AHIP FINAL EXAM, PRACTICE EXAM
AND STUDY GUIDE LATEST 2026/2027
ACTUAL EXAM 955 QUESTIONS WITH
CORRECT ANSWERS 100% VERIFIED
GRADED A+
1. Medicare Advantage Eligibility
Question: Which of the following individuals is eligible to enroll in a Medicare
Advantage (MA) plan?
ANSWER: A 72-year-old with Medicare Parts A and B who lives within the plan's service
area .
Rationale: To enroll in an MA plan, a beneficiary must be entitled to Part A, enrolled in
Part B, and reside in the plan’s service area .
2. Original Medicare Coverage
Question: Mr. Schmidt would like to plan for retirement and has asked you what is
covered under Original Fee-for-Service (FFS) Medicare. What could you tell him?
ANSWER: Part A, which covers hospital, skilled nursing facility, hospice and home health
services and Part B, which covers professional services such as those provided by a
doctor are covered under Original Medicare .
3. Medicare Part A Coverage Details
Question: Which of the following services are not covered under Medicare Part A?
ANSWER: Outpatient physical therapy .
Rationale: Outpatient therapy is covered under Part B, not Part A, which primarily
covers inpatient and facility-based care .
, 4. Medicare Part D Structure
Question: Which statement is true regarding Medicare Part D coverage stages?
ANSWER: There are four stages: deductible, initial coverage, coverage gap, and
catastrophic coverage .
5. Medicare Savings Account (MSA) Plans
Question: Which of the following statement(s) is/are correct about a Medicare Savings
Account (MSA) Plans?
1. MSAs may have either a partial network, full network, or no network of providers.
2. MSA plans cover Part A and Part B benefits but not Part D prescription drug benefits.
3. An individual who is enrolled in an MSA plan is responsible for a minimal deductible of
$500 indexed for inflation.
4. Non-network providers must accept the same amount that Original Medicare would pay
them as payment in full.
ANSWER: I, II, and IV only .
6. Marketing and Compliance
Question: Which of the following is a prohibited marketing practice under CMS rules?
ANSWER: Cross-selling non-health products during a Medicare sales presentation .
Rationale: Agents cannot promote non-health products (e.g., life insurance, annuities)
during Medicare marketing sessions .
7. Appeals Process
Question: Mrs. Duarte is enrolled in Original Medicare Parts A and B. She has recently
reviewed her Medicare Summary Notice (MSN) and disagrees with a determination that
partially denied one of her claims for services. What advice would you give her?
ANSWER: Mrs. Duarte should file an appeal of this initial determination within 120 days
of the date she received the MSN in the mail .
,8. Enrollment Periods
Question: During the Annual Election Period (AEP), beneficiaries can:
ANSWER: Switch from MA back to Original Medicare and selecting Part D coverage if
desired .
9. Employer-Sponsored Coverage
Question: Mr. Chen is enrolled in his employer's group health plan and will be retiring
soon. He would like to know his options since he has decided to drop his retiree
coverage and is eligible for Medicare. What should you tell him?
ANSWER: Mr. Chen can disenroll from his employer-sponsored coverage to elect a
Medicare Advantage or Part D plan within 2 months of his disenrollment, but he should
revaluate if he really wants to drop his employer coverage .
10. Agent Training Requirements
Question: You are seeking to represent an individual Medicare Advantage plan and an
individual Part D plan in your state. You have completed the required training for each
plan, but you did not achieve a passing score on the tests that came after the training.
What can you do in this situation?
ANSWER: You will not be able to represent any Medicare Advantage or Part D plan until
you complete the training and achieve an adequate score, although you will not have to
take a test if you exclusively market employer/union group plans and the companies do
not require testing .
Mr. Davies is turning 65 next month. He would like to enroll in a Medicare health plan,
but does not want to be limited in terms of where he obtains his care. What should you
tell him about how a Medicare Cost Plan might fit his needs? - ANSWER-a. Cost plan
enrollees can choose to receive Medicare covered services under the plan's benefits by
going to plan network providers and paying plan cost sharing, or may receive services
from non-network providers and pay cost-sharing due under Original Medicare.
b. Ms. Lopez is considered a marketing representative of BestCare and thus is
obligated to comply with CMS marketing requirements, including those regarding using
only approved call scripts. - ANSWER-Ms. Lopez is an independent agent under
, contract with MarketCo, a third-party marketing organization. MarketCo has a contract
with BestCare health plan, a Medicare Advantage (MA) organization, to offer marketing
services through its contracted agents and agencies. Ms. Lopez returns calls to
individuals who contact MarketCo in response to its mailers promoting BestCare health
plan. Which of the following best describes the responsibilities of Ms. Lopez?
