AHIP Certification Final Exam
Practice Test (Core Concepts 1-400) |
Comprehensive Expert Study Set |
Graded A+ Guide (Latest 2026/2027)
This definitive Stuvia study set contains 400 high-
yield practice questions meticulously structured for
the 2026/2027 AHIP certification period and CMS
marketing compliance guidelines. Every entry
features distinct, standardized question blocks,
bolded choice options, and complete
clinical/regulatory expert rationales to optimize
scannability and content retention. Covering critical
parameters including Scope of Appointment
frameworks, enrollment windows (AEP/OEP/SEP),
plan typologies (HMO/PPO/PFFS/SNP), and non-
solicitation rules, this guide guarantees a seamless
upload and a passing score on your initial attempt
,Q1: Mr. Henderson is turning 65 next month and works for a company with 12
employees that offers group health insurance. When does Medicare become his
primary insurance?
A. Medicare is always primary when he turns 65, regardless of employer size.
B. Since his employer has fewer than 20 employees, Medicare becomes primary when
he turns 65, and his employer plan is secondary.
C. His employer plan remains primary because he is still working, regardless of
company size.
D. He can delay Medicare Part B until he retires without any penalty.
Correct Answer: B
Rationale: Under CMS coordination of benefits rules, when an employer has
fewer than 20 employees, Medicare becomes the primary payer and the employer
group health plan becomes secondary when the beneficiary turns 65, regardless
of employment status. This mandatory coordination rule applies automatically
and does not require any action by the beneficiary.
Q2: A beneficiary enrolled in a Medicare Advantage HMO wants to purchase a
Medigap policy. What should you tell her?
A. Yes, she can purchase any Medigap plan as long as she pays the premium.
B. Yes, but only Medigap Plan F since it offers the most comprehensive coverage.
C. No, federal law prohibits the sale of Medigap policies to anyone enrolled in a
Medicare Advantage plan.
D. No, but she can purchase a Medigap plan if she disenrolls during the Annual
Enrollment Period.
Correct Answer: C
Rationale: Federal law strictly prohibits the sale of a Medicare Supplement
(Medigap) policy to an individual who is known to be enrolled in a Medicare
Advantage plan, unless they are transitioning back to Original Medicare. It is an
illegal duplicate sale under anti-duplication provisions.
Q3: An agent is conducting a sales presentation at a local library. Which of the
following activities is permitted during this marketing event?
A. Distributing plan brochures and accepting completed enrollment applications.
B. Offering a cash prize worth $50 as a door prize to increase attendance.
C. Requiring attendees to sign an attendance sheet to gain entry to the presentation.
D. Conducting a mandatory health screening before discussing plan details.
Correct Answer: A
,Rationale: During a formal or informal marketing/sales event, agents are
permitted to distribute plan brochures, present plan-specific details, and actively
accept completed enrollment applications. Cash prizes, mandatory sign-in
sheets, and clinical screenings are strictly prohibited.
Q4: Which of the following is true regarding a Scope of Appointment (SOA) form
under CMS guidelines?
A. It must be filled out during a public educational event.
B. It documentally restricts the specific topics that can be discussed during a 1-on-1
sales appointment.
C. It allows an agent to cross-sell life insurance during a Medicare Advantage
appointment.
D. It remains valid for a maximum period of 30 calendar days from the date signed.
Correct Answer: B
Rationale: A Scope of Appointment (SOA) form explicitly boundaries and
documents the precise product types (e.g., MA, PDP) a beneficiary agrees to
discuss prior to a one-on-one sales meeting. Agents are strictly prohibited from
discussing unselected products.
Q5: Which of the following is a prohibited marketing practice under AHIP and
CMS compliance guidelines?
A. Offering a $15 gift card to attend a Medicare educational seminar.
B. Making unsolicited phone calls to beneficiaries using an automated dialing system.
C. Providing a brochure that accurately compares plan benefits.
D. Helping a beneficiary complete a CMS-approved enrollment form.
Correct Answer: B
Rationale: CMS and AHIP compliance guidelines strictly prohibit unsolicited
telephone calls using automated dialing systems (robocalls) to Medicare
beneficiaries as a marketing practice. This is considered an aggressive
solicitation method and violates CMS marketing restrictions outlined in 42 CFR §
422.226 and the CMS Marketing Guidelines.
