2026 AHIP MODULE 5 PRACTICE EXAM ENROLLMENT
GUIDANCE: MEDICARE ADVANTAGE AND PART D
ELECTION, ENROLLMENT, AND DISENROLLMENT
1. Regarding Annual Election Period, How should this situation be interpreted?
A. April 1-June 30
B. The AEP runs October 15 through December 7, with elections generally effective January 1
C. January 1-March 31
D. September 1-September 30
Correct Answer: B. The AEP runs October 15 through December 7, with elections generally effective January 1
Rationale: The Medicare Annual Election Period is October 15-December 7 each year, generally for coverage
effective January 1.
2. A beneficiary is comparing several enrollment statements involving Authorized representative. Which
statement is accurate under Medicare rules?
A. Any neighbor may sign without authority
B. The selling agent automatically becomes legal representative
C. Only the beneficiary may ever sign
D. A legally authorized representative may complete an enrollment request on behalf of a beneficiary when
applicable requirements are met
Correct Answer: D. A legally authorized representative may complete an enrollment request on behalf of a
beneficiary when applicable requirements are met
Rationale: Medicare enrollment permits authorized representatives but requires valid authority.
3. Janet is reviewing Medicare coverage after receiving a plan notice and asks about Medicaid or Extra
Help SEP. What should the beneficiary be told?
A. Eligible people with Medicaid or Extra Help may have a recurring SEP allowing plan changes on the schedule
set by current CMS rules
B. They may change only during AEP
C. They are locked in for the full year
D. Extra Help affects costs but never enrollment rights
Correct Answer: A. Eligible people with Medicaid or Extra Help may have a recurring SEP allowing plan
changes on the schedule set by current CMS rules
Rationale: Current Medicare rules provide special enrollment flexibility for certain beneficiaries with Medicaid
or Extra Help.
4. A plan receives an enrollment-related request involving Discrimination. Which disposition best follows
Medicare enrollment rules?
A. Hospital use automatically disqualifies an applicant
B. Agents may require medical underwriting
C. Plans may not deny enrollment to an otherwise eligible person based on health status, except where lawful
specialized eligibility criteria apply
D. Ordinary MA plans may screen out high-cost members
Correct Answer: C. Plans may not deny enrollment to an otherwise eligible person based on health status, except
where lawful specialized eligibility criteria apply
Rationale: Medicare MA and Part D enrollment rules include nondiscrimination protections.
5. Regarding 5-star SEP, Which conclusion is correct?
A. It guarantees lower premiums
B. It is available only during AEP
C. A beneficiary may use the 5-star SEP to switch to an available 5-star Medicare plan during the permitted
period, subject to eligibility rules
D. A 5-star SEP allows switching to any 2-star plan
Correct Answer: C. A beneficiary may use the 5-star SEP to switch to an available 5-star Medicare plan during
the permitted period, subject to eligibility rules
Rationale: Medicare offers a special election opportunity for switching to qualifying 5-star plans when available.
,6. A beneficiary is comparing several enrollment statements involving Annual Election Period. Which
statement is accurate under Medicare rules?
A. The AEP runs October 15 through December 7, with elections generally effective January 1
B. September 1-September 30
C. January 1-March 31
D. April 1-June 30
Correct Answer: A. The AEP runs October 15 through December 7, with elections generally effective January 1
Rationale: The Medicare Annual Election Period is October 15-December 7 each year, generally for coverage
effective January 1.
7. Walter is reviewing Medicare coverage after moving to a new county and asks about Failure to pay
premium. Which statement is most accurate?
A. Agents choose the disenrollment date
B. Immediate disenrollment after one late day is required
C. Premium nonpayment can never affect enrollment
D. A plan may involuntarily disenroll for failure to pay required plan premiums only if CMS rules and required
notices/grace procedures are followed
Correct Answer: D. A plan may involuntarily disenroll for failure to pay required plan premiums only if CMS
rules and required notices/grace procedures are followed
Rationale: Involuntary disenrollment is tightly regulated and requires compliance with CMS notice and process
standards.
8. A plan receives an enrollment-related request involving Valid election period. Which disposition best
follows Medicare enrollment rules?
