AHIP CERTIFICATION COMPREHENSIVE EXAM BANK 2026 |
ACCURATE REAL EXAM QUESTIONS AND DETAILED
ANSWERS WITH RATIONALES AND A STUDY GUIDE |
LATEST UPDATE
1
Mr. Garcia was told he qualifies for a Special Enrollment Period (SEP) but lost the paper. What
can you tell him?
A. He gets unlimited MA changes for 6 months
B. He must wait for AEP to change MA plans
C. If the SEP is for MA coverage, he generally has one opportunity to change his MA
coverage ✅
D. He can change MA plans every 30 days during the SEP
Rationale: Most SEPs allow a single MA election; specifics depend on the SEP reason.
2
Mrs. Walters has Part A and an employer retiree plan without drug coverage; she’s not in Part B.
Can she enroll in a Part D plan?
A. No, she must have Part B
B. Only during AEP
C. Yes. Entitled to Part A or enrolled in Part B qualifies for Part D
D. Only if she drops retiree coverage
Rationale: Part D eligibility requires Part A entitlement or Part B enrollment.
3
Mrs. Goodman enrolled in an MA-PD during AEP. In mid-January she wants to go back to
Original Medicare and add a PDP. What applies?
A. Must wait until next AEP
,B. Use MA OEP (Jan 1–Mar 31) to disenroll to Original Medicare and add a PDP
C. Only SEP can allow this
D. PDP cannot be added after MA disenroll
Rationale: MA OEP permits one switch to OM + PDP.
4
When can Mrs. Berkowitz enroll in an MA plan without drug coverage AND a stand-alone PDP?
A. Any MA plan allows it
B. Only HMOs
C. If the MA plan is a PFFS (no drug coverage) or an MSA plan
D. Only during OEP
Rationale: PDP pairing is allowed with PFFS (no Rx) and MSA.
5
Ms. Lee will move out of her MA-PD service area next month. Must she wait for AEP to enroll
again?
A. Yes, unless a 5-star plan exists
B. Only if she notifies CMS
C. No. She has an SEP beginning the month before the move (if notified) or when she gives
notice; typically lasts 2 additional months
D. Only if she loses Part B
Rationale: Permanent moves create an SEP.
6
Which sales statement is prohibited?
A. “Let’s compare your drugs to the formulary.”
B. “This plan has a $0 premium in your county.”
C. “If you’re not in very good health, you will probably do better with a different product.”
,D. “Your copays may vary by pharmacy.”
Rationale: Health-status-based steering is prohibited.
7
Mr. Anderson brings you a completed enrollment form on Oct 10 for a plan effective Jan 1. He’s
on Original Medicare. What do you do?
A. Submit it immediately
B. Hold it until Jan 1
C. Tell him you cannot accept enrollment forms until AEP begins
D. Ask him to mail it now
Rationale: Agents cannot accept/solicit enrollments before AEP.
8
Mr. Tully has advanced Alzheimer’s and cannot consent. Can his daughter sign his enrollment?
A. Yes, adult children may sign
B. Only with two witnesses
C. Only if she has legal authority (court guardian, durable POA, or state-authorized
surrogate)
D. No, must be Mr. Tully
Rationale: A legally authorized representative may enroll on behalf.
9
Ms. Gonzales stayed in OM + Part D during AEP. In January she hears about MA OEP. Can she
use it to join MA?
A. Yes, anyone can use MA OEP
B. Only if she’s low-income
C. No. MA OEP is only for current MA enrollees
D. Yes, with a SEP code
Rationale: MA OEP does not apply to OM-only beneficiaries.
10
, Ms. Claggett (age 66) has been on OM due to disability and never had MA or Part D. She thinks
her Part D IEP is still open. What applies?
A. She has one IEP at any time she chooses
B. She gets an IEP every odd year
C. She had two Part D IEPs (disability entitlement and at 65) and missed both
D. No IEPs were available
Rationale: IEP at disability Medicare entitlement and another at age 65.
11
Mary is admitted to a rehab hospital outside her MA plan’s area for several months. Coverage
options?
A. Wait for AEP
B. She may make unlimited MA enrollment requests and may disenroll from her current
MA plan
C. Must keep current MA plan
D. Only PDP changes allowed
Rationale: Institutionalized/temporary residence creates special rights.
12
Mrs. Pierce wants a Medicare Cost plan with Part D. When can she enroll?
A. Anytime
B. Only during MA OEP
C. During Part D enrollment periods; Cost plans must accept enrollments then
D. Only during IEP at 65
Rationale: Cost plan PD coverage follows Part D timing.
13
Mr. Ford chose an MA-only plan in mid-November (AEP). On Dec 1 he wants an MA-PD
instead. What applies?
