AHIP Final Exam | Questions And Answers | With
Verified Study Solutions | 2026/2027 Updates
QUESTION 1
Mr. Khan's employer has recently dropped comprehensive creditable prescription drug coverage that was
offered to company retirees. The company told Mr. Khan that, because he was affected by this change, he
would qualify for a special election period. Mr. Khan contacted you to find out more about what this
means. What can you tell him?
A. It means he can enroll in a Medicare Advantage plan at any time
B. It means he qualifies for a one-time opportunity to enroll in a Part D prescription drug plan
C. It means he must wait until the Annual Election Period to enroll
D. It means he can switch plans multiple times during the year
Correct Answer: B. It means he qualifies for a one-time opportunity to enroll in a Part D prescription drug
plan
Expert Rationale: When an employer drops creditable prescription drug coverage, beneficiaries qualify
for a Special Election Period (SEP) that allows them a one-time opportunity to enroll in a Part D
prescription drug plan. This SEP is triggered by the loss of creditable coverage. The SEP is not unlimited
(A) and does not require waiting for the Annual Election Period (C). The SEP provides a single
enrollment opportunity, not multiple switches (D).
QUESTION 2
Mr. Chambers suffers from diabetes which has gotten progressively worse during the last year. He is
currently enrolled in Original Medicare (Parts A and B) and a Part D prescription drug plan and did not
enroll in a Medicare Advantage (MA) plan during the last annual open enrollment period (AEP) which
has just closed. Mr. Chambers has heard certain MA plans might provide him with more specialized
coverage for his diabetes and wants to know if he must wait until the next annual open enrollment period
(AEP) before enrolling in such a plan. What should you tell him?
A. He must wait until the next AEP to enroll in any MA plan
B. He can enroll in any MA plan at any time due to his diabetes diagnosis
,C. If there is a special needs plan (SNP) in his area that specializes in caring for individuals with diabetes,
he may enroll in the SNP at any time under a special election period (SEP)
D. He can only enroll in an MA plan during the Medicare Advantage Open Enrollment Period (MA OEP)
Correct Answer: C. If there is a special needs plan (SNP) in his area that specializes in caring for
individuals with diabetes, he may enroll in the SNP at any time under a special election period (SEP)
Expert Rationale: Individuals with diabetes may qualify for a Chronic Condition Special Needs Plan (C-
SNP) if available in their area. They can enroll in such plans at any time through a Special Election Period
(SEP). The patient does not have to wait for the AEP (A). Not all MA plans are available at any time (B),
only SNPs for qualifying conditions. The MA OEP (D) is not the only enrollment opportunity.
QUESTION 3
Which of the following individuals are likely to qualify for a special election period (SEP) for either an
MA or Part D due to a change of residence?
I. Edward (enrolled in MA and Part D) moves to a new home within the same neighborhood in his
existing plan's service area.
II. Fiona (enrolled in MA and Part D) moves cross-country to an area outside her existing plan's service
area.
III. Gilbert moves into a plan service area where there is now a Part D plan available to him from a
service area where no Part D plan was available.
IV. Henry makes a permanent move to a new state providing him with new MA and Part D options
A. I, II, III, and IV
B. II, III, and IV only
C. I and II only
D. I, II, and III only
,Correct Answer: B. II, III, and IV only
Expert Rationale: A change of residence qualifies for a SEP when the beneficiary moves outside the plan's
service area (II), moves into an area where a Part D plan is now available where none was available
before (III), or makes a permanent move to a new state with new MA and Part D options (IV). Moving
within the same neighborhood in the existing plan's service area (I) does NOT qualify for a SEP, as the
beneficiary still has access to their current plan.
QUESTION 4
Mr. Washington is turning 65 next month and has asked you what he can do, and when he must do it, with
respect to enrolling in Part D. What could you tell him?
A. He must wait until the Annual Election Period to enroll in Part D
B. He is currently in the Part D Initial Enrollment Period (IEP), and during this time, he may make one
Part D enrollment choice, including enrollment in a stand-alone Part D plan or an MA-PD plan
C. He can only enroll in a stand-alone Part D plan during his IEP
D. He has a 6-month window after turning 65 to enroll without penalty
Correct Answer: B. He is currently in the Part D Initial Enrollment Period (IEP), and during this time, he
may make one Part D enrollment choice, including enrollment in a stand-alone Part D plan or an MA-PD
plan
Expert Rationale: The Initial Enrollment Period (IEP) for Part D begins 3 months before the month of
eligibility and ends 3 months after. During this time, beneficiaries can make one Part D enrollment
choice, which includes enrolling in a stand-alone Part D plan or an MA-PD plan. They do not have to
wait for the AEP (A). They are not limited to stand-alone plans only (C). The IEP is 7 months total, not
just 6 months after turning 65 (D).
