AHIP 2025/2026 Final Exam Updated Questions and
Verified Answers, 100% Guarantee Pass Practice Test for
Medicare Advantage and Fraud, Waste, and Abuse Certification
Instructions
This practice test contains 80 original multiple-choice questions tailored for the
AHIP Final Exam for 2025/2026, aligning with the latest Centers for Medicare
Medicaid Services (CMS) regulations and AHIP training modules. Each ques-
tion includes four answer options, one verified correct answer, and an expert-
level rationale covering Medicare Advantage (MA), Medicare Part D, compliance,
ethics, and Fraud, Waste, and Abuse (FWA). Select the best answer for each ques-
tion. This open-book exam tests application of knowledge and adherence to CMS
marketing and compliance standards.
Questions
1. Which Medicare Advantage plan type requires beneficiaries to use network
providers for most services?
a) Private Fee-for-Service (PFFS)
b) Preferred Provider Organization (PPO)
c) Health Maintenance Organization (HMO)
d) Medical Savings Account (MSA)
Correct Answer: c)
Rationale: HMO plans require beneficiaries to use in-network providers for
non-emergency services, except in urgent cases, to control costs and ensure
coordinated care. PPO plans offer out-of-network flexibility, PFFS allows any
willing provider, and MSA plans have high-deductible structures.
2. During the Annual Election Period (AEP), what can a beneficiary do?
a) Enroll in a new MA plan effective the following January 1
b) Disenroll from an MA plan effective immediately
c) Change Medigap plans without underwriting
d) Enroll in Part A for the first time
Correct Answer: a)
Rationale: The AEP (October 15–December 7) allows beneficiaries to enroll
in or switch MA or Part D plans, with changes effective January 1. Immediate
disenrollment is not permitted, Medigap changes may require underwriting,
and Part A enrollment occurs separately.
3. What is the purpose of the Scope of Appointment (SOA) form?
a) To enroll a beneficiary in a plan
b) To document beneficiary consent for plan discussions
c) To report Fraud, Waste, and Abuse
d) To verify agent certification
Correct Answer: b)
1
, Rationale: The SOA, required by CMS, documents a beneficiary’s consent to
discuss specific MA or Part D plans, ensuring compliance with marketing rules
and protecting against unsolicited contact.
4. What is an example of Fraud, Waste, and Abuse (FWA) in Medicare?
a) A provider prescribing generic drugs
b) Billing for unperformed medical tests
c) Offering free health education seminars
d) Coordinating care with a plan
Correct Answer: b)
Rationale: Billing for services not rendered is fraud, a type of FWA that mis-
uses Medicare funds. Prescribing generics, offering seminars, and coordinat-
ing care are legitimate practices.
5. What must an agent do if a beneficiary refuses to sign an SOA?
a) Proceed with the plan discussion
b) End the appointment and reschedule
c) Enroll the beneficiary without consent
d) Report the refusal to CMS
Correct Answer: b)
Rationale: Without an SOA, agents cannot discuss plan-specific details. The
appointment must end, and a new meeting scheduled after obtaining consent,
per CMS regulations.
6. What is the maximum out-of-pocket (MOOP) limit for in-network services in
MA plans for 2025?
a) $5,000
b) $8,850
c) $10,000
d) No limit
Correct Answer: b)
Rationale: CMS sets the 2025 MOOP limit for in-network services in MA plans
at $8,850, protecting beneficiaries from excessive costs. Out-of-network limits
may be higher.
7. When can a beneficiary enroll in a Medicare Advantage Special Needs Plan
(SNP)?
a) Only during the General Enrollment Period
b) Anytime they meet eligibility criteria
c) Only after losing employer coverage
d) During the Part D Open Enrollment Period
Correct Answer: b)
Rationale: SNPs allow enrollment anytime a beneficiary meets specific eli-
gibility (e.g., chronic conditions, dual eligibility, or institutional status), pro-
vided they have Parts A and B.
