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AHIP 2025/2026 Final Exam –
Updated Questions and Verified
Answers | 100% Pass Guaranteed with
Expert Explanations
Question 1
What is a key requirement for marketing Medicare Advantage (MA) plans?
A. Agents may use unapproved materials during sales presentations
B. All marketing materials must be approved by CMS prior to use
C. Marketing can occur anytime without restrictions
D. Gifts can be offered without value limits
Correct Answer: B. All marketing materials must be approved by CMS prior to use
Rationale: CMS requires that all marketing materials for MA and Part D plans be submitted for
approval before use to ensure compliance with MCMG, protecting beneficiaries from misleading
information. Unapproved materials, unrestricted marketing, or unlimited gifts violate CMS
guidelines.
Question 2
Mrs. Johnson is enrolled in Original Medicare and wants to know if her skilled nursing facility
stay will be covered after a hip surgery. What should you tell her?
A. Medicare covers the entire stay without copays
B. Medicare covers the first 20 days fully, with copays for days 21–100
C. Medicare does not cover skilled nursing care
D. Coverage requires a separate Medigap policy
Correct Answer: B. Medicare covers the first 20 days fully, with copays for days 21–100
Rationale: Under Original Medicare Part A, skilled nursing facility care is covered for up to 100
days per benefit period, with the first 20 days fully covered and copays required for days 21–100,
provided the stay follows a qualifying hospital stay of at least 3 d ays.
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Question 3
Which action is considered fraud under Medicare guidelines?
A. Billing for services not provided
B. Offering educational seminars to beneficiaries
C. Submitting accurate claims for services rendered
D. Providing generic plan information
Correct Answer: A. Billing for services not provided
Rationale: Fraud involves intentional deception, such as billing for services not provided, to
obtain unauthorized Medicare payments. Educational seminars, accurate claims, and generic plan
information are compliant activities.
Question 4
During which period can a beneficiary enroll in a Medicare Part D plan without penalty?
A. Initial Enrollment Period (IEP), Annual Election Period (AEP), or Special Enrollment
Period (SEP)
B. Only during the AEP
C. Only during the IEP
D. Only during the Open Enrollment Period (OEP)
Correct Answer: A. Initial Enrollment Period (IEP), Annual Election Period (AEP), or
Special Enrollment Period (SEP)
Rationale: Beneficiaries can enroll in a Part D plan without penalty during their IEP (7-month
period around their 65th birthday), AEP (October 15–December 7), or SEP (triggered by
qualifying events like moving or losing other coverage). The OEP allows changes but is not
penalty-free for new enrollments.
Question 5
What should an agent do if a beneficiary requests to disenroll from an MA plan?
A. Deny the request and suggest alternatives
B. Assist with the disenrollment process and notify the plan
C. Charge a fee for processing the request
D. Delay the request until the next AEP
Correct Answer: B. Assist with the disenrollment process and notify the plan
Rationale: CMS guidelines require agents to assist beneficiaries with disenrollment requests
promptly and notify the plan, ensuring compliance with beneficiary rights. Denying, charging
fees, or delaying violates MCMG.
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Question 6
True or False: Agents may offer gifts valued over $15 to potential enrollees to encourage
enrollment.
A. True
B. False
C. Only if approved by CMS
D. Only during the AEP
Correct Answer: B. False
Rationale: CMS guidelines prohibit offering gifts or incentives exceeding a nominal value of
$15 to influence enrollment, ensuring marketing practices remain ethical and non-coercive.
Question 7
Mr. Lee has end-stage renal disease (ESRD) and is starting dialysis. Can he enroll in a Medicare
Advantage plan?
A. Only in a Special Needs Plan (SNP) designed for ESRD
B. In any MA plan
C. Only in Original Medicare
D. Only with a Medigap policy
Correct Answer: A. Only in a Special Needs Plan (SNP) designed for ESRD
Rationale: Beneficiaries with ESRD are generally restricted from enrolling in most MA plans
but can join SNPs specifically designed for ESRD, as these plans cater to their specialized needs.
Question 8
What is the maximum out-of-pocket (MOOP) limit for a Medicare Advantage plan in 2025?
A. $5,000
B. $7,550
C. $10,000
D. No limit
Correct Answer: B. $7,550
Rationale: CMS sets the voluntary MOOP limit for MA plans at $7,550 for in-network services
in 2025, ensuring beneficiaries have predictable cost protections. Higher limits are allowed but
less benefit the beneficiary.
