AHIP Modules 1–5 Exam Review &
Final Practice Test | 2025/2026
Study Guide
Description:
Prepare for the AHIP certification with this comprehensive study guide covering Modules
1–5, final exam practice questions, and full exam review material for the 2025/2026 cycle.
This resource is designed to help learners strengthen understanding of Medicare-related
concepts, compliance rules, and key insurance principles tested in the AHIP assessment.
It includes structured practice questions and answers to support efficient revision, improve
retention, and build confidence before taking the final exam.
Topics Covered:
• Medicare Parts A, B, C, and D Overview
• Medicare Advantage (Part C) Concepts
• Prescription Drug Coverage (Part D)
• Medicare Eligibility and Enrollment Rules
• Marketing Guidelines and Compliance Standards
• Fraud, Waste, and Abuse (FWA) Prevention
• Beneficiary Rights and Protections
,• Coordination of Benefits
• Plan Types and Coverage Rules
• Final Exam Practice Questions (Modules 1–5 Review)
Ideal for insurance agents, healthcare professionals, and anyone preparing for AHIP certification and
Medicare training exams.
AHIP 2026 Final Exam – (With
Answers)
1. Mr. Arias stopped paying Part B premiums but has Part A and wants MA plan. What
should you tell him?
ANSWER: He cannot enroll in a Medicare Advantage plan until he re-enrolls in
Medicare Part B.
2. Mrs. Joy has Part A only and wants MA plan. What must she do first?
ANSWER: She must enroll in Part B.
3. MA HMO provider access rule?
ANSWER: Must generally use in-network providers except emergencies or
unavailable care.
4. MA PPO provider access rule?
ANSWER: Can see any Medicare provider, but out-of-network costs more.
5. Mrs. Lester wants MA MSA plan and Part D coverage. Advice?
ANSWER: She may enroll in MA MSA and keep her standalone Part D plan.
6. Can Mr. Dalton join a Special Needs Plan (SNP)?
ANSWER: No. SNPs are for specific eligible populations only.
7. PFFS eligibility requirements?
ANSWER: Must have Part A, Part B, and live in the plan’s service area.
8. Herber (non-citizen) Medicare Advantage eligibility?
ANSWER: Eligible if he has Part A and Part B.
,9. Who is most likely eligible for Part D?
ANSWER: Jose (lawfully present immigrant granted asylum and long-term worker).
10.No creditable drug coverage delay consequence?
ANSWER: Permanent premium penalty (1% per month delay).
11. Lost creditable employer coverage recently—what should Mr. Chen do?
ANSWER: Enroll in Part D within 63 days to avoid penalty.
12. Traveling MA-PD member needs prescriptions filled—what happens?
ANSWER: Can use non-network pharmacy but may pay higher cost.
13. Part D tools affecting drug access?
ANSWER: Formularies, tiered copays, step therapy, prior authorization.
14. Is shingles vaccine covered?
ANSWER: Yes, no cost-sharing (ACIP-recommended vaccine).
15. Part D transition policy for new enrollee?
ANSWER: One-time 30-day supply allowed during 90-day transition period.
16. FEHB vs Part D decision?
ANSWER: Compare coverage and costs; decide if Part D adds value.
17. Paying Part D premiums multiple ways?
ANSWER: Must choose one payment method for the year.
18.Agent compensation rule?
ANSWER: Paid initial-year commission first year, renewal after if member stays
enrolled.
19. Marketing compliance responsibility?
ANSWER: Plans are responsible for agents; state licensure laws still apply.
20.Educational event rules?
ANSWER: Snacks ≤ $15 allowed; business reply cards allowed.
21. Presentation in assisted living facility?
ANSWER: Only scheduled individual appointments, not group marketing.
, 22.TPMO lead-sharing rule?
ANSWER: Requires prior written consent naming each entity.
23.Scope of appointment—what can be done?
ANSWER: Provide enrollment materials and take completed application.
24.Changing MA plan near AEP deadline?
ANSWER: Complete SOA and schedule appointment.
25.Using enrollee data for non-health marketing?
ANSWER: Requires HIPAA-compliant authorization.
26.Agent misconduct penalties?
ANSWER: Retraining, commission loss, reporting, or termination.
27.Institutionalized individual SEP duration?
ANSWER: Continues during stay and 2 months after discharge.
28.Losing creditable coverage SEP timing?
ANSWER: SEP starts when notified and lasts until 2 months after loss.
29.Required MA enrollment discussion topics?
ANSWER: Networks, prescriptions, premiums, benefits, and costs.
30.What does new MA member receive?
ANSWER: Proof of coverage, effective date, and service instructions.
31. CMS enrollment approval notification timing?
ANSWER: Plan must notify within 10 calendar days.
32.ICEP restriction?
ANSWER: Cannot enroll in Medigap to supplement MA plan.
33.Switching MA plans during AEP?
ANSWER: Enrolling in new plan automatically disenrolls old one.
34.Missing MA-PD premium payment?
ANSWER: Plan may allow grace period or disenroll after notice.
35.Dual-eligible “at-risk” beneficiary SEP rule?
ANSWER: Cannot use dual SEP while flagged as at-risk.
