AHIP Final Exam 2025/2026 | 50 Real Exam Questions with Verified
Multiple-Choice Answers and Detailed Rationales | Medicare Training
& Certification Study Guide | Updated CMS Compliance | 100% Pass
Guarantee | Graded A+
This document provides 50 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.
1. Which government program provides health coverage to low-income individuals and families?
A. Medicare
B. Medicaid
C. TRICARE
D. CHIP
Answer: B. Medicaid
Rationale: Medicaid is a joint federal and state program that provides health coverage to
eligible low-income individuals and families.
2. Which part of Medicare covers outpatient services and preventive care?
A. Part A
B. Part B
C. Part C
D. Part D
Answer: B. Part B
Rationale: Medicare Part B covers physician services, outpatient care, preventive services, and
durable medical equipment.
3. Medicare Part D covers which type of service?
A. Hospital stays
B. Prescription drugs
C. Physical therapy
D. Dental care
Answer: B. Prescription drugs
Rationale: Part D is the prescription drug benefit under Medicare.
4. What is the primary goal of risk adjustment in Medicare Advantage?
A. Penalize high-risk patients
B. Reward providers for sicker enrollees
C. Prevent fraud
D. Eliminate copays
Answer: B. Reward providers for sicker enrollees
, Rationale: Risk adjustment adjusts payments to health plans based on the health status of their
enrollees, so plans are not penalized for enrolling sicker individuals.
5. Which law protects individuals’ health information privacy?
A. FERPA
B. ADA
C. HIPAA
D. FMLA
Answer: C. HIPAA
Rationale: HIPAA (Health Insurance Portability and Accountability Act) includes provisions for
privacy and security of health information.
6. What is a formulary?
A. A plan’s benefit package
B. A list of covered drugs
C. A provider network
D. A claims processing system
Answer: B. A list of covered drugs
Rationale: A formulary is the list of prescription drugs a health plan covers.
7. Which type of Medicare Advantage plan restricts network providers but may offer lower
costs?
A. PPO
B. HMO
C. PFFS
D. EPO
Answer: B. HMO
Rationale: HMOs typically require use of plan network providers and often lower
premiums/co-pays as trade-offs.
8. Which entity sets the payment rates for Medicare Part A and B services?
A. CMS
B. AMA
C. FDA
D. OMB
Answer: A. CMS
Rationale: The Centers for Medicare & Medicaid Services define reimbursement rules and rates
for Medicare.
9. What is “coordination of benefits” in health insurance?
A. When two providers split payment
B. Determining which plan pays first when multiple policies exist
C. When plan covers preventive care
D. Matching beneficiaries to plans
Answer: B. Determining which plan pays first when multiple policies exist
Rationale: Coordination of benefits ensures that multiple insurers work together, so coverage is
not duplicated.
Multiple-Choice Answers and Detailed Rationales | Medicare Training
& Certification Study Guide | Updated CMS Compliance | 100% Pass
Guarantee | Graded A+
This document provides 50 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.
1. Which government program provides health coverage to low-income individuals and families?
A. Medicare
B. Medicaid
C. TRICARE
D. CHIP
Answer: B. Medicaid
Rationale: Medicaid is a joint federal and state program that provides health coverage to
eligible low-income individuals and families.
2. Which part of Medicare covers outpatient services and preventive care?
A. Part A
B. Part B
C. Part C
D. Part D
Answer: B. Part B
Rationale: Medicare Part B covers physician services, outpatient care, preventive services, and
durable medical equipment.
3. Medicare Part D covers which type of service?
A. Hospital stays
B. Prescription drugs
C. Physical therapy
D. Dental care
Answer: B. Prescription drugs
Rationale: Part D is the prescription drug benefit under Medicare.
4. What is the primary goal of risk adjustment in Medicare Advantage?
A. Penalize high-risk patients
B. Reward providers for sicker enrollees
C. Prevent fraud
D. Eliminate copays
Answer: B. Reward providers for sicker enrollees
, Rationale: Risk adjustment adjusts payments to health plans based on the health status of their
enrollees, so plans are not penalized for enrolling sicker individuals.
5. Which law protects individuals’ health information privacy?
A. FERPA
B. ADA
C. HIPAA
D. FMLA
Answer: C. HIPAA
Rationale: HIPAA (Health Insurance Portability and Accountability Act) includes provisions for
privacy and security of health information.
6. What is a formulary?
A. A plan’s benefit package
B. A list of covered drugs
C. A provider network
D. A claims processing system
Answer: B. A list of covered drugs
Rationale: A formulary is the list of prescription drugs a health plan covers.
7. Which type of Medicare Advantage plan restricts network providers but may offer lower
costs?
A. PPO
B. HMO
C. PFFS
D. EPO
Answer: B. HMO
Rationale: HMOs typically require use of plan network providers and often lower
premiums/co-pays as trade-offs.
8. Which entity sets the payment rates for Medicare Part A and B services?
A. CMS
B. AMA
C. FDA
D. OMB
Answer: A. CMS
Rationale: The Centers for Medicare & Medicaid Services define reimbursement rules and rates
for Medicare.
9. What is “coordination of benefits” in health insurance?
A. When two providers split payment
B. Determining which plan pays first when multiple policies exist
C. When plan covers preventive care
D. Matching beneficiaries to plans
Answer: B. Determining which plan pays first when multiple policies exist
Rationale: Coordination of benefits ensures that multiple insurers work together, so coverage is
not duplicated.
