AHIP 2026 Certification Exam | Latest
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1. Which of the following individuals is most likely to be eligible for Medicare?
A) A 62-year-old retiree
B) A 68-year-old U.S. citizen entitled to Social Security retirement benefits
C) A 50-year-old with end-stage renal disease (ESRD) who has never worked
D) A 30-year-old receiving disability benefits for 12 months
Answer: B
Rationale: Medicare eligibility generally begins at age 65 for individuals entitled to
Social Security or Railroad Retirement benefits. Individuals under 65 may qualify
after receiving Social Security Disability Insurance (SSDI) for 24 months, or
immediately if diagnosed with ESRD requiring dialysis or ALS.
2. Medicare Part A primarily covers which type of services?
A) Prescription drugs
B) Physician visits and outpatient care
C) Inpatient hospital stays, skilled nursing facility care, hospice, and some home
health
D) Routine dental and vision care
,Answer: C
Rationale: Medicare Part A is hospital insurance covering inpatient hospital care,
skilled nursing facility care (not custodial), hospice, and some home health
services. Part B covers physician and outpatient services; Part D covers
prescription drugs.
3. Which of the following is a correct statement about Medicare Part B?
A) It is free for all beneficiaries
B) It covers outpatient care, physician services, and preventive services, and
requires payment of a monthly premium
C) It provides coverage for long-term custodial nursing home care
D) It is only available to individuals with low income
Answer: B
Rationale: Medicare Part B covers medically necessary outpatient services,
physician visits, preventive services, and durable medical equipment. Most
beneficiaries pay a standard monthly premium (income-related adjustments may
apply). It does not cover custodial care.
4. Mrs. Jones is enrolled in Original Medicare (Parts A and B). She wants
additional prescription drug coverage. Which option could she choose?
A) Enroll in a Medicare Cost Plan
B) Purchase a standalone Medicare Part D Prescription Drug Plan
C) Enroll in a Medicare Medical Savings Account (MSA) plan
D) Purchase a Medigap policy that includes drug coverage
,Answer: B
Rationale: Beneficiaries with Original Medicare can add prescription drug coverage
by enrolling in a standalone Medicare Part D plan. Medigap policies sold today do
not include drug coverage (except those purchased before 2006 with creditable
drug coverage).
5. When does the Medicare Annual Enrollment Period (AEP) occur each year?
A) January 1 to March 31
B) October 15 to December 7
C) April 1 to June 30
D) November 1 to January 15
Answer: B
Rationale: The Medicare Annual Enrollment Period runs from October 15 through
December 7 each year. During AEP, beneficiaries can enroll in or switch Medicare
Advantage and Part D plans, with coverage effective January 1.
6. Mr. Smith enrolled in a Medicare Advantage plan during his Initial Enrollment
Period. He now wants to switch to a different Medicare Advantage plan during
the Medicare Advantage Open Enrollment Period (MA OEP). When does this
period run, and what can he do?
A) October 15 – December 7; switch to any other Medicare Advantage plan or
return to Original Medicare with Part D
B) January 1 – March 31; switch to a different Medicare Advantage plan or return to
Original Medicare and enroll in a Part D plan
, C) April 1 – June 30; only switch Part D plans
D) Anytime; change plans once per month
Answer: B
Rationale: The Medicare Advantage Open Enrollment Period (MA OEP) is from
January 1 through March 31. During this time, individuals enrolled in a Medicare
Advantage plan can switch to another Medicare Advantage plan or disenroll and
return to Original Medicare with a Part D plan.
7. Which of the following actions is a marketing violation under CMS rules?
A) Providing a detailed, accurate comparison of plan benefits
B) Inviting a beneficiary to an educational event and not requiring a scope of
appointment form
C) Calling a beneficiary on the Do Not Call list after they have given express
permission to contact
D) Door-to-door solicitation to enroll a beneficiary in a Medicare Advantage plan
without a prior invitation
Answer: D
Rationale: CMS strictly prohibits unsolicited door-to-door marketing. Agents may
only visit a beneficiary’s home if the beneficiary has provided explicit invitation.
Educational events do not require a scope of appointment, but marketing
appointments do.
8. A scope of appointment (SOA) form must be obtained before a one-on-one
marketing meeting. Which of the following is true about the SOA?
