answer: b. No, gifts must be valued under $15.
Explanation: CMS limits promotional gifts at marketing events to a nominal value of $15 or
less to prevent undue influence.

Question 6
A pharmacy technician notices a discrepancy in prescription drug records. What should they
do?
a. Ignore it, as it’s a minor issue.
b. Follow the pharmacy’s compliance procedures.
c. Adjust the records without reporting.
d. Contact CMS directly.
Answer: b. Follow the pharmacy’s compliance procedures.
Explanation: Discrepancies must be addressed per the pharmacy’s compliance protocols to
ensure adherence to CMS regulations and prevent FWA.


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, Question 7
Mrs. Patel, enrolled in an MA plan, wants to switch to Original Medicare during January 2025.
What should you tell her?
a. She can switch during the Medicare Advantage Open Enrollment Period.
b. She must wait until the Annual Enrollment Period.
c. She cannot switch back to Original Medicare.
d. She needs a Medigap plan to switch.
Answer: a. She can switch during the Medicare Advantage Open Enrollment Period.
Explanation: The MA Open Enrollment Period (January 1–March 31) allows beneficiaries to
switch from an MA plan to Original Medicare, per CMS.

Question 8
Mr. Nguyen, a dual-eligible beneficiary, asks if his Medicaid benefits will coordinate with his
MA plan. What should you say?
a. Medicaid benefits coordinate only with in-network providers.
b. Medicaid replaces all MA plan benefits.
c. Medicaid has no coordination with MA plans.
d. He must disenroll from Medicaid to join an MA plan.
Answer: a. Medicaid benefits coordinate only with in-network providers.
Explanation: For dual-eligible beneficiaries, Medicaid coordinates benefits with MA plans
when providers accept Medicaid, per CMS.

Question 9
You suspect a colleague is submitting false claims for MA plan enrollments. What is your next
step?
a. Discuss it with the colleague directly.
b. Report it anonymously to the compliance department.
c. Ignore it, as it’s not your responsibility.
d. Report it to the local police.
Answer: b. Report it anonymously to the compliance department.
Explanation: Suspected FWA, like false claims, should be reported anonymously to the com-
pliance department to ensure CMS compliance and avoid retaliation.

Question 10
Mrs. Gomez, age 70, missed her Part B Initial Enrollment Period and wants to enroll now.
When can she enroll, and what penalty might apply?


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