A. Plans may enroll anyone at any time
B. A plan generally may accept an enrollment only when the beneficiary is eligible and the request is made during
a valid election period
C. Eligibility is checked after the first claim
D. Election periods apply only to agents
Correct Answer: B. A plan generally may accept an enrollment only when the beneficiary is eligible and the
request is made during a valid election period
Rationale: MA and Part D enrollment requests must satisfy eligibility and election-period requirements.
9. Regarding MA-OEP effective date, Which response best applies?
A. A valid MA-OEP change generally becomes effective the first day of the month after the plan receives the
request
B. The same day
C. Six months later
D. Always January 1 of the next year
Correct Answer: A. A valid MA-OEP change generally becomes effective the first day of the month after the
plan receives the request
Rationale: MA-OEP changes generally take effect the first of the month after the election is received.
10. A plan receives an enrollment-related request involving Initial Coverage Election Period. Which
disposition best follows Medicare enrollment rules?
A. It is the same as the AEP every year
B. The ICEP gives a newly eligible person a period to make an initial Medicare Advantage election
C. It occurs only after five years on Medicare
D. It is the Medigap 6-month period
Correct Answer: B. The ICEP gives a newly eligible person a period to make an initial Medicare Advantage
election
Rationale: The ICEP is the initial opportunity to elect Medicare Advantage when Part A and Part B
entitlement/enrollment timing requirements are met.
11. Anthony is reviewing Medicare coverage at a community information session and asks about Part D
Initial Enrollment Period. Which option best reflects Medicare rules?
A. It begins only after a Part D penalty is assessed
B. It requires prior MA enrollment
C. It occurs only in January
, D. The Part D IEP generally aligns with the beneficiary initial Medicare eligibility window and allows initial
drug-plan enrollment
Correct Answer: D. The Part D IEP generally aligns with the beneficiary initial Medicare eligibility window and
allows initial drug-plan enrollment
Rationale: Part D has an initial enrollment period tied to Medicare eligibility.
12. A beneficiary is comparing several enrollment statements involving AEP effective date. Which
statement is accurate under Medicare rules?
A. Immediately the same day
B. The beneficiary chooses any retroactive date
C. A valid AEP election is generally effective January 1 of the following year
D. July 1
Correct Answer: C. A valid AEP election is generally effective January 1 of the following year
Rationale: AEP elections made October 15-December 7 generally take effect January 1.
13. Regarding Exceptional circumstance SEP, Which statement best resolves the question?
A. Any inconvenience creates an unlimited SEP
B. Disasters never affect election rights
C. Only state governments can create Medicare SEPs
D. CMS may establish SEPs for qualifying exceptional circumstances such as certain disasters or emergencies
that prevented timely enrollment
Correct Answer: D. CMS may establish SEPs for qualifying exceptional circumstances such as certain disasters
or emergencies that prevented timely enrollment
Rationale: CMS can provide special enrollment relief when extraordinary events prevent beneficiaries from
making timely elections.
14. A beneficiary is comparing several enrollment statements involving MA Open Enrollment Period.
Which statement is accurate under Medicare rules?
A. It allows unlimited monthly changes
B. It runs October 15-December 7
C. From January 1 through March 31, a person already enrolled in MA may make one permitted MA change,
including returning to Original Medicare and adding Part D if appropriate
D. It is for anyone in Original Medicare to join MA for the first time
Correct Answer: C. From January 1 through March 31, a person already enrolled in MA may make one
permitted MA change, including returning to Original Medicare and adding Part D if appropriate
Rationale: The MA OEP is available to people already enrolled in MA and generally allows one change during
January 1-March 31.
15. Nina is reviewing Medicare coverage after receiving a plan notice and asks about MA-OEP effective
date. What should the beneficiary be told?
A. Always January 1 of the next year
B. A valid MA-OEP change generally becomes effective the first day of the month after the plan receives the
request
C. Six months later
D. The same day
Correct Answer: B. A valid MA-OEP change generally becomes effective the first day of the month after the
plan receives the request
Rationale: MA-OEP changes generally take effect the first of the month after the election is received.
16. A plan receives an enrollment-related request involving Provider and drug review. Which disposition
best follows Medicare enrollment rules?
