AHIP Exam Latest (2025/2026) | 50 Verified
Questions and Correct Answers| A+ Graded
Mr. Capadona is interested in enrolling in a Medicare Advantage (MA) plan and
also purchasing a Medigap policy to cover costs not paid by the MA plan. What
should you tell him?
a) He can enroll in both an MA plan and Medigap.
b) It is illegal to sell him a Medigap policy if he enrolls in an MA plan.
c) Medigap policies only work with Medicare Advantage plans.
d) He must disenroll from Original Medicare first
Correct: b) It is illegal to sell him a Medigap policy if he enrolls in an MA plan.
(Medigap supplements Original Medicare only.)
Mrs. Park has a low fixed income. What program might help her with her
Medicare costs?
a) Medicare Advantage
b) Extra Help (Low-Income Subsidy for Part D)
c) Medigap Plan G
d) Hospice coverage
Correct: b) Extra Help (Assists with Part D premiums, deductibles, and copays for
low-income beneficiaries.)
What is the Annual Election Period (AEP) for Medicare Advantage and Part D
plans?
a) January 1 to March 31
,b) October 15 to December 7
c) June 1 to August 31
d) Anytime during the yearCorrect: b) October 15 to December 7 (Changes
effective January 1 of the following year.)
Mr. Singh wants prescription drug coverage but does not want to enroll in a
Medicare Advantage plan. What option is available?
a) He must join an MA-PD plan.
b) He can enroll in a stand-alone Medicare Part D plan (PDP).
c) He cannot get drug coverage without an MA plan.
d) He should wait for a Special Enrollment Period.Correct: b) He can enroll in a
stand-alone Medicare Part D plan.
Which of the following is a type of Medicare Advantage plan?
a) Medigap
b) Private Fee-for-Service (PFFS)
c) Original Medicare
d) Part D only Correct: b) Private Fee-for-Service (PFFS) (Other types include HMO,
PPO, etc.)
Agents must document a Scope of Appointment (SOA) before discussing:
a) General Medicare information at an educational event
b) Specific Medicare Advantage or Part D plans with a beneficiary
c) Fraud, Waste, and Abuse reporting
d) Hospice benefits Correct: b) Specific Medicare Advantage or Part D plans.
What is the maximum out-of-pocket cap for Medicare Part D in 2025?
a) No cap
b) $2,000 (after which catastrophic coverage begins)
c) $5,000
,d) $8,000 Correct: b) $2,000 (Due to Inflation Reduction Act changes.)
Mr. Bauer is 49 years old and has been receiving Social Security Disability
Insurance for 24 months. Is he eligible for Medicare?
a) No, he must be 65.
b) Yes, automatically after 24 months of disability.
c) Only if he has ESRD.
d) He must apply during AEP.Correct: b) Yes, automatically after 24 months.
Which of the following is considered Fraud, Waste, or Abuse?
a) Reporting suspected FWA to the plan's compliance hotline
b) Billing for services not provided
c) Educating beneficiaries about plan options
d) Completing required compliance training Correct: b) Billing for services not
provided.
During what period can someone new to Medicare enroll in Part A and/or Part B
without penalty?
a) Annual Election Period
b) Initial Enrollment Period (IEP) – 3 months before to 3 months after turning 65
c) Open Enrollment Period
d) Special Election Period only Correct: b) Initial Enrollment Period (IEP).
A Private Fee-for-Service (PFFS) plan allows beneficiaries to:
a) Only see in-network providers
b) See any provider who accepts Medicare and the plan's terms
c) Automatically include Part D coverage
d) Enroll without a Scope of Appointment Correct: b) See any provider who
accepts Medicare and the plan's terms.
What is a Special Enrollment Period (SEP)?
, a) The yearly period for plan changes
b) A time when someone qualifies for enrollment due to certain life events (e.g.,
moving, losing coverage)
c) Only for low-income beneficiaries
d) The same as the General Enrollment Period Correct: b) Triggered by qualifying
events.
Agents are prohibited from:
a) Providing factual plan comparison information
b) Offering meals valued over $15 at sales events
c) Answering beneficiary questions
d) Completing annual compliance training Correct: b) Offering meals valued over
$15 at sales events (Nominal gifts only.)
Medicare Advantage plans must cover:
a) All services Original Medicare covers (except hospice)
b) Only emergency services
c) Long-term care
d) Vision and dental only Correct: a) All Part A and B services (except hospice,
which remains under Original Medicare).
If a beneficiary disagrees with a Part D coverage determination, they can:
a) Do nothing – it's final
b) Request an appeal or redetermination
c) Switch plans immediately
d) File a complaint with the IRS Correct: b) Request an appeal.