A. Cannot change
ACCURATE REAL EXAM QUESTIONS AND DETAILED
ANSWERS WITH RATIONALES AND A STUDY GUIDE |
LATEST UPDATE
1
Mr. Garcia was told he qualifies for a Special Enrollment Period (SEP) but lost the paper. What
can you tell him?
A. He gets unlimited MA changes for 6 months
B. He must wait for AEP to change MA plans
C. If the SEP is for MA coverage, he generally has one opportunity to change his MA
coverage ✅
D. He can change MA plans every 30 days during the SEP
Rationale: Most SEPs allow a single MA election; specifics depend on the SEP reason.
2
Mrs. Walters has Part A and an employer retiree plan without drug coverage; she’s not in Part B.
Can she enroll in a Part D plan?
A. No, she must have Part B
B. Only during AEP
C. Yes. Entitled to Part A or enrolled in Part B qualifies for Part D
D. Only if she drops retiree coverage
Rationale: Part D eligibility requires Part A entitlement or Part B enrollment.
3
Mrs. Goodman enrolled in an MA-PD during AEP. In mid-January she wants to go back to
Original Medicare and add a PDP. What applies?
A. Must wait until next AEP
,B. Use MA OEP (Jan 1–Mar 31) to disenroll to Original Medicare and add a PDP
C. Only SEP can allow this
D. PDP cannot be added after MA disenroll
Rationale: MA OEP permits one switch to OM + PDP.
4
When can Mrs. Berkowitz enroll in an MA plan without drug coverage AND a stand-alone PDP?
A. Any MA plan allows it
B. Only HMOs
C. If the MA plan is a PFFS (no drug coverage) or an MSA plan
D. Only during OEP
Rationale: PDP pairing is allowed with PFFS (no Rx) and MSA.
5
Ms. Lee will move out of her MA-PD service area next month. Must she wait for AEP to enroll
again?
A. Yes, unless a 5-star plan exists
B. Only if she notifies CMS
C. No. She has an SEP beginning the month before the move (if notified) or when she gives
notice; typically lasts 2 additional months
D. Only if she loses Part B
Rationale: Permanent moves create an SEP.
6
Which sales statement is prohibited?
A. “Let’s compare your drugs to the formulary.”
B. “This plan has a $0 premium in your county.”
C. “If you’re not in very good health, you will probably do better with a different product.”
,D. “Your copays may vary by pharmacy.”
Rationale: Health-status-based steering is prohibited.
7
Mr. Anderson brings you a completed enrollment form on Oct 10 for a plan effective Jan 1. He’s
on Original Medicare. What do you do?
A. Submit it immediately
B. Hold it until Jan 1
C. Tell him you cannot accept enrollment forms until AEP begins
D. Ask him to mail it now
Rationale: Agents cannot accept/solicit enrollments before AEP.
8
Mr. Tully has advanced Alzheimer’s and cannot consent. Can his daughter sign his enrollment?
A. Yes, adult children may sign
B. Only with two witnesses
C. Only if she has legal authority (court guardian, durable POA, or state-authorized
surrogate)
D. No, must be Mr. Tully
Rationale: A legally authorized representative may enroll on behalf.
9
Ms. Gonzales stayed in OM + Part D during AEP. In January she hears about MA OEP. Can she
use it to join MA?
A. Yes, anyone can use MA OEP
B. Only if she’s low-income
C. No. MA OEP is only for current MA enrollees
D. Yes, with a SEP code
Rationale: MA OEP does not apply to OM-only beneficiaries.
10
, Ms. Claggett (age 66) has been on OM due to disability and never had MA or Part D. She thinks
her Part D IEP is still open. What applies?
A. She has one IEP at any time she chooses
B. She gets an IEP every odd year
C. She had two Part D IEPs (disability entitlement and at 65) and missed both
D. No IEPs were available
Rationale: IEP at disability Medicare entitlement and another at age 65.
11
Mary is admitted to a rehab hospital outside her MA plan’s area for several months. Coverage
options?
A. Wait for AEP
B. She may make unlimited MA enrollment requests and may disenroll from her current
MA plan
C. Must keep current MA plan
D. Only PDP changes allowed
Rationale: Institutionalized/temporary residence creates special rights.
12
Mrs. Pierce wants a Medicare Cost plan with Part D. When can she enroll?
A. Anytime
B. Only during MA OEP
C. During Part D enrollment periods; Cost plans must accept enrollments then
D. Only during IEP at 65
Rationale: Cost plan PD coverage follows Part D timing.
13
Mr. Ford chose an MA-only plan in mid-November (AEP). On Dec 1 he wants an MA-PD
instead. What applies?
A. Cannot change