a. Ms. Lopez is considered a marketing representative of BestCare but is exempt from
the marketing rules regarding approved call scripts because she works directly for
MarketCo.
b. Ms. Lopez is considered a marketing representative of BestCare and thus is
obligated to comply with CMS marketing requirements, including those regarding using
only approved call scripts.
c. Ms. Lopez no longer needs to be concerned about state licensure since she is
marketing an MA product subject to federal rules.
d. Ms. Lopez needs to maintain state licensure, but because she is working for a third-
party marketing organization she is exempt from CMS training requirements that apply
to BestCare captive agents.
Mr. Edwards, a marketing representative of the ACME Insurance Company, scheduled
a marketing event and expects about 40 people to attend. He has hired a magician at a
cost of $200 to entertain attendees. Can he do this in a way that complies with guidance
from the Medicare agency? - ANSWER-a. He can do this because the estimated
number of attendees is based on the venue size and response rate and the value of the
gift does not exceed $15.
Mrs. Ramos is considering a Medicare Advantage PPO and has questions about which
providers she can go to for her health care. What should you tell her? - ANSWER-b.
Mrs. Ramos can obtain care from any provider who participates in Original Medicare,
but generally will have a higher cost-sharing amount if she sees a provider who/that is
not a part of the PPO network.
Julia Harris is turning 66 in July, at which time she will retire. She has contacted your
office and requested a meeting so that she can learn about Medicare and the products
you represent. How should you respond? - ANSWER-c. Tell Julia that you will meet with
her to explain Medicare and should she be interested you can accept and submit an
enrollment request, since this is an initial enrollment qualifying her for a special
enrollment period.
Mr. Rivera has Qualified Medicare Beneficiary (QMB) eligibility and is thus covered by
both Medicare and Medicaid. He decides to enroll in a Medicare Advantage (MA) PPO
plan. Later he sees an out-of-network doctor to receive a Medicare covered service.
How much The doctor may only collect from Mr. Rivera the cost sharing allowable under
the state's Medicaid program.may the doctor collect from Mr. Rivera? - ANSWER-The
AND STUDY GUIDE LATEST 2026/2027
ACTUAL EXAM 955 QUESTIONS WITH
CORRECT ANSWERS 100% VERIFIED
GRADED A+
1. Medicare Advantage Eligibility
Question: Which of the following individuals is eligible to enroll in a Medicare
Advantage (MA) plan?
ANSWER: A 72-year-old with Medicare Parts A and B who lives within the plan's service
area .
Rationale: To enroll in an MA plan, a beneficiary must be entitled to Part A, enrolled in
Part B, and reside in the plan’s service area .
2. Original Medicare Coverage
Question: Mr. Schmidt would like to plan for retirement and has asked you what is
covered under Original Fee-for-Service (FFS) Medicare. What could you tell him?
ANSWER: Part A, which covers hospital, skilled nursing facility, hospice and home health
services and Part B, which covers professional services such as those provided by a
doctor are covered under Original Medicare .
3. Medicare Part A Coverage Details
Question: Which of the following services are not covered under Medicare Part A?
ANSWER: Outpatient physical therapy .
Rationale: Outpatient therapy is covered under Part B, not Part A, which primarily
covers inpatient and facility-based care .
, 4. Medicare Part D Structure
Question: Which statement is true regarding Medicare Part D coverage stages?
ANSWER: There are four stages: deductible, initial coverage, coverage gap, and
catastrophic coverage .
5. Medicare Savings Account (MSA) Plans
Question: Which of the following statement(s) is/are correct about a Medicare Savings
Account (MSA) Plans?
1. MSAs may have either a partial network, full network, or no network of providers.
2. MSA plans cover Part A and Part B benefits but not Part D prescription drug benefits.
3. An individual who is enrolled in an MSA plan is responsible for a minimal deductible of
$500 indexed for inflation.
4. Non-network providers must accept the same amount that Original Medicare would pay
them as payment in full.
ANSWER: I, II, and IV only .
6. Marketing and Compliance
Question: Which of the following is a prohibited marketing practice under CMS rules?
ANSWER: Cross-selling non-health products during a Medicare sales presentation .
Rationale: Agents cannot promote non-health products (e.g., life insurance, annuities)
during Medicare marketing sessions .