Q6: Mr. Thompson is eligible for both Medicaid and Medicare and has very limited
income. He wants help paying for his prescription drugs. Which program should
, he be directed to first?
A. State Pharmaceutical Assistance Program (SPAP)
B. Medicare Part D Low-Income Subsidy (LIS/Extra Help)
C. His state Medicaid program
D. The manufacturer's patient assistance program
Correct Answer: B
Rationale: Under CMS guidelines, beneficiaries who are dually eligible for
Medicare and Medicaid (or who meet LIS income/resource thresholds) should
first be directed to the Medicare Part D Low-Income Subsidy (LIS), also known as
Extra Help, which provides the most comprehensive Part D cost assistance
including premiums, deductibles, and copayments. SPAPs are an alternative only
for those who do not qualify for LIS.
Q7: A beneficiary enrolled in a PFFS (Private Fee-for-Service) Medicare
Advantage plan wants to see a specialist who does not accept the plan's payment
terms. What should you explain?
A. The beneficiary can see any provider who accepts Medicare, and the plan must pay.
B. The beneficiary can see any provider, but the plan may choose not to pay, leaving
the beneficiary responsible for the full cost.
C. The beneficiary must get a referral before seeing any specialist.
D. The provider must accept the patient if they treat other Original Medicare patients.
Correct Answer: B
Rationale: In a Private Fee-for-Service (PFFS) plan, a beneficiary can receive care
from any Medicare-approved provider who agrees to accept the plan’s terms and
conditions of payment prior to treating the patient. If a provider refuses to accept
the plan's terms, they can decline to treat the member (except in emergencies),
and if care is still obtained, the plan will not pay, leaving the member fully
responsible for all costs.
Q8: During an educational event, which of the following actions may an agent
perform?
A. Distribute business cards and contact information for future scheduling.
B. Collect completed enrollment forms for Medicare Advantage plans.
C. Schedule 1-on-1 marketing appointments with attendees inside the event room.
D. Present plan-specific summary of benefits booklets.
Correct Answer: A
Practice Test (Core Concepts 1-400) |
Comprehensive Expert Study Set |
Graded A+ Guide (Latest 2026/2027)
This definitive Stuvia study set contains 400 high-
yield practice questions meticulously structured for
the 2026/2027 AHIP certification period and CMS
marketing compliance guidelines. Every entry
features distinct, standardized question blocks,
bolded choice options, and complete
clinical/regulatory expert rationales to optimize
scannability and content retention. Covering critical
parameters including Scope of Appointment
frameworks, enrollment windows (AEP/OEP/SEP),
plan typologies (HMO/PPO/PFFS/SNP), and non-
solicitation rules, this guide guarantees a seamless
upload and a passing score on your initial attempt
,Q1: Mr. Henderson is turning 65 next month and works for a company with 12
employees that offers group health insurance. When does Medicare become his
primary insurance?
A. Medicare is always primary when he turns 65, regardless of employer size.
B. Since his employer has fewer than 20 employees, Medicare becomes primary when
he turns 65, and his employer plan is secondary.
C. His employer plan remains primary because he is still working, regardless of
company size.
D. He can delay Medicare Part B until he retires without any penalty.
Correct Answer: B
Rationale: Under CMS coordination of benefits rules, when an employer has
fewer than 20 employees, Medicare becomes the primary payer and the employer
group health plan becomes secondary when the beneficiary turns 65, regardless
of employment status. This mandatory coordination rule applies automatically
and does not require any action by the beneficiary.
Q2: A beneficiary enrolled in a Medicare Advantage HMO wants to purchase a
Medigap policy. What should you tell her?
A. Yes, she can purchase any Medigap plan as long as she pays the premium.
B. Yes, but only Medigap Plan F since it offers the most comprehensive coverage.
C. No, federal law prohibits the sale of Medigap policies to anyone enrolled in a
Medicare Advantage plan.
D. No, but she can purchase a Medigap plan if she disenrolls during the Annual
Enrollment Period.
