AHIP Final Exam 2026/2027 | Latest Version
50 Verified Questions and Correct Answers | A+ Graded
Q1: During an in-home appointment with a prospective client, the client asks about the
agent's personal opinion on which Medicare Advantage Plan is "best." What is the most
compliant response?
A. "Based on my experience, I think Company X's HMO plan is the best for most people."
B. "I can't recommend a specific plan as 'best.' My role is to help you compare all
available plans based on your specific needs, budget, and providers to find the one
that's the best fit for you." [CORRECT]
C. "The plan with the lowest premium is usually the best choice."
D. "Let me check with my manager and get back to you."
Correct Answer: B
Rationale: B is correct. [CORRECT] Ethical & Compliant Communication: CMS Marketing
Guidelines strictly prohibit steering or unduly influencing beneficiaries. Agents must act
as objective facilitators, presenting plan options without bias. Stating personal opinions
(A), giving generic advice (C), or deferring (D) violate the principle of unbiased
assistance and could be considered steering, which is a serious compliance violation.
Q2: A client who is turning 65 and retiring in June asks when her Initial Enrollment
Period (IEP) for Medicare Part B begins and ends.
,A. It is the 3 months before, the month of, and the 3 months after her 65th birthday
month.
B. It is the 3 months before, the month of, and the 3 months after her 65th birthday
month. If she retires in June, she may also qualify for a Special Enrollment Period (SEP)
when she loses employer coverage. [CORRECT]
C. It is only the month of her 65th birthday.
D. It is January 1 through March 31 every year.
Correct Answer: B
Rationale: B is correct. [CORRECT] Enrollment Period Rules: The IEP is the 7-month
window around the 65th birthday month. Crucially, if she has credible employer
coverage at 65, she can delay Part B without penalty and use the 8-month SEP that
begins when employment or group coverage ends. Agents must understand both
periods to provide complete guidance. Why others are wrong: (A) Is true but incomplete
for this client's situation. (C) & (D) Are factually incorrect.
Q3: What is the maximum out-of-pocket (MOOP) limit for Medicare Advantage Plans in
2026?
A. $3,400
B. $9,250 (in-network) [CORRECT]
C. $5,500
D. There is no federal limit; it is set by each plan.
Correct Answer: B
,Rationale: B is correct. [CORRECT] Current Year (2026) Knowledge: For 2026, the
CMS-set mandatory maximum out-of-pocket limit for Medicare Advantage Plans is
$9,250 for in-network services . Plans may set lower limits. This represents an increase
from previous years and is a critical figure agents must know. Why others are wrong: (A)
& (C) Are outdated figures. (D) Is false; CMS sets a mandatory maximum that plans
cannot exceed.
Q4: An agent is preparing to meet with a client who requested information about
Medicare Advantage plans. What must the agent have prior to the appointment?
A. A list of the agent's top three plan recommendations.
B. A completed and signed Scope of Appointment (SOA) form. [CORRECT]
C. The client's medical history to ensure plan eligibility.
D. A gift card to thank the client for their time.
Correct Answer: B
Rationale: B is correct. [CORRECT] Compliance Requirement: CMS Marketing Guidelines
strictly require a Scope of Appointment (SOA) form to be completed before a personal
marketing appointment . The SOA documents the types of products the beneficiary
agrees to discuss. Proceeding without one is a serious compliance violation. Why
others are wrong: (A) Could be considered steering. (C) Agents cannot collect medical
history for underwriting; MA plans accept all eligible beneficiaries. (D) Offering
inducements to enroll is prohibited.
Q5: A client enrolled in a Medicare Advantage HMO plan wants to see a specialist. What
must the client typically do first to ensure coverage?
, A. Just make an appointment with any specialist; referrals aren't needed.
B. Obtain a referral from their Primary Care Physician (PCP). [CORRECT]
C. Get pre-authorization from the specialist's office.
D. Pay out-of-pocket and submit a claim.
Correct Answer: B
Rationale: B is correct. [CORRECT] Plan Type Rules: A key feature of HMO plans is that
they usually require a referral from a PCP to see a specialist for the visit to be covered.
This is a fundamental difference from PPO plans that the agent and beneficiary must
understand. Why others are wrong: (A) Describes a PPO or some PFFS plans. (C)
Pre-authorization may also be required, but the referral is typically the first step. (D)
Would likely result in a denied claim.
Q6: Which of the following is considered a permissible marketing activity by CMS?
A. Sending unsolicited text messages to potential clients.
B. Leaving a voicemail message that includes a call-back number and states that the
call is about Medicare, if you have an existing client relationship. [CORRECT]
C. Door-to-door canvassing without an appointment.
D. Holding an educational event in a public library and collecting SOA forms at the door.
Correct Answer: B
Rationale: B is correct. [CORRECT] Marketing Rules: Leaving a voicemail is permissible
under specific conditions, especially with an existing relationship. Unsolicited text
messages (A) and door-to-door canvassing without an appointment (C) are prohibited .
