AHIP Final Exam 2026 Test Questions NEWEST
EXAM 2026-2027 COMPLETE 200 QUESTIONS
AND CORRECT DETAILED ANSWERS
(VERIFIED ANSWERS) ALREADY GRADED
Agent Armstrong is employed by XYZ Agency, which is under contract with ABC Health Plan, a
Medicare Advantage (MA) plan that offers plans in multiple states. XYZ Agency maintains a
website marketing the MA plans with which it has contracts. Agent Armstrong follows up with
individuals who request more information about ABC MA plans via the website and tries to
persuade them to enroll in ABC plans. What statement best describes the marketing and
compliance rules that apply to Agent Armstrong? - CORRECT ANSWER: Agent Armstrong
needs to be licensed and appointed in every state in which beneficiaries to whom he markets
ABC MA plans are located.
Agent Jennings makes a presentation on Medicare advertised as an educational event. Agent
Jennings distributes materials that are solely educational in nature. However, she gives a brief
presentation that mentions plan-specific premiums. Is this a prohibited activity at an event that
has been advertised as educational? - CORRECT ANSWER: Yes. When an event has been
advertised as "educational," discussing plan-specific premiums is impermissible.
Agent Martinez wishes to solicit Medicare Advantage prospects through e-mail and asks you for
advice as to whether this is possible. What should you tell her? - CORRECT ANSWER:
Marketing representatives may initiate electronic contact through e-mail but the subject line must
say "marketing" and an opt-out process must be provided.
Alice is enrolled in a MA-PD plan. She makes a permanent move across the country and
wonders what her options are for continuing MA-PD coverage. What would you say to her in
regard to a special enrollment period (SEP)? - CORRECT ANSWER: She is likely to qualify for
a SEP. She can choose an effective date of up to three months after the month in which the
enrollment form is received by the new plan, but the effective date may not be earlier than the
date of her permanent move.
Another agent working for your agency claims that because you are not employed by the
Medicare Advantage plans that you represent, you are not subject to the same requirements as the
,plans themselves. How should you respond to such a statement? - CORRECT ANSWER: Your
coworker is not correct. Marketing on behalf of a plan is considered marketing by the plan and
requires that all contracted and employed agents comply with all Medicare marketing rules.
During a sales presentation, your client asks you whether the Medicare agency recommends that
she sign up for your plan or stay in Original Medicare. What should you tell her? - CORRECT
ANSWER: Tell her that the Medicare agency does not endorse or recommend any plan.
Mr. and Mrs. Nunez attended one of your sales presentations. They've asked you to come to their
home to clear up a few questions. During the presentation, Mrs. Nunez feels tired and tells you
that her husband can finish things up. She goes to bed. At the end of your discussion, Mr. Nunez
says that he wants to enroll both himself and his wife. What should you do? - CORRECT
ANSWER: As long as she is able to do so, only Mrs. Nunez can sign her enrollment form. Mrs.
Nunez will have to wake up to sign her form or do so at another time.
Mr. Barker enjoys a comfortable retirement income. He recently had surgery and expected that
he would have certain services and items covered by the plan with minimal out-of-pocket costs
because his MA-PD coverage has been very good. However, when he received the bill, he was
surprised to see large charges in excess of his maximum out-of-pocket limit that included a
number of services and items he thought would be fully covered. He called you to ask what he
could do? What could you tell him? - CORRECT ANSWER: You can offer to review the plans
appeal process to help him ask the plan to review the coverage decision.
Mr. Bickford did not quite qualify for the extra help low-income subsidy under the Medicare Part
D Prescription Drug program and he is wondering if there is any other option he has for
obtaining help with his considerable drug costs. What should you tell him? - CORRECT
ANSWER: He could check with the manufacturers of his medications to see if they offer an
assistance program to help people with limited means obtain the medications they need.
Alternatively, he could check to see whether his state has a pharmacy assistance program to help
him with his expenses.
