AHIP Medicare Training Certification
2025 – 100% Correct Questions with
Expert Policy Explanations
Question 1
What is the Annual Enrollment Period (AEP) for Medicare Advantage and Part D changes in
2025?
A. January 1 - March 31 B. October 15 - December 7 C. April 1 - June 30 D. July 1 -
September 30
Rationale: The AEP allows all beneficiaries to enroll, disenroll, or switch MA/PDP plans;
changes effective January 1 (CMS 2025 Enrollment Guidelines, AHIP Module 1).
Question 2
A beneficiary enrolls in a Medicare Advantage plan during AEP. When does coverage begin?
A. Immediately B. January 1 of the following year C. The first of the next month D. January 1
of the following year
Rationale: AEP enrollments take effect January 1; this ensures orderly plan transitions (CMS 42
CFR § 422.62, AHIP Enrollment Rules).
Question 3
What is the Medicare Advantage Open Enrollment Period (OEP) in 2025?
A. October 15 - December 7 B. January 1 - March 31 C. November 1 - January 15 D. April 1 -
June 30
Rationale: OEP allows MA enrollees to switch plans or return to Original Medicare once per
year; limited to MA beneficiaries (CMS 2025 MA Final Rule, AHIP Module 2).
,Question 4
A new Medicare beneficiary turns 65 on March 15, 2025. What is their Initial Enrollment Period
(IEP)?
A. January 1 - March 31 B. December 2024 - June 2025 C. March 1 - May 31 D. April 1 - June
30
Rationale: IEP spans 3 months before, the month of, and 3 months after the birthday month for
Parts A/B (CMS 2025 Eligibility Rules, AHIP Basics).
Question 5
Under which Special Enrollment Period (SEP) can a beneficiary switch plans due to moving out
of their plan's service area in 2025?
A. AEP B. SEP for Loss of Service Area C. OEP D. IEP
Rationale: This SEP allows immediate disenrollment and switch if moving outside the plan's
area (CMS 42 CFR § 422.74(b), AHIP Enrollment Module).
Question 6
For 2025, what is the maximum out-of-pocket (MOOP) limit for Medicare Advantage plans?
A. $6,700 B. $8,850 C. $7,550 D. No limit
Rationale: CMS sets voluntary MOOP at $8,850 for in-network services to protect beneficiaries
(CMS 2025 MA Final Rule, AHIP MA Benefits).
Question 7
In 2025, Medicare Advantage plans must cover which new behavioral health provider type at
network adequacy standards?
A. Psychiatrists only B. Marriage and family therapists (MFTs) and mental health
counselors (MHCs) C. Social workers exclusively D. Addiction counselors only
Rationale: Consolidated Appropriations Act 2023 requires MFT/MHC inclusion; CMS finalized
network standards (CMS CY 2025 Final Rule, AHIP Compliance).
, Question 8
What is the 2025 threshold for D-SNP look-alike plans in Medicare Advantage?
A. 80% B. 90% C. 70% D. 60%
Rationale: CMS lowered from 80% to 70% to reduce non-D-SNP plans serving dual eligibles
without full requirements (CMS 2025 MA Final Rule, AHIP MA Types).
Question 9
For 2025, what compensation cap applies to administrative payments for MA agents/brokers?
A. $100 per beneficiary B. $100 per beneficiary C. $200 per beneficiary D. No cap
Rationale: CMS caps admin payments at $100 to prevent steering; fair market value for training
allowed (CMS 2025 Compensation Rules, AHIP Ethics).
Question 10
In 2025, MA plans must conduct annual health equity analyses for which process?
A. Premium setting B. Utilization management policies C. Network contracting D. Star Ratings
Rationale: CMS requires analysis to ensure equitable access in UM (CMS 2025 Final Rule,
AHIP Compliance Training).
Question 11
What is the Part B deductible for 2025?
A. $240 B. $257 C. $174 D. $226
Rationale: Annual adjustment based on costs; $257 reflects 2025 inflation (CMS 2025
Premiums Fact Sheet, AHIP Basics).
