AHIP 2026 CERTIFICATION EXAM
(UPDATED 2025)-QUESTIONS AND
ANSWERS WITH COMPLETE
SOLUTIONS-VERIFIED AND GRADED-
INSTANT DOWNLOAD
Mrs. Hamilton likes to handle most of her business matters through telephone calls. She is currently
enrolled in Original Medicare Parts A and B but has heard about a Medicare Advantage plan offered
by Senior Health from a neighbor. Mrs. Hamilton asks you whether she can enroll in Senior Health's
MA plan over the telephone. What can you tell her?
I. Enrollment requests can only be made in face-to-face interviews or by mail.
II. Telephone enrollment request calls must be recorded.
III. Telephonic enrollments must include all required elements necessary to complete an enrollment.
IV. The signature element must be completed via certified mail.
II and III only
Mr. Weitz was quite ill recently and forgot to pay his monthly premium for his MA-PD plan. He is
worried that he will lose his coverage now when he needs it the most. He is certain his plan will
disenroll him because that is what happened to a friend of his in a similar type of plan. What can you
tell Mr. Weitz about his situation?
Plan sponsors have the option to do nothing when a plan member does not pay their premiums or
disenroll the member after a grace period and notice.
Mr. Lu is selling his home to permanently move into a retirement facility near his daughter in a
neighboring state before the Annual Election Period. He has a stand-alone prescription drug plan and
has learned it is not available where he is moving. He doesn't know what he should do. What can you
tell him?
Because he is moving outside of the service area, the plan must automatically disenroll him. He will
have a special election period to select a new plan.
You are doing a sales presentation for Mrs. Mayo. You know that Medicare marketing guidelines
prohibit certain types of statements. Apply those guidelines to the following statements and identify
which would be prohibited.
"If you're not in very good health, you will probably do better with a different product."
,Mr. Bean has just entered his MA Initial Coverage Election Period (ICEP). What action could you help
him take during this time?
He will have one opportunity to enroll in a Medicare Advantage plan.
Miles is a licensed agent who represents Colgate Health and its Medicare Advantage (MA) plans. Miles
has several clients who have recently come to him for help. They are in their initial coverage periods)
(ICEP) and are interested in enrolling in one of Colgate Health's MA plans. Adam will soon turn 68 and
has decided to retire. Betty is about to turn 65 and has also decided to retire. Adam and Betty both
currently have coverage through Colgate Health. Charles had health coverage through Colgate but
dropped the coverage when he retired early to travel to Europe. Charles has just turned age 65 and is
now back in the United States. Diedre, who will turn 65 next month, currently has coverage through
Ditmas Health - a company that Miles also represents. Who qualifies for the opt-in simplified
enrollment mechanism?
Adam and Betty because each of them will not have a break between their non-Medicare and
Medicare coverage through Colgate Health Plan.
Mr. White has been enrolled in the Lexington Private Fee-for-Service (PFFS) Medicare Advantage
Health Plan (Lexington) for several years. Recently, Mr. White decided to spend time with his children
who live in another state that is not in Lexington's service area. In the future, he may relocate near his
children permanently. How does this move to another service area impact his PFFS MA coverage?
Lexington can allow for Mr. White's continued enrollment for up to 12 months whether or not he is in
a visitor/traveler (V/T) program since it is a PFFS plan.
Melina Giles recently suffered a stroke while visiting her daughter and grandchildren. As a result,
Melina has been admitted to a rehabilitation hospital where she is expected to reside for several
months. The rehabilitation hospital is located outside the geographic area served by her current
Medicare Advantage (MA) plan. What options are available to Melina regarding her health plan
coverage?
Melina may make an unlimited number of MA enrollment requests and may disenroll from her
current MA plan.
Ms. Moss decided to remain in Original Medicare (Parts A and B) and Part D during the Annual
Enrollment Period (AEP). At the beginning of January, her neighbor told her about the Medicare
Advantage (MA) plan he selected. He also told her there was an open enrollment period that she
might be able to use to enroll in an MA plan. Ms. Moss comes to you for advice shortly after speaking
to her neighbor. What should you tell her?
