AHIP 2026–2027
Medicare Certification
Enhanced Original Study Guide & Practice Exam
Medicare fundamentals • Parts A–D • Medicare Advantage • Part D • Enrollment • Marketing & compliance
• Ethics • Appeals • 2027 updates
Important: This is an original educational study guide created from the publicly visible Stuvia preview and current CMS materials.
It does not reproduce or provide paid/locked test-bank content, and it is not an actual or guaranteed AHIP exam.
Prepared for intensive review of the 2026–2027 certification cycle.
AHIP 2026–2027 Enhanced Original Study Guide Page 1
, 1. Exam Blueprint & How to Use This Guide
The public preview of the referenced 29-page Stuvia document shows an exam-elaboration format centered on Medicare
fundamentals, eligibility/enrollment, Parts A and B, Part D, and current-year cost figures. The preview also contains several
figures that conflict with current CMS-published 2026 values. This guide deliberately prioritizes current CMS sources when
a discrepancy exists.
High-yield domains: Medicare eligibility and enrollment periods; Original Medicare vs Medicare Advantage; Medigap; Part
D structure and late-enrollment penalty; Medicare Advantage plan types; SNPs; formularies and utilization management;
beneficiary protections; marketing and agent/broker rules; TPMO consent; grievances/appeals; fraud, waste and abuse;
ethics and compliant sales conversations.
Study method: First memorize the comparison tables and enrollment timelines. Then complete the practice questions
without looking at the answers. Finish with the case scenarios and 60-second recall checklist.
2. Medicare at a Glance
Component Core purpose High-yield distinction
Part A Hospital Insurance Inpatient hospital, SNF, hospice, certain home health
Part B Medical Insurance Physician/outpatient services, DME, preventive services and other medically necessary care
Part C Medicare Advantage Private Medicare-approved alternative to Original Medicare; generally includes Part A and Part B
Part D Prescription drug coverage Stand-alone PDP or integrated into MA-PD
Medigap Supplement to Original Medicare
Helps pay certain Original Medicare cost sharing; generally cannot be used with Medicare Advantage
2026 verified figures: CMS lists the standard Part B premium at $202.90/month and the Part B deductible at $283. The Part A
inpatient deductible is $1,736 per benefit period. These values supersede conflicting figures appearing in the public Stuvia
preview.
A benefit period for Part A hospital coverage is not the same thing as a calendar year. A new Part A hospital deductible can
apply when a new benefit period begins.
3. Eligibility & Enrollment Timelines
Initial Enrollment Period (IEP): For someone becoming eligible because of age 65, the IEP is generally a 7-month
window: 3 months before the birthday month, the birthday month, and 3 months after. The exact effective-date rules can
vary based on when enrollment occurs.
Part B Special Enrollment Period: People who delay Part B because they have qualifying group health coverage based
on current employment may generally enroll while covered or during the 8-month period after employment or group health
coverage ends, subject to the governing rules.
General Enrollment Period (GEP): Used for certain people who miss their initial opportunity to enroll in Part B. Coverage
timing and late-enrollment penalties should be distinguished from an SEP.
Part D election periods: CMS's current 2027 guidance identifies the Part D IEP, ICEP, AEP, MA OEP, OEPI, and SEPs
as election-period categories.
Period Remember
AEP Annual Election Period: October 15–December 7; changes generally take effect January 1
MA OEP Medicare Advantage enrollees may make a permitted change during Jan 1–Mar 31; this is not an open shopping period for everyone
SEP Special circumstance-based election opportunity; rules depend on the triggering event
ICEP Initial Coverage Election Period associated with first becoming eligible for Medicare Advantage
AHIP 2026–2027 Enhanced Original Study Guide Page 2
Medicare Certification
Enhanced Original Study Guide & Practice Exam
Medicare fundamentals • Parts A–D • Medicare Advantage • Part D • Enrollment • Marketing & compliance
• Ethics • Appeals • 2027 updates
Important: This is an original educational study guide created from the publicly visible Stuvia preview and current CMS materials.
It does not reproduce or provide paid/locked test-bank content, and it is not an actual or guaranteed AHIP exam.
Prepared for intensive review of the 2026–2027 certification cycle.
AHIP 2026–2027 Enhanced Original Study Guide Page 1
, 1. Exam Blueprint & How to Use This Guide
The public preview of the referenced 29-page Stuvia document shows an exam-elaboration format centered on Medicare
fundamentals, eligibility/enrollment, Parts A and B, Part D, and current-year cost figures. The preview also contains several
figures that conflict with current CMS-published 2026 values. This guide deliberately prioritizes current CMS sources when
a discrepancy exists.
High-yield domains: Medicare eligibility and enrollment periods; Original Medicare vs Medicare Advantage; Medigap; Part
D structure and late-enrollment penalty; Medicare Advantage plan types; SNPs; formularies and utilization management;
beneficiary protections; marketing and agent/broker rules; TPMO consent; grievances/appeals; fraud, waste and abuse;
ethics and compliant sales conversations.
Study method: First memorize the comparison tables and enrollment timelines. Then complete the practice questions
without looking at the answers. Finish with the case scenarios and 60-second recall checklist.
2. Medicare at a Glance
Component Core purpose High-yield distinction
Part A Hospital Insurance Inpatient hospital, SNF, hospice, certain home health
Part B Medical Insurance Physician/outpatient services, DME, preventive services and other medically necessary care
Part C Medicare Advantage Private Medicare-approved alternative to Original Medicare; generally includes Part A and Part B
Part D Prescription drug coverage Stand-alone PDP or integrated into MA-PD
Medigap Supplement to Original Medicare
Helps pay certain Original Medicare cost sharing; generally cannot be used with Medicare Advantage
2026 verified figures: CMS lists the standard Part B premium at $202.90/month and the Part B deductible at $283. The Part A
inpatient deductible is $1,736 per benefit period. These values supersede conflicting figures appearing in the public Stuvia
preview.
A benefit period for Part A hospital coverage is not the same thing as a calendar year. A new Part A hospital deductible can
apply when a new benefit period begins.
3. Eligibility & Enrollment Timelines
Initial Enrollment Period (IEP): For someone becoming eligible because of age 65, the IEP is generally a 7-month
window: 3 months before the birthday month, the birthday month, and 3 months after. The exact effective-date rules can
vary based on when enrollment occurs.
Part B Special Enrollment Period: People who delay Part B because they have qualifying group health coverage based
on current employment may generally enroll while covered or during the 8-month period after employment or group health
coverage ends, subject to the governing rules.
General Enrollment Period (GEP): Used for certain people who miss their initial opportunity to enroll in Part B. Coverage
timing and late-enrollment penalties should be distinguished from an SEP.
Part D election periods: CMS's current 2027 guidance identifies the Part D IEP, ICEP, AEP, MA OEP, OEPI, and SEPs
as election-period categories.
Period Remember
AEP Annual Election Period: October 15–December 7; changes generally take effect January 1
MA OEP Medicare Advantage enrollees may make a permitted change during Jan 1–Mar 31; this is not an open shopping period for everyone
SEP Special circumstance-based election opportunity; rules depend on the triggering event
ICEP Initial Coverage Election Period associated with first becoming eligible for Medicare Advantage
AHIP 2026–2027 Enhanced Original Study Guide Page 2