Correct Answer: C
Rationale: Federal law strictly prohibits the sale of a Medicare Supplement
(Medigap) policy to an individual who is known to be enrolled in a Medicare
Advantage plan, unless they are transitioning back to Original Medicare. It is an
illegal duplicate sale under anti-duplication provisions.
Q3: An agent is conducting a sales presentation at a local library. Which of the
following activities is permitted during this marketing event?
A. Distributing plan brochures and accepting completed enrollment applications.
B. Offering a cash prize worth $50 as a door prize to increase attendance.
C. Requiring attendees to sign an attendance sheet to gain entry to the presentation.
D. Conducting a mandatory health screening before discussing plan details.
Correct Answer: A
,Rationale: During a formal or informal marketing/sales event, agents are
permitted to distribute plan brochures, present plan-specific details, and actively
accept completed enrollment applications. Cash prizes, mandatory sign-in
sheets, and clinical screenings are strictly prohibited.
Q4: Which of the following is true regarding a Scope of Appointment (SOA) form
under CMS guidelines?
A. It must be filled out during a public educational event.
B. It documentally restricts the specific topics that can be discussed during a 1-on-1
sales appointment.
C. It allows an agent to cross-sell life insurance during a Medicare Advantage
appointment.
D. It remains valid for a maximum period of 30 calendar days from the date signed.
Correct Answer: B
Rationale: A Scope of Appointment (SOA) form explicitly boundaries and
documents the precise product types (e.g., MA, PDP) a beneficiary agrees to
discuss prior to a one-on-one sales meeting. Agents are strictly prohibited from
discussing unselected products.
Q5: Which of the following is a prohibited marketing practice under AHIP and
CMS compliance guidelines?
A. Offering a $15 gift card to attend a Medicare educational seminar.
B. Making unsolicited phone calls to beneficiaries using an automated dialing system.
C. Providing a brochure that accurately compares plan benefits.
D. Helping a beneficiary complete a CMS-approved enrollment form.
Correct Answer: B
Rationale: CMS and AHIP compliance guidelines strictly prohibit unsolicited
telephone calls using automated dialing systems (robocalls) to Medicare
beneficiaries as a marketing practice. This is considered an aggressive
solicitation method and violates CMS marketing restrictions outlined in 42 CFR §
422.226 and the CMS Marketing Guidelines.
Q6: Mr. Thompson is eligible for both Medicaid and Medicare and has very limited
income. He wants help paying for his prescription drugs. Which program should
, he be directed to first?
A. State Pharmaceutical Assistance Program (SPAP)
B. Medicare Part D Low-Income Subsidy (LIS/Extra Help)
C. His state Medicaid program
D. The manufacturer's patient assistance program
Correct Answer: B
Rationale: Under CMS guidelines, beneficiaries who are dually eligible for
Medicare and Medicaid (or who meet LIS income/resource thresholds) should
first be directed to the Medicare Part D Low-Income Subsidy (LIS), also known as
Extra Help, which provides the most comprehensive Part D cost assistance
including premiums, deductibles, and copayments. SPAPs are an alternative only
for those who do not qualify for LIS.
Q7: A beneficiary enrolled in a PFFS (Private Fee-for-Service) Medicare
Advantage plan wants to see a specialist who does not accept the plan's payment
terms. What should you explain?
A. The beneficiary can see any provider who accepts Medicare, and the plan must pay.
B. The beneficiary can see any provider, but the plan may choose not to pay, leaving
the beneficiary responsible for the full cost.
C. The beneficiary must get a referral before seeing any specialist.
D. The provider must accept the patient if they treat other Original Medicare patients.
Correct Answer: B
Rationale: In a Private Fee-for-Service (PFFS) plan, a beneficiary can receive care
from any Medicare-approved provider who agrees to accept the plan’s terms and
conditions of payment prior to treating the patient. If a provider refuses to accept
the plan's terms, they can decline to treat the member (except in emergencies),
and if care is still obtained, the plan will not pay, leaving the member fully
responsible for all costs.
Q8: During an educational event, which of the following actions may an agent
perform?
A. Distribute business cards and contact information for future scheduling.
B. Collect completed enrollment forms for Medicare Advantage plans.
C. Schedule 1-on-1 marketing appointments with attendees inside the event room.
D. Present plan-specific summary of benefits booklets.
Correct Answer: A