A. Before enrollment, beneficiaries should receive and review information about networks, drug coverage,
premiums, cost sharing, benefits, and key needs
B. Agents should conceal network status until after enrollment
C. Prescription coverage should be checked only after the first refill
D. Only the monthly premium matters
Correct Answer: A. Before enrollment, beneficiaries should receive and review information about networks,
drug coverage, premiums, cost sharing, benefits, and key needs
GUIDANCE: MEDICARE ADVANTAGE AND PART D
ELECTION, ENROLLMENT, AND DISENROLLMENT
1. Regarding Annual Election Period, How should this situation be interpreted?
A. April 1-June 30
B. The AEP runs October 15 through December 7, with elections generally effective January 1
C. January 1-March 31
D. September 1-September 30
Correct Answer: B. The AEP runs October 15 through December 7, with elections generally effective January 1
Rationale: The Medicare Annual Election Period is October 15-December 7 each year, generally for coverage
effective January 1.
2. A beneficiary is comparing several enrollment statements involving Authorized representative. Which
statement is accurate under Medicare rules?
A. Any neighbor may sign without authority
B. The selling agent automatically becomes legal representative
C. Only the beneficiary may ever sign
D. A legally authorized representative may complete an enrollment request on behalf of a beneficiary when
applicable requirements are met
Correct Answer: D. A legally authorized representative may complete an enrollment request on behalf of a
beneficiary when applicable requirements are met
Rationale: Medicare enrollment permits authorized representatives but requires valid authority.
3. Janet is reviewing Medicare coverage after receiving a plan notice and asks about Medicaid or Extra
Help SEP. What should the beneficiary be told?
A. Eligible people with Medicaid or Extra Help may have a recurring SEP allowing plan changes on the schedule
set by current CMS rules
B. They may change only during AEP
C. They are locked in for the full year
D. Extra Help affects costs but never enrollment rights
Correct Answer: A. Eligible people with Medicaid or Extra Help may have a recurring SEP allowing plan
changes on the schedule set by current CMS rules
Rationale: Current Medicare rules provide special enrollment flexibility for certain beneficiaries with Medicaid
or Extra Help.
4. A plan receives an enrollment-related request involving Discrimination. Which disposition best follows
Medicare enrollment rules?
A. Hospital use automatically disqualifies an applicant
B. Agents may require medical underwriting
C. Plans may not deny enrollment to an otherwise eligible person based on health status, except where lawful
specialized eligibility criteria apply
D. Ordinary MA plans may screen out high-cost members
Correct Answer: C. Plans may not deny enrollment to an otherwise eligible person based on health status, except
where lawful specialized eligibility criteria apply
Rationale: Medicare MA and Part D enrollment rules include nondiscrimination protections.
5. Regarding 5-star SEP, Which conclusion is correct?
A. It guarantees lower premiums
B. It is available only during AEP
C. A beneficiary may use the 5-star SEP to switch to an available 5-star Medicare plan during the permitted
period, subject to eligibility rules
D. A 5-star SEP allows switching to any 2-star plan
Correct Answer: C. A beneficiary may use the 5-star SEP to switch to an available 5-star Medicare plan during
the permitted period, subject to eligibility rules
Rationale: Medicare offers a special election opportunity for switching to qualifying 5-star plans when available.
,6. A beneficiary is comparing several enrollment statements involving Annual Election Period. Which
statement is accurate under Medicare rules?
A. The AEP runs October 15 through December 7, with elections generally effective January 1
B. September 1-September 30
C. January 1-March 31
D. April 1-June 30
Correct Answer: A. The AEP runs October 15 through December 7, with elections generally effective January 1
Rationale: The Medicare Annual Election Period is October 15-December 7 each year, generally for coverage
effective January 1.
7. Walter is reviewing Medicare coverage after moving to a new county and asks about Failure to pay
premium. Which statement is most accurate?
A. Agents choose the disenrollment date
B. Immediate disenrollment after one late day is required
C. Premium nonpayment can never affect enrollment
D. A plan may involuntarily disenroll for failure to pay required plan premiums only if CMS rules and required
notices/grace procedures are followed
Correct Answer: D. A plan may involuntarily disenroll for failure to pay required plan premiums only if CMS
rules and required notices/grace procedures are followed
Rationale: Involuntary disenrollment is tightly regulated and requires compliance with CMS notice and process
standards.
8. A plan receives an enrollment-related request involving Valid election period. Which disposition best
follows Medicare enrollment rules?
A. Plans may enroll anyone at any time
B. A plan generally may accept an enrollment only when the beneficiary is eligible and the request is made during
a valid election period
C. Eligibility is checked after the first claim
D. Election periods apply only to agents
Correct Answer: B. A plan generally may accept an enrollment only when the beneficiary is eligible and the
request is made during a valid election period
Rationale: MA and Part D enrollment requests must satisfy eligibility and election-period requirements.
