AHIP FINAL EXAM 2025/2026 ACTUAL EXAM QUESTIONS AND CORRECT ANSWERS WITH RATIONALES GRADED A+ LATEST

AHIP FINAL EXAM 2025/2026 ACTUAL EXAM
QUESTIONS AND CORRECT ANSWERS WITH
RATIONALES GRADED A+ LATEST

AHIP Final Exam 2025/2026 sw sw sw




The exam covers Medicare Advantage, Part D, plan benefits, compliance, fra
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ud prevention, care coordination, member communications, and ethical consi
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derations. Each question includes the correct answer and detailed rationale.
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1.

Which of the following individuals is eligible to enroll in a Medicare Advantag
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e (MA) plan?
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A. A 65-year-old with Medicare Part A only
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B. A 72-year- sw



old with Medicare Parts A and B who lives within the plan’s service area
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C. A 60-year-old with employer group coverage only
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D. A 68-year-old who permanently resides outside the United States
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✅ Answer: B. A 72-year-
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old with Medicare Parts A and B who lives within the plan’s service area
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Rationale:
To enroll in an MA plan, a beneficiary must be entitled to Part A, enrolled in P
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art B, and reside in the plan’s service area.
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,2.

What is the primary goal of Medicare Advantage plans?
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A. Replace Original Medicare with private coverage that adds more out-of-
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pocket costs sw



B. Provide Medicare- sw



covered benefits through private insurers that meet CMS standards
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C. Eliminate Part D coverage s w sw sw



D. Offer coverage only for hospital services
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✅ Answer: B. Provide Medicare-
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covered benefits through private insurers that meet CMS standards
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Rationale:
MA plans deliver Medicare benefits via CMS-
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approved private insurers, often with additional benefits like vision or dental.
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3.

Which of the following services are not covered under Medicare Part A?
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A. Skilled nursing facility care sw sw sw



B. Hospice care sw



C. Home health services sw sw



D. Outpatient physical therapy sw sw




✅ Answer: D. Outpatient physical therapy Ration
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ale:
Outpatient therapy is covered under Part B, not Part A, which primarily covers inpat
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ient and facility-based care.
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4.

During the Annual Election Period (AEP), beneficiaries can:
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A. Only drop their current plan
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B. Only enroll in a new plan if they have a special circumstance
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,C. Enroll, switch, or disenroll from Medicare Advantage or Part D plans
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D. Only switch from MA to Original Medicare
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✅ Answer: C. Enroll, switch, or disenroll from Medicare Advantage or Part
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D plans
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Rationale:
AEP (October 15 –
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December 7) allows plan changes, enrollment, or disenrollment for the upco
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ming year. sw




5.

Which of the following best defines a Special Enrollment Period (SEP)?
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A. A set period when everyone can join Medicare
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B. Time allowed for changes due to specific qualifying events
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C. The first time a person becomes eligible for Medicare
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D. Period between AEPs sw sw




✅ Answer: B. Time allowed for changes due to specific qualifying events Ration
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ale:
SEPs occur after specific life events, such as moving out of a service area or losing
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employer coverage.
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6.

Which entity regulates and oversees Medicare Advantage and Part D plans?
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A. The Department of Health and Human Services (HHS)
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B. The Centers for Medicare & Medicaid Services (CMS)
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C. The National Association of Insurance Commissioners (NAIC)
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D. State insurance departments only
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✅ Answer: B. The Centers for Medicare & Medicaid Services (CMS) Ratio
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nale:
CMS oversees all Medicare Advantage and Part D plans, ensuring compliance
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with federal standards.
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, 7.

A Marketing Misrepresentation occurs when:
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A. An agent clearly explains all benefits
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B. A plan is advertised with full disclosures
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C. An agent provides false or misleading information to influence enrollment
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D. CMS approves all materials before distribution
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✅ Answer: C. An agent provides false or misleading information to influence en
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rollment
Rationale:
Misrepresentation violates CMS marketing rules and may lead to disciplinary ac
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tions and revocation of certification.
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8.

Which statement is true regarding Medicare Part D coverage stages?
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A. The coverage gap (“donut hole”) no longer exists
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B. Beneficiaries pay 100% of drug costs during the initial coverage phase
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C. There are four stages: deductible, initial coverage, coverage gap, an
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d catastrophic coverage
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D. Premiums vary only by income sw sw sw sw




✅ Answer: C. There are four stages: deductible, initial coverage, coverage g
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ap, and catastrophic coverage
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Rationale:
Part D follows four stages that determine member cost-
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sharing throughout the plan year.sw sw sw sw