7. Appeals Process
Question: Mrs. Duarte is enrolled in Original Medicare Parts A and B. She has recently
reviewed her Medicare Summary Notice (MSN) and disagrees with a determination that
partially denied one of her claims for services. What advice would you give her?
ANSWER: Mrs. Duarte should file an appeal of this initial determination within 120 days
of the date she received the MSN in the mail .
,8. Enrollment Periods
Question: During the Annual Election Period (AEP), beneficiaries can:
ANSWER: Switch from MA back to Original Medicare and selecting Part D coverage if
desired .
9. Employer-Sponsored Coverage
Question: Mr. Chen is enrolled in his employer's group health plan and will be retiring
soon. He would like to know his options since he has decided to drop his retiree
coverage and is eligible for Medicare. What should you tell him?
ANSWER: Mr. Chen can disenroll from his employer-sponsored coverage to elect a
Medicare Advantage or Part D plan within 2 months of his disenrollment, but he should
revaluate if he really wants to drop his employer coverage .
10. Agent Training Requirements
Question: You are seeking to represent an individual Medicare Advantage plan and an
individual Part D plan in your state. You have completed the required training for each
plan, but you did not achieve a passing score on the tests that came after the training.
What can you do in this situation?
ANSWER: You will not be able to represent any Medicare Advantage or Part D plan until
you complete the training and achieve an adequate score, although you will not have to
take a test if you exclusively market employer/union group plans and the companies do
not require testing .
Mr. Davies is turning 65 next month. He would like to enroll in a Medicare health plan,
but does not want to be limited in terms of where he obtains his care. What should you
tell him about how a Medicare Cost Plan might fit his needs? - ANSWER-a. Cost plan
enrollees can choose to receive Medicare covered services under the plan's benefits by
going to plan network providers and paying plan cost sharing, or may receive services
from non-network providers and pay cost-sharing due under Original Medicare.
b. Ms. Lopez is considered a marketing representative of BestCare and thus is
obligated to comply with CMS marketing requirements, including those regarding using
only approved call scripts. - ANSWER-Ms. Lopez is an independent agent under
, contract with MarketCo, a third-party marketing organization. MarketCo has a contract
with BestCare health plan, a Medicare Advantage (MA) organization, to offer marketing
services through its contracted agents and agencies. Ms. Lopez returns calls to
individuals who contact MarketCo in response to its mailers promoting BestCare health
plan. Which of the following best describes the responsibilities of Ms. Lopez?
a. Ms. Lopez is considered a marketing representative of BestCare but is exempt from
the marketing rules regarding approved call scripts because she works directly for
MarketCo.
b. Ms. Lopez is considered a marketing representative of BestCare and thus is
obligated to comply with CMS marketing requirements, including those regarding using
only approved call scripts.
c. Ms. Lopez no longer needs to be concerned about state licensure since she is
marketing an MA product subject to federal rules.
d. Ms. Lopez needs to maintain state licensure, but because she is working for a third-
party marketing organization she is exempt from CMS training requirements that apply
to BestCare captive agents.
Mr. Edwards, a marketing representative of the ACME Insurance Company, scheduled
a marketing event and expects about 40 people to attend. He has hired a magician at a
cost of $200 to entertain attendees. Can he do this in a way that complies with guidance
from the Medicare agency? - ANSWER-a. He can do this because the estimated
number of attendees is based on the venue size and response rate and the value of the
gift does not exceed $15.
Mrs. Ramos is considering a Medicare Advantage PPO and has questions about which
providers she can go to for her health care. What should you tell her? - ANSWER-b.
Mrs. Ramos can obtain care from any provider who participates in Original Medicare,
but generally will have a higher cost-sharing amount if she sees a provider who/that is
not a part of the PPO network.
Julia Harris is turning 66 in July, at which time she will retire. She has contacted your
office and requested a meeting so that she can learn about Medicare and the products
you represent. How should you respond? - ANSWER-c. Tell Julia that you will meet with
her to explain Medicare and should she be interested you can accept and submit an
enrollment request, since this is an initial enrollment qualifying her for a special
enrollment period.
Mr. Rivera has Qualified Medicare Beneficiary (QMB) eligibility and is thus covered by
both Medicare and Medicaid. He decides to enroll in a Medicare Advantage (MA) PPO
plan. Later he sees an out-of-network doctor to receive a Medicare covered service.
How much The doctor may only collect from Mr. Rivera the cost sharing allowable under
the state's Medicaid program.may the doctor collect from Mr. Rivera? - ANSWER-The