9. Regarding MA-OEP effective date, Which response best applies?
A. A valid MA-OEP change generally becomes effective the first day of the month after the plan receives the
request
B. The same day
C. Six months later
D. Always January 1 of the next year
Correct Answer: A. A valid MA-OEP change generally becomes effective the first day of the month after the
plan receives the request
Rationale: MA-OEP changes generally take effect the first of the month after the election is received.
10. A plan receives an enrollment-related request involving Initial Coverage Election Period. Which
disposition best follows Medicare enrollment rules?
A. It is the same as the AEP every year
B. The ICEP gives a newly eligible person a period to make an initial Medicare Advantage election
C. It occurs only after five years on Medicare
D. It is the Medigap 6-month period
Correct Answer: B. The ICEP gives a newly eligible person a period to make an initial Medicare Advantage
election
Rationale: The ICEP is the initial opportunity to elect Medicare Advantage when Part A and Part B
entitlement/enrollment timing requirements are met.
11. Anthony is reviewing Medicare coverage at a community information session and asks about Part D
Initial Enrollment Period. Which option best reflects Medicare rules?
A. It begins only after a Part D penalty is assessed
B. It requires prior MA enrollment
C. It occurs only in January
, D. The Part D IEP generally aligns with the beneficiary initial Medicare eligibility window and allows initial
drug-plan enrollment
Correct Answer: D. The Part D IEP generally aligns with the beneficiary initial Medicare eligibility window and
allows initial drug-plan enrollment
Rationale: Part D has an initial enrollment period tied to Medicare eligibility.
12. A beneficiary is comparing several enrollment statements involving AEP effective date. Which
statement is accurate under Medicare rules?
A. Immediately the same day
B. The beneficiary chooses any retroactive date
C. A valid AEP election is generally effective January 1 of the following year
D. July 1
Correct Answer: C. A valid AEP election is generally effective January 1 of the following year
Rationale: AEP elections made October 15-December 7 generally take effect January 1.
13. Regarding Exceptional circumstance SEP, Which statement best resolves the question?
A. Any inconvenience creates an unlimited SEP
B. Disasters never affect election rights
C. Only state governments can create Medicare SEPs
D. CMS may establish SEPs for qualifying exceptional circumstances such as certain disasters or emergencies
that prevented timely enrollment
Correct Answer: D. CMS may establish SEPs for qualifying exceptional circumstances such as certain disasters
or emergencies that prevented timely enrollment
Rationale: CMS can provide special enrollment relief when extraordinary events prevent beneficiaries from
making timely elections.
14. A beneficiary is comparing several enrollment statements involving MA Open Enrollment Period.
Which statement is accurate under Medicare rules?
A. It allows unlimited monthly changes
B. It runs October 15-December 7
C. From January 1 through March 31, a person already enrolled in MA may make one permitted MA change,
including returning to Original Medicare and adding Part D if appropriate
D. It is for anyone in Original Medicare to join MA for the first time
Correct Answer: C. From January 1 through March 31, a person already enrolled in MA may make one
permitted MA change, including returning to Original Medicare and adding Part D if appropriate
Rationale: The MA OEP is available to people already enrolled in MA and generally allows one change during
January 1-March 31.
15. Nina is reviewing Medicare coverage after receiving a plan notice and asks about MA-OEP effective
date. What should the beneficiary be told?
A. Always January 1 of the next year
B. A valid MA-OEP change generally becomes effective the first day of the month after the plan receives the
request
C. Six months later
D. The same day
Correct Answer: B. A valid MA-OEP change generally becomes effective the first day of the month after the
plan receives the request
Rationale: MA-OEP changes generally take effect the first of the month after the election is received.
16. A plan receives an enrollment-related request involving Provider and drug review. Which disposition
best follows Medicare enrollment rules?
A. Before enrollment, beneficiaries should receive and review information about networks, drug coverage,
premiums, cost sharing, benefits, and key needs
B. Agents should conceal network status until after enrollment
C. Prescription coverage should be checked only after the first refill
D. Only the monthly premium matters
Correct Answer: A. Before enrollment, beneficiaries should receive and review information about networks,
drug coverage, premiums, cost sharing, benefits, and key needs