QUESTION 5
Mrs. Fowler is moving and a friend told her she might qualify for a "special election period" to enroll in a
new Medicare Advantage plan. She contacted you to ask what a special election period is. What could
you tell her?
, A. It is a period when all Medicare beneficiaries can change plans
B. It is a period, outside of the Annual Election Period, when a Medicare beneficiary can select a new or
different Medicare Advantage and/or Part D prescription drug plan. Typically, the special election period
is beneficiary specific and results from events, such as when the beneficiary moves outside of the service
area
C. It is a period that occurs once per year for all beneficiaries
D. It is a period that only applies to Part D prescription drug plans
Correct Answer: B. It is a period, outside of the Annual Election Period, when a Medicare beneficiary can
select a new or different Medicare Advantage and/or Part D prescription drug plan. Typically, the special
election period is beneficiary specific and results from events, such as when the beneficiary moves
outside of the service area
Expert Rationale: A Special Election Period (SEP) is a beneficiary-specific enrollment period triggered by
qualifying events such as moving outside the service area, losing creditable coverage, or
institutionalization. It occurs outside the Annual Election Period and allows beneficiaries to change their
MA and/or Part D coverage. SEPs are not for all beneficiaries (A), do not occur annually (C), and apply to
both MA and Part D plans (D).
QUESTION 6
When Emma first became eligible for Medicare, she enrolled in Original Medicare (Parts A and B). She is
now 67 and will turn 68 on July 1. She would now like to enroll in a Medicare Advantage (MA) plan and
approaches you about her options. What advice would you give her?
A. She can enroll in an MA plan at any time since she is 67
B. She should remain in Original Medicare until the annual election period running from October 15 to
December 7, during which she can select an MA plan
C. She must wait until she turns 68 to enroll in an MA plan
D. She can enroll in an MA plan during the Medicare Advantage Open Enrollment Period (MA OEP)
from January 1 to March 31
Correct Answer: B. She should remain in Original Medicare until the annual election period running from
October 15 to December 7, during which she can select an MA plan
Verified Study Solutions | 2026/2027 Updates
QUESTION 1
Mr. Khan's employer has recently dropped comprehensive creditable prescription drug coverage that was
offered to company retirees. The company told Mr. Khan that, because he was affected by this change, he
would qualify for a special election period. Mr. Khan contacted you to find out more about what this
means. What can you tell him?
A. It means he can enroll in a Medicare Advantage plan at any time
B. It means he qualifies for a one-time opportunity to enroll in a Part D prescription drug plan
C. It means he must wait until the Annual Election Period to enroll
D. It means he can switch plans multiple times during the year
Correct Answer: B. It means he qualifies for a one-time opportunity to enroll in a Part D prescription drug
plan
Expert Rationale: When an employer drops creditable prescription drug coverage, beneficiaries qualify
for a Special Election Period (SEP) that allows them a one-time opportunity to enroll in a Part D
prescription drug plan. This SEP is triggered by the loss of creditable coverage. The SEP is not unlimited
(A) and does not require waiting for the Annual Election Period (C). The SEP provides a single
enrollment opportunity, not multiple switches (D).
QUESTION 2
Mr. Chambers suffers from diabetes which has gotten progressively worse during the last year. He is
currently enrolled in Original Medicare (Parts A and B) and a Part D prescription drug plan and did not
enroll in a Medicare Advantage (MA) plan during the last annual open enrollment period (AEP) which
has just closed. Mr. Chambers has heard certain MA plans might provide him with more specialized
coverage for his diabetes and wants to know if he must wait until the next annual open enrollment period
(AEP) before enrolling in such a plan. What should you tell him?
A. He must wait until the next AEP to enroll in any MA plan
B. He can enroll in any MA plan at any time due to his diabetes diagnosis
,C. If there is a special needs plan (SNP) in his area that specializes in caring for individuals with diabetes,
he may enroll in the SNP at any time under a special election period (SEP)
D. He can only enroll in an MA plan during the Medicare Advantage Open Enrollment Period (MA OEP)
Correct Answer: C. If there is a special needs plan (SNP) in his area that specializes in caring for
individuals with diabetes, he may enroll in the SNP at any time under a special election period (SEP)
Expert Rationale: Individuals with diabetes may qualify for a Chronic Condition Special Needs Plan (C-
SNP) if available in their area. They can enroll in such plans at any time through a Special Election Period
(SEP). The patient does not have to wait for the AEP (A). Not all MA plans are available at any time (B),
only SNPs for qualifying conditions. The MA OEP (D) is not the only enrollment opportunity.