Mr. Castillo, a naturalized citizen, previously enrolled in Medicare Part B but has recently
stopped paying his Part B premium. Mr. Castillo is still covered by Part A. He would like to
enroll in a Medicare Advantage (MA) plan and is still covered by Part A. What should you tell
,him? - CORRECT ANSWER: He is not eligible to enroll in a Medicare Advantage plan until he
re-enrolls in Medicare Part B.
Mr. Chen has heard about Medical Savings Account (MSA), but wants to know if it is just about
saving money, or if he will get insurance coverage for his health care expenditures as well. What
should you tell him? - CORRECT ANSWER: Under the Medicare Advantage program. an MSA
plan involves the combination of high deductible health plan and savings account for health
expenses. Medicare will make contributions to this savings account to help him pay his health
care expenses while in the deductible.
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? - CORRECT 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.
Mr. Cole has been a Medicaid beneficiary for some time, and recently qualified for Medicare as
well. He is concerned about changes in his cost-sharing. What should you tell him? - CORRECT
ANSWER: He should know that Medicaid will pay cost sharing only for services provided by
Medicaid participating providers.
Mr. Davis is 52 years old and has recently been diagnosed with end-stage renal disease (ESRD)
and will soon begin dialysis. He is wondering if he can obtain coverage under Medicare. What
should you tell him? - CORRECT ANSWER: He may sign-up for Medicare at any time however
coverage usually begins on the fourth month after dialysis treatments start.
Mr. Jacob understands that there is a standard Medicare Part D prescription drug benefit, but
when he looks at information on various plans available in his area, he sees a wide range in what
they charge for deductibles, premiums and cost sharing. How can you explain this to him? -
CORRECT ANSWER: Medicare Part D drug plans may have different benefit structures, but on
average, they must all be at least as good as the standard model established by the government.
Mr. Johannsen is entitled to Medicare Part A and Part B. He gains the Part D low-income
subsidy. How does that affect his ability to enroll or disenroll in a Part D plan? - CORRECT
, ANSWER: He qualifies for a special election period and can enroll in or disenroll from a Part D
plan once during that period.
Mr. Lombardi is interested in a Medicare Advantage (MA) PPO plan that you represent. It is one
of three plans operated by the same organization in Mr. Lombardi's area. The MA PPO plan does
not include drug coverage, but the other two plans do. Mr. Lombardi likes the PPO plan that does
not include drug coverage and intends to obtain his drug coverage through a stand-alone
Medicare prescription drug plan. What should you tell him about this situation? - CORRECT
ANSWER: He could enroll in one of the MA plans that include prescription drug coverage or a
Medigap plan and a stand-alone prescription drug plan, but he cannot enroll in the MA-only PPO
plan and a stand-alone prescription drug plan.
Mr. Lopez, who is fairly well-off financially, would like to enroll in a Medicare prescription drug
plan you represent and simply give you a check to cover his premiums for the entire year. What
should you tell him? - CORRECT ANSWER: Enrollees should pay using automatic withdrawal
from a bank account or credit or debit card, direct monthly billing from the plan, or deductions
from their Social Security check.
Mr. Moy's wife has a Medicare Advantage plan, but he wants to understand what coverage
Medicare Supplemental Insurance provides since his health care needs are different from his
wife's needs. What could you tell Mr. Moy? - CORRECT ANSWER: Medicare Supplemental
Insurance would help cover his Part A and Part B cost sharing in Original Fee-for-Service (FFS)
Medicare as well as possibly some services that Medicare does not cover.