There is an MA Open Enrollment Period (OEP) that takes place between January 1 and March 31, but
Ms. Moss cannot use it because eligibility to use the OEP is available only to MA enrollees.
Archer works as a representative focused on the senior marketplace. What would be considered
prohibited activity by Archer?
Implying that only seniors can enroll in a Medicare Advantage plan when meeting with Mr. Lynn, who
is 58 but qualifies for Medicare because he is disabled.
, Edward suffered from serious kidney disease. As a result, Edward became eligible for Medicare
coverage due to end-stage renal disease (ESRD). A close relative donated their kidney and Edward
successfully underwent transplant surgery 12 months ago. Edward is now age 50 and asks you if his
Medicare coverage will continue, what should you say?
Ms. Henderson believes that she will qualify for Medicare Coverage when she turns 65, without
paying any premiums, because she has been working for 40 years and paying Medicare taxes. What
should you tell her?
To obtain Part B coverage, she must pay a standard monthly premium, though it is higher for individuals
with higher incomes.
Ms. Lewis has aggressive cancer and would like to know if Medicare will cover hospice services in case
she needs them. What should you tell her?
Medicare covers hospice services under Part A.
Mr. Capadona would like to purchase a Medicare Advantage (MA) plan and a Medigap plan to pick up
costs not covered by that plan. What should you tell him?
It is illegal for you to sell Mr. Capadona a Medigap plan if he is enrolled in an MA plan, and besides,
Medigap only works with Original Medicare.
Mr. Vasquez 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 because of an illness. In general terms, what could you tell him about
his costs for inpatient hospital services under Original Medicare?
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
Mrs. Foster is covered by Original Medicare. She sustained a hip fracture and is being successfully
treated for that condition. However, she and her physicians feel that after her lengthy hospital stay,
she will need a month or two of nursing and rehabilitative care. What should you tell them about
Original Medicare's coverage of care in a skilled nursing facility?
Medicare will cover Mrs. Foster's skilled nursing services provided during the first 20 days of her stay,
after which she would have a copay until she has been in the facility for 100 days.
Mr. Wu is eligible for Medicare. He has limited financial resources but failed to qualify for the Part D
low-income subsidy. Where might he turn for help with his prescription drug costs?
Mr. Wu may still qualify for help in paying Part D costs through his State Pharmaceutical Assistance
Program (SPAP).
Mr. Singh would like drug coverage but does not want to be enrolled in a Medicare Advantage plan.
What should you tell him?
(UPDATED 2025)-QUESTIONS AND
ANSWERS WITH COMPLETE
SOLUTIONS-VERIFIED AND GRADED-
INSTANT DOWNLOAD
Mrs. Hamilton likes to handle most of her business matters through telephone calls. She is currently
enrolled in Original Medicare Parts A and B but has heard about a Medicare Advantage plan offered
by Senior Health from a neighbor. Mrs. Hamilton asks you whether she can enroll in Senior Health's
MA plan over the telephone. What can you tell her?
I. Enrollment requests can only be made in face-to-face interviews or by mail.
II. Telephone enrollment request calls must be recorded.
III. Telephonic enrollments must include all required elements necessary to complete an enrollment.
IV. The signature element must be completed via certified mail.
II and III only
Mr. Weitz was quite ill recently and forgot to pay his monthly premium for his MA-PD plan. He is
worried that he will lose his coverage now when he needs it the most. He is certain his plan will
disenroll him because that is what happened to a friend of his in a similar type of plan. What can you
tell Mr. Weitz about his situation?
Plan sponsors have the option to do nothing when a plan member does not pay their premiums or
disenroll the member after a grace period and notice.
Mr. Lu is selling his home to permanently move into a retirement facility near his daughter in a
neighboring state before the Annual Election Period. He has a stand-alone prescription drug plan and
has learned it is not available where he is moving. He doesn't know what he should do. What can you
tell him?
Because he is moving outside of the service area, the plan must automatically disenroll him. He will
have a special election period to select a new plan.
You are doing a sales presentation for Mrs. Mayo. You know that Medicare marketing guidelines
prohibit certain types of statements. Apply those guidelines to the following statements and identify
which would be prohibited.
"If you're not in very good health, you will probably do better with a different product."