QUESTION 3
Which of the following individuals are likely to qualify for a special election period (SEP) for either an
MA or Part D due to a change of residence?
I. Edward (enrolled in MA and Part D) moves to a new home within the same neighborhood in his
existing plan's service area.
II. Fiona (enrolled in MA and Part D) moves cross-country to an area outside her existing plan's service
area.
III. Gilbert moves into a plan service area where there is now a Part D plan available to him from a
service area where no Part D plan was available.
IV. Henry makes a permanent move to a new state providing him with new MA and Part D options
A. I, II, III, and IV
B. II, III, and IV only
C. I and II only
D. I, II, and III only
,Correct Answer: B. II, III, and IV only
Expert Rationale: A change of residence qualifies for a SEP when the beneficiary moves outside the plan's
service area (II), moves into an area where a Part D plan is now available where none was available
before (III), or makes a permanent move to a new state with new MA and Part D options (IV). Moving
within the same neighborhood in the existing plan's service area (I) does NOT qualify for a SEP, as the
beneficiary still has access to their current plan.
QUESTION 4
Mr. Washington is turning 65 next month and has asked you what he can do, and when he must do it, with
respect to enrolling in Part D. What could you tell him?
A. He must wait until the Annual Election Period to enroll in Part D
B. He is currently in the Part D Initial Enrollment Period (IEP), and during this time, he may make one
Part D enrollment choice, including enrollment in a stand-alone Part D plan or an MA-PD plan
C. He can only enroll in a stand-alone Part D plan during his IEP
D. He has a 6-month window after turning 65 to enroll without penalty
Correct Answer: B. He is currently in the Part D Initial Enrollment Period (IEP), and during this time, he
may make one Part D enrollment choice, including enrollment in a stand-alone Part D plan or an MA-PD
plan
Expert Rationale: The Initial Enrollment Period (IEP) for Part D begins 3 months before the month of
eligibility and ends 3 months after. During this time, beneficiaries can make one Part D enrollment
choice, which includes enrolling in a stand-alone Part D plan or an MA-PD plan. They do not have to
wait for the AEP (A). They are not limited to stand-alone plans only (C). The IEP is 7 months total, not
just 6 months after turning 65 (D).
QUESTION 5
Mrs. Fowler is moving and a friend told her she might qualify for a "special election period" to enroll in a
new Medicare Advantage plan. She contacted you to ask what a special election period is. What could
you tell her?
, A. It is a period when all Medicare beneficiaries can change plans
B. It is a period, outside of the Annual Election Period, when a Medicare beneficiary can select a new or
different Medicare Advantage and/or Part D prescription drug plan. Typically, the special election period
is beneficiary specific and results from events, such as when the beneficiary moves outside of the service
area
C. It is a period that occurs once per year for all beneficiaries
D. It is a period that only applies to Part D prescription drug plans
Correct Answer: B. It is a period, outside of the Annual Election Period, when a Medicare beneficiary can
select a new or different Medicare Advantage and/or Part D prescription drug plan. Typically, the special
election period is beneficiary specific and results from events, such as when the beneficiary moves
outside of the service area
Expert Rationale: A Special Election Period (SEP) is a beneficiary-specific enrollment period triggered by
qualifying events such as moving outside the service area, losing creditable coverage, or
institutionalization. It occurs outside the Annual Election Period and allows beneficiaries to change their
MA and/or Part D coverage. SEPs are not for all beneficiaries (A), do not occur annually (C), and apply to
both MA and Part D plans (D).
QUESTION 6
When Emma first became eligible for Medicare, she enrolled in Original Medicare (Parts A and B). She is
now 67 and will turn 68 on July 1. She would now like to enroll in a Medicare Advantage (MA) plan and
approaches you about her options. What advice would you give her?
A. She can enroll in an MA plan at any time since she is 67
B. She should remain in Original Medicare until the annual election period running from October 15 to
December 7, during which she can select an MA plan
C. She must wait until she turns 68 to enroll in an MA plan
D. She can enroll in an MA plan during the Medicare Advantage Open Enrollment Period (MA OEP)
from January 1 to March 31
Correct Answer: B. She should remain in Original Medicare until the annual election period running from
October 15 to December 7, during which she can select an MA plan