50 Verified Questions and Correct Answers | A+ Graded
Q1: During an in-home appointment with a prospective client, the client asks about the
agent's personal opinion on which Medicare Advantage Plan is "best." What is the most
compliant response?
A. "Based on my experience, I think Company X's HMO plan is the best for most people."
B. "I can't recommend a specific plan as 'best.' My role is to help you compare all
available plans based on your specific needs, budget, and providers to find the one
that's the best fit for you." [CORRECT]
C. "The plan with the lowest premium is usually the best choice."
D. "Let me check with my manager and get back to you."
Correct Answer: B
Rationale: B is correct. [CORRECT] Ethical & Compliant Communication: CMS Marketing
Guidelines strictly prohibit steering or unduly influencing beneficiaries. Agents must act
as objective facilitators, presenting plan options without bias. Stating personal opinions
(A), giving generic advice (C), or deferring (D) violate the principle of unbiased
assistance and could be considered steering, which is a serious compliance violation.
Q2: A client who is turning 65 and retiring in June asks when her Initial Enrollment
Period (IEP) for Medicare Part B begins and ends.
,A. It is the 3 months before, the month of, and the 3 months after her 65th birthday
month.
B. It is the 3 months before, the month of, and the 3 months after her 65th birthday
month. If she retires in June, she may also qualify for a Special Enrollment Period (SEP)
when she loses employer coverage. [CORRECT]
C. It is only the month of her 65th birthday.
D. It is January 1 through March 31 every year.
Correct Answer: B
Rationale: B is correct. [CORRECT] Enrollment Period Rules: The IEP is the 7-month
window around the 65th birthday month. Crucially, if she has credible employer
coverage at 65, she can delay Part B without penalty and use the 8-month SEP that
begins when employment or group coverage ends. Agents must understand both
periods to provide complete guidance. Why others are wrong: (A) Is true but incomplete
for this client's situation. (C) & (D) Are factually incorrect.
Q3: What is the maximum out-of-pocket (MOOP) limit for Medicare Advantage Plans in
2026?
A. $3,400
B. $9,250 (in-network) [CORRECT]
C. $5,500
D. There is no federal limit; it is set by each plan.
Correct Answer: B
,Rationale: B is correct. [CORRECT] Current Year (2026) Knowledge: For 2026, the
CMS-set mandatory maximum out-of-pocket limit for Medicare Advantage Plans is
$9,250 for in-network services . Plans may set lower limits. This represents an increase
from previous years and is a critical figure agents must know. Why others are wrong: (A)
& (C) Are outdated figures. (D) Is false; CMS sets a mandatory maximum that plans
cannot exceed.
Q4: An agent is preparing to meet with a client who requested information about
Medicare Advantage plans. What must the agent have prior to the appointment?
A. A list of the agent's top three plan recommendations.
B. A completed and signed Scope of Appointment (SOA) form. [CORRECT]
C. The client's medical history to ensure plan eligibility.
D. A gift card to thank the client for their time.
Correct Answer: B
Rationale: B is correct. [CORRECT] Compliance Requirement: CMS Marketing Guidelines
strictly require a Scope of Appointment (SOA) form to be completed before a personal
marketing appointment . The SOA documents the types of products the beneficiary
agrees to discuss. Proceeding without one is a serious compliance violation. Why
others are wrong: (A) Could be considered steering. (C) Agents cannot collect medical
history for underwriting; MA plans accept all eligible beneficiaries. (D) Offering
inducements to enroll is prohibited.
Q5: A client enrolled in a Medicare Advantage HMO plan wants to see a specialist. What
must the client typically do first to ensure coverage?
, A. Just make an appointment with any specialist; referrals aren't needed.
B. Obtain a referral from their Primary Care Physician (PCP). [CORRECT]
C. Get pre-authorization from the specialist's office.
D. Pay out-of-pocket and submit a claim.
Correct Answer: B
Rationale: B is correct. [CORRECT] Plan Type Rules: A key feature of HMO plans is that
they usually require a referral from a PCP to see a specialist for the visit to be covered.
This is a fundamental difference from PPO plans that the agent and beneficiary must
understand. Why others are wrong: (A) Describes a PPO or some PFFS plans. (C)
Pre-authorization may also be required, but the referral is typically the first step. (D)
Would likely result in a denied claim.
Q6: Which of the following is considered a permissible marketing activity by CMS?
A. Sending unsolicited text messages to potential clients.
B. Leaving a voicemail message that includes a call-back number and states that the
call is about Medicare, if you have an existing client relationship. [CORRECT]
C. Door-to-door canvassing without an appointment.
D. Holding an educational event in a public library and collecting SOA forms at the door.
Correct Answer: B
Rationale: B is correct. [CORRECT] Marketing Rules: Leaving a voicemail is permissible
under specific conditions, especially with an existing relationship. Unsolicited text
messages (A) and door-to-door canvassing without an appointment (C) are prohibited .