2025 – 100% Correct Questions with
Expert Policy Explanations
Question 1
What is the Annual Enrollment Period (AEP) for Medicare Advantage and Part D changes in
2025?
A. January 1 - March 31 B. October 15 - December 7 C. April 1 - June 30 D. July 1 -
September 30
Rationale: The AEP allows all beneficiaries to enroll, disenroll, or switch MA/PDP plans;
changes effective January 1 (CMS 2025 Enrollment Guidelines, AHIP Module 1).
Question 2
A beneficiary enrolls in a Medicare Advantage plan during AEP. When does coverage begin?
A. Immediately B. January 1 of the following year C. The first of the next month D. January 1
of the following year
Rationale: AEP enrollments take effect January 1; this ensures orderly plan transitions (CMS 42
CFR § 422.62, AHIP Enrollment Rules).
Question 3
What is the Medicare Advantage Open Enrollment Period (OEP) in 2025?
A. October 15 - December 7 B. January 1 - March 31 C. November 1 - January 15 D. April 1 -
June 30
Rationale: OEP allows MA enrollees to switch plans or return to Original Medicare once per
year; limited to MA beneficiaries (CMS 2025 MA Final Rule, AHIP Module 2).
,Question 4
A new Medicare beneficiary turns 65 on March 15, 2025. What is their Initial Enrollment Period
(IEP)?
A. January 1 - March 31 B. December 2024 - June 2025 C. March 1 - May 31 D. April 1 - June
30
Rationale: IEP spans 3 months before, the month of, and 3 months after the birthday month for
Parts A/B (CMS 2025 Eligibility Rules, AHIP Basics).
Question 5
Under which Special Enrollment Period (SEP) can a beneficiary switch plans due to moving out
of their plan's service area in 2025?
A. AEP B. SEP for Loss of Service Area C. OEP D. IEP
Rationale: This SEP allows immediate disenrollment and switch if moving outside the plan's
area (CMS 42 CFR § 422.74(b), AHIP Enrollment Module).
Question 6
For 2025, what is the maximum out-of-pocket (MOOP) limit for Medicare Advantage plans?
A. $6,700 B. $8,850 C. $7,550 D. No limit
Rationale: CMS sets voluntary MOOP at $8,850 for in-network services to protect beneficiaries
(CMS 2025 MA Final Rule, AHIP MA Benefits).
Question 7
In 2025, Medicare Advantage plans must cover which new behavioral health provider type at
network adequacy standards?
A. Psychiatrists only B. Marriage and family therapists (MFTs) and mental health
counselors (MHCs) C. Social workers exclusively D. Addiction counselors only
Rationale: Consolidated Appropriations Act 2023 requires MFT/MHC inclusion; CMS finalized
network standards (CMS CY 2025 Final Rule, AHIP Compliance).
, Question 8
What is the 2025 threshold for D-SNP look-alike plans in Medicare Advantage?
A. 80% B. 90% C. 70% D. 60%
Rationale: CMS lowered from 80% to 70% to reduce non-D-SNP plans serving dual eligibles
without full requirements (CMS 2025 MA Final Rule, AHIP MA Types).
Question 9
For 2025, what compensation cap applies to administrative payments for MA agents/brokers?
A. $100 per beneficiary B. $100 per beneficiary C. $200 per beneficiary D. No cap
Rationale: CMS caps admin payments at $100 to prevent steering; fair market value for training
allowed (CMS 2025 Compensation Rules, AHIP Ethics).
Question 10
In 2025, MA plans must conduct annual health equity analyses for which process?
A. Premium setting B. Utilization management policies C. Network contracting D. Star Ratings
Rationale: CMS requires analysis to ensure equitable access in UM (CMS 2025 Final Rule,
AHIP Compliance Training).
Question 11
What is the Part B deductible for 2025?
A. $240 B. $257 C. $174 D. $226
Rationale: Annual adjustment based on costs; $257 reflects 2025 inflation (CMS 2025
Premiums Fact Sheet, AHIP Basics).