Mr. Patel is in good health and is preparing a budget in anticipation of his retirement when he
turns 66. He wants to understand the health care costs he might be exposed to under Medicare if
he were to require hospitalization as a result of an illness. In general terms, what could you tell
him about his costs for inpatient hospital services under Original Medicare? - CORRECT
ANSWER: Under Original Medicare, there is a single deductible amount due for the first 60
days of any inpatient
hospital stay, after which it converts into a per-day amount through day 90. After day 90, he
would pay a daily
amount up to 60 days over his lifetime, after which he would be responsible for all costs
EXAM 2026-2027 COMPLETE 200 QUESTIONS
AND CORRECT DETAILED ANSWERS
(VERIFIED ANSWERS) ALREADY GRADED
Agent Armstrong is employed by XYZ Agency, which is under contract with ABC Health Plan, a
Medicare Advantage (MA) plan that offers plans in multiple states. XYZ Agency maintains a
website marketing the MA plans with which it has contracts. Agent Armstrong follows up with
individuals who request more information about ABC MA plans via the website and tries to
persuade them to enroll in ABC plans. What statement best describes the marketing and
compliance rules that apply to Agent Armstrong? - CORRECT ANSWER: Agent Armstrong
needs to be licensed and appointed in every state in which beneficiaries to whom he markets
ABC MA plans are located.
Agent Jennings makes a presentation on Medicare advertised as an educational event. Agent
Jennings distributes materials that are solely educational in nature. However, she gives a brief
presentation that mentions plan-specific premiums. Is this a prohibited activity at an event that
has been advertised as educational? - CORRECT ANSWER: Yes. When an event has been
advertised as "educational," discussing plan-specific premiums is impermissible.
Agent Martinez wishes to solicit Medicare Advantage prospects through e-mail and asks you for
advice as to whether this is possible. What should you tell her? - CORRECT ANSWER:
Marketing representatives may initiate electronic contact through e-mail but the subject line must
say "marketing" and an opt-out process must be provided.
Alice is enrolled in a MA-PD plan. She makes a permanent move across the country and
wonders what her options are for continuing MA-PD coverage. What would you say to her in
regard to a special enrollment period (SEP)? - CORRECT ANSWER: She is likely to qualify for
a SEP. She can choose an effective date of up to three months after the month in which the
enrollment form is received by the new plan, but the effective date may not be earlier than the
date of her permanent move.
Another agent working for your agency claims that because you are not employed by the
Medicare Advantage plans that you represent, you are not subject to the same requirements as the
,plans themselves. How should you respond to such a statement? - CORRECT ANSWER: Your
coworker is not correct. Marketing on behalf of a plan is considered marketing by the plan and
requires that all contracted and employed agents comply with all Medicare marketing rules.
During a sales presentation, your client asks you whether the Medicare agency recommends that
she sign up for your plan or stay in Original Medicare. What should you tell her? - CORRECT
ANSWER: Tell her that the Medicare agency does not endorse or recommend any plan.
Mr. and Mrs. Nunez attended one of your sales presentations. They've asked you to come to their
home to clear up a few questions. During the presentation, Mrs. Nunez feels tired and tells you
that her husband can finish things up. She goes to bed. At the end of your discussion, Mr. Nunez
says that he wants to enroll both himself and his wife. What should you do? - CORRECT
ANSWER: As long as she is able to do so, only Mrs. Nunez can sign her enrollment form. Mrs.
Nunez will have to wake up to sign her form or do so at another time.
Mr. Barker enjoys a comfortable retirement income. He recently had surgery and expected that
he would have certain services and items covered by the plan with minimal out-of-pocket costs
because his MA-PD coverage has been very good. However, when he received the bill, he was
surprised to see large charges in excess of his maximum out-of-pocket limit that included a
number of services and items he thought would be fully covered. He called you to ask what he
could do? What could you tell him? - CORRECT ANSWER: You can offer to review the plans
appeal process to help him ask the plan to review the coverage decision.
Mr. Bickford did not quite qualify for the extra help low-income subsidy under the Medicare Part
D Prescription Drug program and he is wondering if there is any other option he has for
obtaining help with his considerable drug costs. What should you tell him? - CORRECT
ANSWER: He could check with the manufacturers of his medications to see if they offer an
assistance program to help people with limited means obtain the medications they need.
Alternatively, he could check to see whether his state has a pharmacy assistance program to help
him with his expenses.