Final Practice Test | 2025/2026
Study Guide
Description:
Prepare for the AHIP certification with this comprehensive study guide covering Modules
1–5, final exam practice questions, and full exam review material for the 2025/2026 cycle.
This resource is designed to help learners strengthen understanding of Medicare-related
concepts, compliance rules, and key insurance principles tested in the AHIP assessment.
It includes structured practice questions and answers to support efficient revision, improve
retention, and build confidence before taking the final exam.
Topics Covered:
• Medicare Parts A, B, C, and D Overview
• Medicare Advantage (Part C) Concepts
• Prescription Drug Coverage (Part D)
• Medicare Eligibility and Enrollment Rules
• Marketing Guidelines and Compliance Standards
• Fraud, Waste, and Abuse (FWA) Prevention
• Beneficiary Rights and Protections
,• Coordination of Benefits
• Plan Types and Coverage Rules
• Final Exam Practice Questions (Modules 1–5 Review)
Ideal for insurance agents, healthcare professionals, and anyone preparing for AHIP certification and
Medicare training exams.
AHIP 2026 Final Exam – (With
Answers)
1. Mr. Arias stopped paying Part B premiums but has Part A and wants MA plan. What
should you tell him?
ANSWER: He cannot enroll in a Medicare Advantage plan until he re-enrolls in
Medicare Part B.
2. Mrs. Joy has Part A only and wants MA plan. What must she do first?
ANSWER: She must enroll in Part B.
3. MA HMO provider access rule?
ANSWER: Must generally use in-network providers except emergencies or
unavailable care.
4. MA PPO provider access rule?
ANSWER: Can see any Medicare provider, but out-of-network costs more.
5. Mrs. Lester wants MA MSA plan and Part D coverage. Advice?
ANSWER: She may enroll in MA MSA and keep her standalone Part D plan.
6. Can Mr. Dalton join a Special Needs Plan (SNP)?
ANSWER: No. SNPs are for specific eligible populations only.
7. PFFS eligibility requirements?
ANSWER: Must have Part A, Part B, and live in the plan’s service area.
8. Herber (non-citizen) Medicare Advantage eligibility?
ANSWER: Eligible if he has Part A and Part B.
,9. Who is most likely eligible for Part D?
ANSWER: Jose (lawfully present immigrant granted asylum and long-term worker).
10.No creditable drug coverage delay consequence?
ANSWER: Permanent premium penalty (1% per month delay).
11. Lost creditable employer coverage recently—what should Mr. Chen do?
ANSWER: Enroll in Part D within 63 days to avoid penalty.
12. Traveling MA-PD member needs prescriptions filled—what happens?
ANSWER: Can use non-network pharmacy but may pay higher cost.
13. Part D tools affecting drug access?
ANSWER: Formularies, tiered copays, step therapy, prior authorization.
14. Is shingles vaccine covered?
ANSWER: Yes, no cost-sharing (ACIP-recommended vaccine).
15. Part D transition policy for new enrollee?
ANSWER: One-time 30-day supply allowed during 90-day transition period.
16. FEHB vs Part D decision?
ANSWER: Compare coverage and costs; decide if Part D adds value.
17. Paying Part D premiums multiple ways?
ANSWER: Must choose one payment method for the year.
18.Agent compensation rule?
ANSWER: Paid initial-year commission first year, renewal after if member stays
enrolled.
19. Marketing compliance responsibility?
ANSWER: Plans are responsible for agents; state licensure laws still apply.
20.Educational event rules?
ANSWER: Snacks ≤ $15 allowed; business reply cards allowed.
21. Presentation in assisted living facility?
ANSWER: Only scheduled individual appointments, not group marketing.
, 22.TPMO lead-sharing rule?
ANSWER: Requires prior written consent naming each entity.
23.Scope of appointment—what can be done?
ANSWER: Provide enrollment materials and take completed application.
24.Changing MA plan near AEP deadline?
ANSWER: Complete SOA and schedule appointment.
25.Using enrollee data for non-health marketing?
ANSWER: Requires HIPAA-compliant authorization.
26.Agent misconduct penalties?
ANSWER: Retraining, commission loss, reporting, or termination.
27.Institutionalized individual SEP duration?
ANSWER: Continues during stay and 2 months after discharge.
28.Losing creditable coverage SEP timing?
ANSWER: SEP starts when notified and lasts until 2 months after loss.
29.Required MA enrollment discussion topics?
ANSWER: Networks, prescriptions, premiums, benefits, and costs.
30.What does new MA member receive?
ANSWER: Proof of coverage, effective date, and service instructions.
31. CMS enrollment approval notification timing?
ANSWER: Plan must notify within 10 calendar days.
32.ICEP restriction?
ANSWER: Cannot enroll in Medigap to supplement MA plan.
33.Switching MA plans during AEP?
ANSWER: Enrolling in new plan automatically disenrolls old one.
34.Missing MA-PD premium payment?
ANSWER: Plan may allow grace period or disenroll after notice.
35.Dual-eligible “at-risk” beneficiary SEP rule?
ANSWER: Cannot use dual SEP while flagged as at-risk.
