AHIP Exam Latest (2025/2026) | 50 Questions and Correct
Answers | Graded A+
Section 1: Overview This document provides 200+ full, verified questions and correct
answers for the AHIP Exam, updated for the 2025/2026 certification cycle. It is tailored to
assist agents and brokers in preparing for the open-book final exam, covering Medicare
basics, plan types, enrollment periods, and CMS compliance requirements as of 2025.
Section 2: Exam Questions and Answers
What impact, if any, have recent regulatory changes had upon Medigap plans? -: answers :-
The Part B deductible is no longer covered for individuals newly eligible for Medicare starting
January 1, 2020.
Mrs. Shields is covered by Original Medicare. She sustained a hip fracture and is being
successfully treated for that condition. However, she and her physicians feel that after her
lengthy hospital stay she will need a month or two of nursing and rehabilitative care. What
should you tell them about Original Medicare's coverage of care in a skilled nursing facility? -:
answers :-Medicare will cover Mrs. Shield's skilled nursing services provided during the first
20 days of her stay, after which she would have a copay until she has been in the facility for 100
days.
Mrs. Willard wants to know generally how the benefits under Original Medicare might compare
to the benefits package of a Medicare Advantage Plan before she starts looking at specific plans.
What could you tell her? -: answers :-Medicare Advantage Plans may offer extra benefits that
Original Medicare does not offer such as vision, hearing, and dental services and must include a
maximum out-of-pocket limit on Part A and Part B services.
,Mrs. Andrews asked how a Private Fee-for-Service (PFFS) plan might affect her access to services
since she receives some assistance for her health care costs from the State. What should you
tell her? -: answers :-Medicaid may provide additional benefits, but Medicaid will only pay
for these services if they are furnished by Medicaid participating providers.
Mrs. Walters is enrolled in her state's Medicaid program in addition to Medicare. What should
she be aware of when considering enrollment in a Medicare Advantage (MA) plan? -:
answers :-She can submit any bills she has for co-payments under Medicare to the state's
Medicaid program and they will always be fully covered.
Mrs. Kelly, age 65, is entitled to Part A but has not yet enrolled in Part B. She is considering
enrollment in a Medicare Advantage plan (Part C). What should you advise her to do before she
will be able to enroll in a Medicare Advantage plan? -: answers :-To join a Medicare
Advantage plan, she also must enroll in Part B.
Ms. Gibson recently lost her employer group health and drug coverage and now she wants to
enroll in a PPO that does not include drug coverage. What should you tell her about obtaining
drug coverage? -: answers :-She can enroll in the PPO, but she will not be able to purchase a
stand-alone Medicare Part D prescription drug plan.
Mrs. Chou likes a Private Fee-for-Service (PFFS) plan available in her area that does not include
drug coverage. She wants to enroll in the plan and enroll in a stand-alone prescription drug
plan. What should you tell her? -: answers :-She could enroll in a PFFS plan and a stand-alone
Medicare prescription drug plan.
Mrs. Lyons is in good health, uses a single prescription, and lives independently in her own
home. She is attracted by the idea of maintaining control over a Medical Savings Account (MSA)
but is not sure if the plan associated with the account will fit her needs. What specific piece of
information about a Medicare MSA plan would it be important for her to know, prior to
enrolling in such a plan? -: answers :-All MSAs cover Part A and Part B benefits, but not Part
D prescription drug benefits, which could be obtained by also enrolling in a separate
prescription drug plan.
,Mrs. Fiore is a retired federal worker with coverage under a Federal Employee Health Benefits
(FEHB) plan that includes creditable drug coverage. She is ready to turn 65 and become
Medicare eligible for the first time. What issues might she consider about whether to enroll in a
Medicare prescription drug plan? -: answers :-She could compare the coverage to see if the
Medicare Part D plan offers better benefits and coverage than the FEHB plan for the specific
medications she needs and whether any additional benefits are worth the Part D premium costs
on top of her FEHB contribution.
Mrs. Roswell is a new Medicare beneficiary who has just retired from retail work. She is
interested in selecting a Medicare Part D prescription drug plan. She takes a number of
medications and is concerned that she has not been able to identify a plan that covers all of her
medications. She does not want to make an abrupt change to new drugs that would be covered
and asks what she should do. What should you tell her? -: answers :-Every Part D drug plan is
required to cover a single one-month fill of her existing medications sometime during a 90-day
transition period.
Mrs. Roberts has Original Medicare and would like to enroll in a Private Fee-for-Service (PFFS)
plan. All types of PFFS plans are available in her area. Which options could Mrs. Roberts
consider before selecting a PFFS plan? -: answers :-A Medicare Advantage Prescription Drug
(MA-PD) PFFS plan that combines medical benefits and Part D prescription drug coverage, a
PFFS plan offering only medical benefits, or a PFFS plan in combination with a stand-alone
prescription drug plan.