AHIP 2025/2026 Final Exam –
Updated Questions and Verified
Answers | 100% Pass Guaranteed with
Expert Explanations
Question 1
What is a key requirement for marketing Medicare Advantage (MA) plans?
A. Agents may use unapproved materials during sales presentations
B. All marketing materials must be approved by CMS prior to use
C. Marketing can occur anytime without restrictions
D. Gifts can be offered without value limits
Correct Answer: B. All marketing materials must be approved by CMS prior to use
Rationale: CMS requires that all marketing materials for MA and Part D plans be submitted for
approval before use to ensure compliance with MCMG, protecting beneficiaries from misleading
information. Unapproved materials, unrestricted marketing, or unlimited gifts violate CMS
guidelines.
Question 2
Mrs. Johnson is enrolled in Original Medicare and wants to know if her skilled nursing facility
stay will be covered after a hip surgery. What should you tell her?
A. Medicare covers the entire stay without copays
B. Medicare covers the first 20 days fully, with copays for days 21–100
C. Medicare does not cover skilled nursing care
D. Coverage requires a separate Medigap policy
Correct Answer: B. Medicare covers the first 20 days fully, with copays for days 21–100
Rationale: Under Original Medicare Part A, skilled nursing facility care is covered for up to 100
days per benefit period, with the first 20 days fully covered and copays required for days 21–100,
provided the stay follows a qualifying hospital stay of at least 3 d ays.
, 2
Question 3
Which action is considered fraud under Medicare guidelines?
A. Billing for services not provided
B. Offering educational seminars to beneficiaries
C. Submitting accurate claims for services rendered
D. Providing generic plan information
Correct Answer: A. Billing for services not provided
Rationale: Fraud involves intentional deception, such as billing for services not provided, to
obtain unauthorized Medicare payments. Educational seminars, accurate claims, and generic plan
information are compliant activities.
Question 4
During which period can a beneficiary enroll in a Medicare Part D plan without penalty?
A. Initial Enrollment Period (IEP), Annual Election Period (AEP), or Special Enrollment
Period (SEP)
B. Only during the AEP
C. Only during the IEP
D. Only during the Open Enrollment Period (OEP)
Correct Answer: A. Initial Enrollment Period (IEP), Annual Election Period (AEP), or
Special Enrollment Period (SEP)
Rationale: Beneficiaries can enroll in a Part D plan without penalty during their IEP (7-month
period around their 65th birthday), AEP (October 15–December 7), or SEP (triggered by
qualifying events like moving or losing other coverage). The OEP allows changes but is not
penalty-free for new enrollments.
Question 5
What should an agent do if a beneficiary requests to disenroll from an MA plan?
A. Deny the request and suggest alternatives
B. Assist with the disenrollment process and notify the plan
C. Charge a fee for processing the request
D. Delay the request until the next AEP
Correct Answer: B. Assist with the disenrollment process and notify the plan
Rationale: CMS guidelines require agents to assist beneficiaries with disenrollment requests
promptly and notify the plan, ensuring compliance with beneficiary rights. Denying, charging
fees, or delaying violates MCMG.
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Question 6
True or False: Agents may offer gifts valued over $15 to potential enrollees to encourage
enrollment.
A. True
B. False
C. Only if approved by CMS
D. Only during the AEP
Correct Answer: B. False
Rationale: CMS guidelines prohibit offering gifts or incentives exceeding a nominal value of
$15 to influence enrollment, ensuring marketing practices remain ethical and non-coercive.
Question 7
Mr. Lee has end-stage renal disease (ESRD) and is starting dialysis. Can he enroll in a Medicare
Advantage plan?
A. Only in a Special Needs Plan (SNP) designed for ESRD
B. In any MA plan
C. Only in Original Medicare
D. Only with a Medigap policy
Correct Answer: A. Only in a Special Needs Plan (SNP) designed for ESRD
Rationale: Beneficiaries with ESRD are generally restricted from enrolling in most MA plans
but can join SNPs specifically designed for ESRD, as these plans cater to their specialized needs.
Question 8
What is the maximum out-of-pocket (MOOP) limit for a Medicare Advantage plan in 2025?
A. $5,000
B. $7,550
C. $10,000
D. No limit
Correct Answer: B. $7,550
Rationale: CMS sets the voluntary MOOP limit for MA plans at $7,550 for in-network services
in 2025, ensuring beneficiaries have predictable cost protections. Higher limits are allowed but
less benefit the beneficiary.