A) It is valid for 18 months after the signature date
Updates, Costs, Module Changes, Study
Guide, Practice Questions, Solutions,
Answers, Compliance Tips & How to Pass
Fast
1. Which of the following individuals is most likely to be eligible for Medicare?
A) A 62-year-old retiree
B) A 68-year-old U.S. citizen entitled to Social Security retirement benefits
C) A 50-year-old with end-stage renal disease (ESRD) who has never worked
D) A 30-year-old receiving disability benefits for 12 months
Answer: B
Rationale: Medicare eligibility generally begins at age 65 for individuals entitled to
Social Security or Railroad Retirement benefits. Individuals under 65 may qualify
after receiving Social Security Disability Insurance (SSDI) for 24 months, or
immediately if diagnosed with ESRD requiring dialysis or ALS.
2. Medicare Part A primarily covers which type of services?
A) Prescription drugs
B) Physician visits and outpatient care
C) Inpatient hospital stays, skilled nursing facility care, hospice, and some home
health
D) Routine dental and vision care
,Answer: C
Rationale: Medicare Part A is hospital insurance covering inpatient hospital care,
skilled nursing facility care (not custodial), hospice, and some home health
services. Part B covers physician and outpatient services; Part D covers
prescription drugs.
3. Which of the following is a correct statement about Medicare Part B?
A) It is free for all beneficiaries
B) It covers outpatient care, physician services, and preventive services, and
requires payment of a monthly premium
C) It provides coverage for long-term custodial nursing home care
D) It is only available to individuals with low income
Answer: B
Rationale: Medicare Part B covers medically necessary outpatient services,
physician visits, preventive services, and durable medical equipment. Most
beneficiaries pay a standard monthly premium (income-related adjustments may
apply). It does not cover custodial care.
4. Mrs. Jones is enrolled in Original Medicare (Parts A and B). She wants
additional prescription drug coverage. Which option could she choose?
A) Enroll in a Medicare Cost Plan
B) Purchase a standalone Medicare Part D Prescription Drug Plan
C) Enroll in a Medicare Medical Savings Account (MSA) plan
D) Purchase a Medigap policy that includes drug coverage
,Answer: B
Rationale: Beneficiaries with Original Medicare can add prescription drug coverage
by enrolling in a standalone Medicare Part D plan. Medigap policies sold today do
not include drug coverage (except those purchased before 2006 with creditable
drug coverage).
5. When does the Medicare Annual Enrollment Period (AEP) occur each year?
A) January 1 to March 31
B) October 15 to December 7
C) April 1 to June 30
D) November 1 to January 15
Answer: B
Rationale: The Medicare Annual Enrollment Period runs from October 15 through
December 7 each year. During AEP, beneficiaries can enroll in or switch Medicare
Advantage and Part D plans, with coverage effective January 1.
6. Mr. Smith enrolled in a Medicare Advantage plan during his Initial Enrollment
Period. He now wants to switch to a different Medicare Advantage plan during
the Medicare Advantage Open Enrollment Period (MA OEP). When does this
period run, and what can he do?
A) October 15 – December 7; switch to any other Medicare Advantage plan or
return to Original Medicare with Part D
B) January 1 – March 31; switch to a different Medicare Advantage plan or return to
Original Medicare and enroll in a Part D plan
, C) April 1 – June 30; only switch Part D plans
D) Anytime; change plans once per month
Answer: B
Rationale: The Medicare Advantage Open Enrollment Period (MA OEP) is from
January 1 through March 31. During this time, individuals enrolled in a Medicare
Advantage plan can switch to another Medicare Advantage plan or disenroll and
return to Original Medicare with a Part D plan.
7. Which of the following actions is a marketing violation under CMS rules?
A) Providing a detailed, accurate comparison of plan benefits
B) Inviting a beneficiary to an educational event and not requiring a scope of
appointment form
C) Calling a beneficiary on the Do Not Call list after they have given express
permission to contact
D) Door-to-door solicitation to enroll a beneficiary in a Medicare Advantage plan
without a prior invitation
Answer: D
Rationale: CMS strictly prohibits unsolicited door-to-door marketing. Agents may
only visit a beneficiary’s home if the beneficiary has provided explicit invitation.
Educational events do not require a scope of appointment, but marketing
appointments do.
8. A scope of appointment (SOA) form must be obtained before a one-on-one
marketing meeting. Which of the following is true about the SOA?
A) It is valid for 18 months after the signature date
