AHIP FINAL EXAM
MEDICARE CERTIFICATION
2026/2027 Certification Period
100-Question Comprehensive Evaluation
Verified Answer Key | 100% Accuracy
EXAM SPECIFICATIONS
Time Allocation: 2 Hours
Total Questions: 100 Questions
Question Format: Multiple Choice with Rationales
Minimum Competency: 90% Required to Pass
Core Focus: Medicare Parts A/B/C/D, Compliance, Marketing Rules
AHIP Final Exam Medicare Certification 2026-2027 Page 1
, Exam Overview & Content Outline
EXAM PURPOSE
AHIP Medicare Certification Final Exam for 2026/2027 covers Medicare Parts A, B, C, D, Medicare
Advantage, Prescription Drug Plans, marketing rules, compliance, and fraud/waste/abuse. Required
annually for agents/brokers selling Medicare products per CMS guidelines.
CONTENT DISTRIBUTION
• Medicare Basics (25%) — Parts A/B/C/D, eligibility, enrollment periods, late enrollment penalties,
coordination of benefits
• Medicare Advantage & Part D (30%) — MA plans, PDP, formularies, coverage stages, LIS, MTM,
star ratings
• Marketing & Sales Compliance (25%) — CMS marketing guidelines, prohibited activities, Scope
of Appointment, educational vs marketing events, election periods
• Fraud, Waste, Abuse & Ethics (20%) — FWA definitions, reporting, HIPAA, agent responsibilities,
disciplinary actions
QUESTION FORMAT & SCORING
Each item presents four options. Correct answers are highlighted in green with checkmark (✓).
Every question includes detailed rationale with CMS regulations. AHIP requires 90% to pass
Medicare + FWA modules.
STUDY STRATEGY
Master Medicare Parts A/B/C/D differences and eligibility. Know enrollment periods: IEP, AEP, OEP,
SEP. Understand MA vs Medigap vs PDP. Review marketing rules: what agents can/cannot do.
Study LIS eligibility and Part D coverage stages. Know FWA reporting requirements.
CURRICULUM ALIGNMENT
Questions reflect 2026-2027 standards: CMS Medicare Managed Care Manual, Medicare
Prescription Drug Benefit Manual, CMS Medicare Marketing Guidelines, AHIP 2026/2027 training,
and 42 CFR Parts 422/423 regulations.
AHIP Final Exam Medicare Certification 2026-2027 Page 2
, SECTION I: Medicare Basics
1. Medicare Part A covers:
A. Physician services
✓ B. Inpatient hospital, SNF, hospice, home health
C. Prescription drugs
D. Dental and vision
Rationale: Part A: Hospital Insurance. Covers inpatient hospital, skilled nursing facility (SNF) after 3-day
qualifying stay, hospice, home health, blood. Premium-free for most (40+ quarters). Deductible $1,676
(2026), coinsurance days 61-90. Part B: Medical Insurance - physician services, outpatient. Part C:
Medicare Advantage. Part D: Prescription drugs.
2. Initial Enrollment Period (IEP) for Medicare:
A. January 1 - March 31 annually
✓ B. 7 months: 3 months before, month of, 3 months after 65th birthday
C. October 15 - December 7
D. Anytime
Rationale: IEP: 7-month period around 65th birthday - 3 months before, month of, 3 months after. If enroll
before month turn 65, coverage starts month turn 65. If enroll month of or after, coverage delayed. AEP: Oct
15-Dec 7 for changes. OEP: Jan 1-Mar 31 MA to Original Medicare. SEP: special circumstances.
3. Part B late enrollment penalty:
A. No penalty
✓ B. 10% for each 12-month period eligible but not enrolled
C. $500 flat fee
D. 50% penalty
Rationale: Part B LEP: 10% of premium for each full 12-month period could have had Part B but didn't sign
up, unless have creditable coverage (employer group health plan). Penalty is lifetime. Part D LEP: 1% of
national base premium for each month without creditable drug coverage. Part A: generally no penalty if
premium-free.
4. Medicare Secondary Payer (MSP) rules:
A. Medicare always primary
✓ B. Employer group 20+ employees: group primary for age 65+
C. Medicare primary if disabled
D. Patient chooses
Rationale: MSP: Age 65+ with employer group 20+ employees: group primary, Medicare secondary. <20
employees: Medicare primary. Disabled <65 with large group 100+: group primary. ESRD: group primary
first 30 months, then Medicare primary. Workers comp, no-fault, liability: those primary. COB prevents
duplicate payment.