Mrs. Walters is entitled to Part A and has medical coverage without drug coverage through an
employer retiree plan. She is not enrolled in Part B. Since the employer plan does not cover
prescription drugs, she wants to enroll in a Medicare prescription drug plan. Will she be able to?
-: answers :-Yes. Mrs. Walters must be entitled to Part A and/or enrolled in Part B to be
eligible for coverage under the Medicare prescription drug program.
Mrs. Fields wants to know whether applying for the Part D low-income subsidy will be worth the
time to fill out the paperwork. What could you tell her? -: answers :-The Part D low-income
subsidy could substantially lower her overall costs. She can apply by contacting her state
Medicaid office or calling the Social Security Administration.
, One of your clients, Lauren Nichols, has heard about a Medicare concept from one of her
neighbors called TrOOP. She asks you to explain it. What do you say? -: answers :-TrOOP
stands for true out-of-pocket expenses that count toward the Medicare Part D catastrophic limit
and include not only expenses paid by a beneficiary but also in some instances drug
manufacturer discounts.
Mr. Shapiro gets by on a very small amount of fixed income. He has heard there may be extra
help paying for Part D prescription drugs for Medicare beneficiaries with limited income. He
wants to know whether he might qualify. What should you tell him? -: answers :-The extra
help is available to beneficiaries whose income and assets do not exceed annual limits specified
by the government.
Mr. Rice is 68, actively working and has coverage for medical services and medications through
his employer's group health plan. He is entitled to premium free Part A and thinking of enrolling
in Part B and switching to an MA-PD because he is paying a very large part of his group coverage
premium and it does not provide coverage for a number of his medications. Which of the
following is NOT a consideration when making the change? -: answers :-Mr. Rice's retiree
plan is required to take him back if, within 63 days of having voluntarily quit the employer's
plan, he decides that he prefers it to his Medicare Part D plan.
This year you have decided to focus your efforts on marketing to employer group plans. One
employer provides you with a list of their retirees and asks you to contact them to explain the
characteristics of the plan they have selected. What should you do? -: answers :-You may go
ahead and call them.
Alice is a marketing representative employed by a health plan. Betty is a captive agent of a
health plan who markets to multiple plans and sponsors. Carl is a captive agent who markets to
only one plan/sponsor. Denise is an independent agent who markets to different types of
groups. Edward is an independent agent who markets only to employer and union groups. CMS
marketing representative compensation rules generally apply to: -: answers :-Betty and
Denise, but not Alice (the employee) or Carl or Edward (to whom exceptions apply).
Answers | Graded A+
Section 1: Overview This document provides 200+ full, verified questions and correct
answers for the AHIP Exam, updated for the 2025/2026 certification cycle. It is tailored to
assist agents and brokers in preparing for the open-book final exam, covering Medicare
basics, plan types, enrollment periods, and CMS compliance requirements as of 2025.
Section 2: Exam Questions and Answers
What impact, if any, have recent regulatory changes had upon Medigap plans? -: answers :-
The Part B deductible is no longer covered for individuals newly eligible for Medicare starting
January 1, 2020.
Mrs. Shields is covered by Original Medicare. She sustained a hip fracture and is being
successfully treated for that condition. However, she and her physicians feel that after her
lengthy hospital stay she will need a month or two of nursing and rehabilitative care. What
should you tell them about Original Medicare's coverage of care in a skilled nursing facility? -:
answers :-Medicare will cover Mrs. Shield's skilled nursing services provided during the first
20 days of her stay, after which she would have a copay until she has been in the facility for 100
days.
Mrs. Willard wants to know generally how the benefits under Original Medicare might compare
to the benefits package of a Medicare Advantage Plan before she starts looking at specific plans.
What could you tell her? -: answers :-Medicare Advantage Plans may offer extra benefits that
Original Medicare does not offer such as vision, hearing, and dental services and must include a
maximum out-of-pocket limit on Part A and Part B services.
,Mrs. Andrews asked how a Private Fee-for-Service (PFFS) plan might affect her access to services
since she receives some assistance for her health care costs from the State. What should you
tell her? -: answers :-Medicaid may provide additional benefits, but Medicaid will only pay
for these services if they are furnished by Medicaid participating providers.
Mrs. Walters is enrolled in her state's Medicaid program in addition to Medicare. What should
she be aware of when considering enrollment in a Medicare Advantage (MA) plan? -:
answers :-She can submit any bills she has for co-payments under Medicare to the state's
Medicaid program and they will always be fully covered.
Mrs. Kelly, age 65, is entitled to Part A but has not yet enrolled in Part B. She is considering
enrollment in a Medicare Advantage plan (Part C). What should you advise her to do before she
will be able to enroll in a Medicare Advantage plan? -: answers :-To join a Medicare
Advantage plan, she also must enroll in Part B.