What is the maximum out-of-pocket cost cap for covered Part D prescription
drugs in 2026?
a) $2,000
Questions and Correct Answers| A+ Graded
Mr. Capadona is interested in enrolling in a Medicare Advantage (MA) plan and
also purchasing a Medigap policy to cover costs not paid by the MA plan. What
should you tell him?
a) He can enroll in both an MA plan and Medigap.
b) It is illegal to sell him a Medigap policy if he enrolls in an MA plan.
c) Medigap policies only work with Medicare Advantage plans.
d) He must disenroll from Original Medicare first
Correct: b) It is illegal to sell him a Medigap policy if he enrolls in an MA plan.
(Medigap supplements Original Medicare only.)
Mrs. Park has a low fixed income. What program might help her with her
Medicare costs?
a) Medicare Advantage
b) Extra Help (Low-Income Subsidy for Part D)
c) Medigap Plan G
d) Hospice coverage
Correct: b) Extra Help (Assists with Part D premiums, deductibles, and copays for
low-income beneficiaries.)
What is the Annual Election Period (AEP) for Medicare Advantage and Part D
plans?
a) January 1 to March 31
,b) October 15 to December 7
c) June 1 to August 31
d) Anytime during the yearCorrect: b) October 15 to December 7 (Changes
effective January 1 of the following year.)
Mr. Singh wants prescription drug coverage but does not want to enroll in a
Medicare Advantage plan. What option is available?
a) He must join an MA-PD plan.
b) He can enroll in a stand-alone Medicare Part D plan (PDP).
c) He cannot get drug coverage without an MA plan.
d) He should wait for a Special Enrollment Period.Correct: b) He can enroll in a
stand-alone Medicare Part D plan.
Which of the following is a type of Medicare Advantage plan?
a) Medigap
b) Private Fee-for-Service (PFFS)
c) Original Medicare
d) Part D only Correct: b) Private Fee-for-Service (PFFS) (Other types include HMO,
PPO, etc.)
Agents must document a Scope of Appointment (SOA) before discussing:
a) General Medicare information at an educational event
b) Specific Medicare Advantage or Part D plans with a beneficiary
c) Fraud, Waste, and Abuse reporting
d) Hospice benefits Correct: b) Specific Medicare Advantage or Part D plans.
What is the maximum out-of-pocket cap for Medicare Part D in 2025?
a) No cap
b) $2,000 (after which catastrophic coverage begins)
c) $5,000
,d) $8,000 Correct: b) $2,000 (Due to Inflation Reduction Act changes.)
Mr. Bauer is 49 years old and has been receiving Social Security Disability
Insurance for 24 months. Is he eligible for Medicare?
a) No, he must be 65.
b) Yes, automatically after 24 months of disability.
c) Only if he has ESRD.
d) He must apply during AEP.Correct: b) Yes, automatically after 24 months.
Which of the following is considered Fraud, Waste, or Abuse?
a) Reporting suspected FWA to the plan's compliance hotline
b) Billing for services not provided
c) Educating beneficiaries about plan options
d) Completing required compliance training Correct: b) Billing for services not
provided.
During what period can someone new to Medicare enroll in Part A and/or Part B
without penalty?
a) Annual Election Period
b) Initial Enrollment Period (IEP) – 3 months before to 3 months after turning 65
c) Open Enrollment Period
d) Special Election Period only Correct: b) Initial Enrollment Period (IEP).
A Private Fee-for-Service (PFFS) plan allows beneficiaries to:
a) Only see in-network providers
b) See any provider who accepts Medicare and the plan's terms
c) Automatically include Part D coverage
d) Enroll without a Scope of Appointment Correct: b) See any provider who
accepts Medicare and the plan's terms.
What is a Special Enrollment Period (SEP)?
, a) The yearly period for plan changes
b) A time when someone qualifies for enrollment due to certain life events (e.g.,
moving, losing coverage)
c) Only for low-income beneficiaries
d) The same as the General Enrollment Period Correct: b) Triggered by qualifying
events.
Agents are prohibited from:
a) Providing factual plan comparison information
b) Offering meals valued over $15 at sales events
c) Answering beneficiary questions
d) Completing annual compliance training Correct: b) Offering meals valued over
$15 at sales events (Nominal gifts only.)
Medicare Advantage plans must cover:
a) All services Original Medicare covers (except hospice)
b) Only emergency services
c) Long-term care
d) Vision and dental only Correct: a) All Part A and B services (except hospice,
which remains under Original Medicare).
If a beneficiary disagrees with a Part D coverage determination, they can:
a) Do nothing – it's final
b) Request an appeal or redetermination
c) Switch plans immediately
d) File a complaint with the IRS Correct: b) Request an appeal.
What is the maximum out-of-pocket cost cap for covered Part D prescription
drugs in 2026?
a) $2,000