8. What is a permissible nominal gift at a Medicare sales event?
a) A $20 gift card
b) A $10 tote bag
2
Verified Answers, 100% Guarantee Pass Practice Test for
Medicare Advantage and Fraud, Waste, and Abuse Certification
Instructions
This practice test contains 80 original multiple-choice questions tailored for the
AHIP Final Exam for 2025/2026, aligning with the latest Centers for Medicare
Medicaid Services (CMS) regulations and AHIP training modules. Each ques-
tion includes four answer options, one verified correct answer, and an expert-
level rationale covering Medicare Advantage (MA), Medicare Part D, compliance,
ethics, and Fraud, Waste, and Abuse (FWA). Select the best answer for each ques-
tion. This open-book exam tests application of knowledge and adherence to CMS
marketing and compliance standards.
Questions
1. Which Medicare Advantage plan type requires beneficiaries to use network
providers for most services?
a) Private Fee-for-Service (PFFS)
b) Preferred Provider Organization (PPO)
c) Health Maintenance Organization (HMO)
d) Medical Savings Account (MSA)
Correct Answer: c)
Rationale: HMO plans require beneficiaries to use in-network providers for
non-emergency services, except in urgent cases, to control costs and ensure
coordinated care. PPO plans offer out-of-network flexibility, PFFS allows any
willing provider, and MSA plans have high-deductible structures.
2. During the Annual Election Period (AEP), what can a beneficiary do?
a) Enroll in a new MA plan effective the following January 1
b) Disenroll from an MA plan effective immediately
c) Change Medigap plans without underwriting
d) Enroll in Part A for the first time
Correct Answer: a)
Rationale: The AEP (October 15–December 7) allows beneficiaries to enroll
in or switch MA or Part D plans, with changes effective January 1. Immediate
disenrollment is not permitted, Medigap changes may require underwriting,
and Part A enrollment occurs separately.
3. What is the purpose of the Scope of Appointment (SOA) form?
a) To enroll a beneficiary in a plan
b) To document beneficiary consent for plan discussions
c) To report Fraud, Waste, and Abuse
d) To verify agent certification
Correct Answer: b)
1
, Rationale: The SOA, required by CMS, documents a beneficiary’s consent to
discuss specific MA or Part D plans, ensuring compliance with marketing rules
and protecting against unsolicited contact.
4. What is an example of Fraud, Waste, and Abuse (FWA) in Medicare?
a) A provider prescribing generic drugs
b) Billing for unperformed medical tests
c) Offering free health education seminars
d) Coordinating care with a plan
Correct Answer: b)
Rationale: Billing for services not rendered is fraud, a type of FWA that mis-
uses Medicare funds. Prescribing generics, offering seminars, and coordinat-
ing care are legitimate practices.
5. What must an agent do if a beneficiary refuses to sign an SOA?
a) Proceed with the plan discussion
b) End the appointment and reschedule
c) Enroll the beneficiary without consent
d) Report the refusal to CMS
Correct Answer: b)
Rationale: Without an SOA, agents cannot discuss plan-specific details. The
appointment must end, and a new meeting scheduled after obtaining consent,
per CMS regulations.
6. What is the maximum out-of-pocket (MOOP) limit for in-network services in
MA plans for 2025?
a) $5,000
b) $8,850
c) $10,000
d) No limit
Correct Answer: b)
Rationale: CMS sets the 2025 MOOP limit for in-network services in MA plans
at $8,850, protecting beneficiaries from excessive costs. Out-of-network limits
may be higher.
7. When can a beneficiary enroll in a Medicare Advantage Special Needs Plan
(SNP)?
a) Only during the General Enrollment Period
b) Anytime they meet eligibility criteria
c) Only after losing employer coverage
d) During the Part D Open Enrollment Period
Correct Answer: b)
Rationale: SNPs allow enrollment anytime a beneficiary meets specific eli-
gibility (e.g., chronic conditions, dual eligibility, or institutional status), pro-
vided they have Parts A and B.
8. What is a permissible nominal gift at a Medicare sales event?
a) A $20 gift card
b) A $10 tote bag
2