Mr. Castillo, a naturalized citizen, previously enrolled in Medicare Part B but has recently
stopped paying his Part B premium. Mr. Castillo is still covered by Part A. He would like to
enroll in a Medicare Advantage (MA) plan and is still covered by Part A. What should you tell
,him? - CORRECT ANSWER: He is not eligible to enroll in a Medicare Advantage plan until he
re-enrolls in Medicare Part B.
Mr. Chen has heard about Medical Savings Account (MSA), but wants to know if it is just about
saving money, or if he will get insurance coverage for his health care expenditures as well. What
should you tell him? - CORRECT ANSWER: Under the Medicare Advantage program. an MSA
plan involves the combination of high deductible health plan and savings account for health
expenses. Medicare will make contributions to this savings account to help him pay his health
care expenses while in the deductible.
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? - CORRECT 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.
Mr. Cole has been a Medicaid beneficiary for some time, and recently qualified for Medicare as
well. He is concerned about changes in his cost-sharing. What should you tell him? - CORRECT
ANSWER: He should know that Medicaid will pay cost sharing only for services provided by
Medicaid participating providers.
Mr. Davis is 52 years old and has recently been diagnosed with end-stage renal disease (ESRD)
and will soon begin dialysis. He is wondering if he can obtain coverage under Medicare. What
should you tell him? - CORRECT ANSWER: He may sign-up for Medicare at any time however
coverage usually begins on the fourth month after dialysis treatments start.
Mr. Jacob understands that there is a standard Medicare Part D prescription drug benefit, but
when he looks at information on various plans available in his area, he sees a wide range in what
they charge for deductibles, premiums and cost sharing. How can you explain this to him? -
CORRECT ANSWER: Medicare Part D drug plans may have different benefit structures, but on
average, they must all be at least as good as the standard model established by the government.
Mr. Johannsen is entitled to Medicare Part A and Part B. He gains the Part D low-income
subsidy. How does that affect his ability to enroll or disenroll in a Part D plan? - CORRECT
, ANSWER: He qualifies for a special election period and can enroll in or disenroll from a Part D
plan once during that period.
Mr. Lombardi is interested in a Medicare Advantage (MA) PPO plan that you represent. It is one
of three plans operated by the same organization in Mr. Lombardi's area. The MA PPO plan does
not include drug coverage, but the other two plans do. Mr. Lombardi likes the PPO plan that does
not include drug coverage and intends to obtain his drug coverage through a stand-alone
Medicare prescription drug plan. What should you tell him about this situation? - CORRECT
ANSWER: He could enroll in one of the MA plans that include prescription drug coverage or a
Medigap plan and a stand-alone prescription drug plan, but he cannot enroll in the MA-only PPO
plan and a stand-alone prescription drug plan.
Mr. Lopez, who is fairly well-off financially, would like to enroll in a Medicare prescription drug
plan you represent and simply give you a check to cover his premiums for the entire year. What
should you tell him? - CORRECT ANSWER: Enrollees should pay using automatic withdrawal
from a bank account or credit or debit card, direct monthly billing from the plan, or deductions
from their Social Security check.
Mr. Moy's wife has a Medicare Advantage plan, but he wants to understand what coverage
Medicare Supplemental Insurance provides since his health care needs are different from his
wife's needs. What could you tell Mr. Moy? - CORRECT ANSWER: Medicare Supplemental
Insurance would help cover his Part A and Part B cost sharing in Original Fee-for-Service (FFS)
Medicare as well as possibly some services that Medicare does not cover.
Mr. Patel is in good health and is preparing a budget in anticipation of his retirement when he
turns 66. He wants to understand the health care costs he might be exposed to under Medicare if
he were to require hospitalization as a result of an illness. In general terms, what could you tell
him about his costs for inpatient hospital services under Original Medicare? - CORRECT
ANSWER: Under Original Medicare, there is a single deductible amount due for the first 60
days of any inpatient
hospital stay, after which it converts into a per-day amount through day 90. After day 90, he
would pay a daily
amount up to 60 days over his lifetime, after which he would be responsible for all costs