Ms. Gibson recently lost her employer group health and drug coverage and now she wants to
enroll in a PPO that does not include drug coverage. What should you tell her about obtaining
drug coverage? -: answers :-She can enroll in the PPO, but she will not be able to purchase a
stand-alone Medicare Part D prescription drug plan.
Mrs. Chou likes a Private Fee-for-Service (PFFS) plan available in her area that does not include
drug coverage. She wants to enroll in the plan and enroll in a stand-alone prescription drug
plan. What should you tell her? -: answers :-She could enroll in a PFFS plan and a stand-alone
Medicare prescription drug plan.
Mrs. Lyons is in good health, uses a single prescription, and lives independently in her own
home. She is attracted by the idea of maintaining control over a Medical Savings Account (MSA)
but is not sure if the plan associated with the account will fit her needs. What specific piece of
information about a Medicare MSA plan would it be important for her to know, prior to
enrolling in such a plan? -: answers :-All MSAs cover Part A and Part B benefits, but not Part
D prescription drug benefits, which could be obtained by also enrolling in a separate
prescription drug plan.
,Mrs. Fiore is a retired federal worker with coverage under a Federal Employee Health Benefits
(FEHB) plan that includes creditable drug coverage. She is ready to turn 65 and become
Medicare eligible for the first time. What issues might she consider about whether to enroll in a
Medicare prescription drug plan? -: answers :-She could compare the coverage to see if the
Medicare Part D plan offers better benefits and coverage than the FEHB plan for the specific
medications she needs and whether any additional benefits are worth the Part D premium costs
on top of her FEHB contribution.
Mrs. Roswell is a new Medicare beneficiary who has just retired from retail work. She is
interested in selecting a Medicare Part D prescription drug plan. She takes a number of
medications and is concerned that she has not been able to identify a plan that covers all of her
medications. She does not want to make an abrupt change to new drugs that would be covered
and asks what she should do. What should you tell her? -: answers :-Every Part D drug plan is
required to cover a single one-month fill of her existing medications sometime during a 90-day
transition period.
Mrs. Roberts has Original Medicare and would like to enroll in a Private Fee-for-Service (PFFS)
plan. All types of PFFS plans are available in her area. Which options could Mrs. Roberts
consider before selecting a PFFS plan? -: answers :-A Medicare Advantage Prescription Drug
(MA-PD) PFFS plan that combines medical benefits and Part D prescription drug coverage, a
PFFS plan offering only medical benefits, or a PFFS plan in combination with a stand-alone
prescription drug plan.
Mrs. Walters is entitled to Part A and has medical coverage without drug coverage through an
employer retiree plan. She is not enrolled in Part B. Since the employer plan does not cover
prescription drugs, she wants to enroll in a Medicare prescription drug plan. Will she be able to?
-: answers :-Yes. Mrs. Walters must be entitled to Part A and/or enrolled in Part B to be
eligible for coverage under the Medicare prescription drug program.
Mrs. Fields wants to know whether applying for the Part D low-income subsidy will be worth the
time to fill out the paperwork. What could you tell her? -: answers :-The Part D low-income
subsidy could substantially lower her overall costs. She can apply by contacting her state
Medicaid office or calling the Social Security Administration.
, One of your clients, Lauren Nichols, has heard about a Medicare concept from one of her
neighbors called TrOOP. She asks you to explain it. What do you say? -: answers :-TrOOP
stands for true out-of-pocket expenses that count toward the Medicare Part D catastrophic limit
and include not only expenses paid by a beneficiary but also in some instances drug
manufacturer discounts.
Mr. Shapiro gets by on a very small amount of fixed income. He has heard there may be extra
help paying for Part D prescription drugs for Medicare beneficiaries with limited income. He
wants to know whether he might qualify. What should you tell him? -: answers :-The extra
help is available to beneficiaries whose income and assets do not exceed annual limits specified
by the government.
Mr. Rice is 68, actively working and has coverage for medical services and medications through
his employer's group health plan. He is entitled to premium free Part A and thinking of enrolling
in Part B and switching to an MA-PD because he is paying a very large part of his group coverage
premium and it does not provide coverage for a number of his medications. Which of the
following is NOT a consideration when making the change? -: answers :-Mr. Rice's retiree
plan is required to take him back if, within 63 days of having voluntarily quit the employer's
plan, he decides that he prefers it to his Medicare Part D plan.
This year you have decided to focus your efforts on marketing to employer group plans. One
employer provides you with a list of their retirees and asks you to contact them to explain the
characteristics of the plan they have selected. What should you do? -: answers :-You may go
ahead and call them.
Alice is a marketing representative employed by a health plan. Betty is a captive agent of a
health plan who markets to multiple plans and sponsors. Carl is a captive agent who markets to
only one plan/sponsor. Denise is an independent agent who markets to different types of
groups. Edward is an independent agent who markets only to employer and union groups. CMS
marketing representative compensation rules generally apply to: -: answers :-Betty and
Denise, but not Alice (the employee) or Carl or Edward (to whom exceptions apply).