5. Medigap (Medicare Supplement) plans:
AHIP Final Exam Medicare Certification 2026-2027 Page 3
MEDICARE CERTIFICATION
2026/2027 Certification Period
100-Question Comprehensive Evaluation
Verified Answer Key | 100% Accuracy
EXAM SPECIFICATIONS
Time Allocation: 2 Hours
Total Questions: 100 Questions
Question Format: Multiple Choice with Rationales
Minimum Competency: 90% Required to Pass
Core Focus: Medicare Parts A/B/C/D, Compliance, Marketing Rules
AHIP Final Exam Medicare Certification 2026-2027 Page 1
, Exam Overview & Content Outline
EXAM PURPOSE
AHIP Medicare Certification Final Exam for 2026/2027 covers Medicare Parts A, B, C, D, Medicare
Advantage, Prescription Drug Plans, marketing rules, compliance, and fraud/waste/abuse. Required
annually for agents/brokers selling Medicare products per CMS guidelines.
CONTENT DISTRIBUTION
• Medicare Basics (25%) — Parts A/B/C/D, eligibility, enrollment periods, late enrollment penalties,
coordination of benefits
• Medicare Advantage & Part D (30%) — MA plans, PDP, formularies, coverage stages, LIS, MTM,
star ratings
• Marketing & Sales Compliance (25%) — CMS marketing guidelines, prohibited activities, Scope
of Appointment, educational vs marketing events, election periods
• Fraud, Waste, Abuse & Ethics (20%) — FWA definitions, reporting, HIPAA, agent responsibilities,
disciplinary actions
QUESTION FORMAT & SCORING
Each item presents four options. Correct answers are highlighted in green with checkmark (✓).
Every question includes detailed rationale with CMS regulations. AHIP requires 90% to pass
Medicare + FWA modules.
STUDY STRATEGY
Master Medicare Parts A/B/C/D differences and eligibility. Know enrollment periods: IEP, AEP, OEP,
SEP. Understand MA vs Medigap vs PDP. Review marketing rules: what agents can/cannot do.
Study LIS eligibility and Part D coverage stages. Know FWA reporting requirements.
CURRICULUM ALIGNMENT
Questions reflect 2026-2027 standards: CMS Medicare Managed Care Manual, Medicare
Prescription Drug Benefit Manual, CMS Medicare Marketing Guidelines, AHIP 2026/2027 training,
and 42 CFR Parts 422/423 regulations.
AHIP Final Exam Medicare Certification 2026-2027 Page 2
, SECTION I: Medicare Basics
1. Medicare Part A covers:
A. Physician services
✓ B. Inpatient hospital, SNF, hospice, home health
C. Prescription drugs
D. Dental and vision
Rationale: Part A: Hospital Insurance. Covers inpatient hospital, skilled nursing facility (SNF) after 3-day
qualifying stay, hospice, home health, blood. Premium-free for most (40+ quarters). Deductible $1,676
(2026), coinsurance days 61-90. Part B: Medical Insurance - physician services, outpatient. Part C:
Medicare Advantage. Part D: Prescription drugs.
2. Initial Enrollment Period (IEP) for Medicare:
A. January 1 - March 31 annually
✓ B. 7 months: 3 months before, month of, 3 months after 65th birthday
C. October 15 - December 7
D. Anytime
Rationale: IEP: 7-month period around 65th birthday - 3 months before, month of, 3 months after. If enroll
before month turn 65, coverage starts month turn 65. If enroll month of or after, coverage delayed. AEP: Oct
15-Dec 7 for changes. OEP: Jan 1-Mar 31 MA to Original Medicare. SEP: special circumstances.
3. Part B late enrollment penalty:
A. No penalty
✓ B. 10% for each 12-month period eligible but not enrolled
C. $500 flat fee
D. 50% penalty
Rationale: Part B LEP: 10% of premium for each full 12-month period could have had Part B but didn't sign
up, unless have creditable coverage (employer group health plan). Penalty is lifetime. Part D LEP: 1% of
national base premium for each month without creditable drug coverage. Part A: generally no penalty if
premium-free.
4. Medicare Secondary Payer (MSP) rules:
A. Medicare always primary
✓ B. Employer group 20+ employees: group primary for age 65+
C. Medicare primary if disabled
D. Patient chooses
Rationale: MSP: Age 65+ with employer group 20+ employees: group primary, Medicare secondary. <20
employees: Medicare primary. Disabled <65 with large group 100+: group primary. ESRD: group primary
first 30 months, then Medicare primary. Workers comp, no-fault, liability: those primary. COB prevents
duplicate payment.
5. Medigap (Medicare Supplement) plans:
AHIP Final Exam Medicare Certification 2026-2027 Page 3