,Mr. Bean has just entered his MA Initial Coverage Election Period (ICEP). What action could you help
him take during this time?
He will have one opportunity to enroll in a Medicare Advantage plan.
Miles is a licensed agent who represents Colgate Health and its Medicare Advantage (MA) plans. Miles
has several clients who have recently come to him for help. They are in their initial coverage periods)
(ICEP) and are interested in enrolling in one of Colgate Health's MA plans. Adam will soon turn 68 and
has decided to retire. Betty is about to turn 65 and has also decided to retire. Adam and Betty both
currently have coverage through Colgate Health. Charles had health coverage through Colgate but
dropped the coverage when he retired early to travel to Europe. Charles has just turned age 65 and is
now back in the United States. Diedre, who will turn 65 next month, currently has coverage through
Ditmas Health - a company that Miles also represents. Who qualifies for the opt-in simplified
enrollment mechanism?
Adam and Betty because each of them will not have a break between their non-Medicare and
Medicare coverage through Colgate Health Plan.
Mr. White has been enrolled in the Lexington Private Fee-for-Service (PFFS) Medicare Advantage
Health Plan (Lexington) for several years. Recently, Mr. White decided to spend time with his children
who live in another state that is not in Lexington's service area. In the future, he may relocate near his
children permanently. How does this move to another service area impact his PFFS MA coverage?
Lexington can allow for Mr. White's continued enrollment for up to 12 months whether or not he is in
a visitor/traveler (V/T) program since it is a PFFS plan.
Melina Giles recently suffered a stroke while visiting her daughter and grandchildren. As a result,
Melina has been admitted to a rehabilitation hospital where she is expected to reside for several
months. The rehabilitation hospital is located outside the geographic area served by her current
Medicare Advantage (MA) plan. What options are available to Melina regarding her health plan
coverage?
Melina may make an unlimited number of MA enrollment requests and may disenroll from her
current MA plan.
Ms. Moss decided to remain in Original Medicare (Parts A and B) and Part D during the Annual
Enrollment Period (AEP). At the beginning of January, her neighbor told her about the Medicare
Advantage (MA) plan he selected. He also told her there was an open enrollment period that she
might be able to use to enroll in an MA plan. Ms. Moss comes to you for advice shortly after speaking
to her neighbor. What should you tell her?
There is an MA Open Enrollment Period (OEP) that takes place between January 1 and March 31, but
Ms. Moss cannot use it because eligibility to use the OEP is available only to MA enrollees.
Archer works as a representative focused on the senior marketplace. What would be considered
prohibited activity by Archer?
Implying that only seniors can enroll in a Medicare Advantage plan when meeting with Mr. Lynn, who
is 58 but qualifies for Medicare because he is disabled.
, Edward suffered from serious kidney disease. As a result, Edward became eligible for Medicare
coverage due to end-stage renal disease (ESRD). A close relative donated their kidney and Edward
successfully underwent transplant surgery 12 months ago. Edward is now age 50 and asks you if his
Medicare coverage will continue, what should you say?
Ms. Henderson believes that she will qualify for Medicare Coverage when she turns 65, without
paying any premiums, because she has been working for 40 years and paying Medicare taxes. What
should you tell her?
To obtain Part B coverage, she must pay a standard monthly premium, though it is higher for individuals
with higher incomes.
Ms. Lewis has aggressive cancer and would like to know if Medicare will cover hospice services in case
she needs them. What should you tell her?
Medicare covers hospice services under Part A.
Mr. Capadona would like to purchase a Medicare Advantage (MA) plan and a Medigap plan to pick up
costs not covered by that plan. What should you tell him?
It is illegal for you to sell Mr. Capadona a Medigap plan if he is enrolled in an MA plan, and besides,
Medigap only works with Original Medicare.
Mr. Vasquez 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 because of an illness. In general terms, what could you tell him about
his costs for inpatient hospital services under Original Medicare?
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
Mrs. Foster is covered by Original Medicare. She sustained a hip fracture and is being successfully
treated for that condition. However, she and her physicians feel that after her lengthy hospital stay,
she will need a month or two of nursing and rehabilitative care. What should you tell them about
Original Medicare's coverage of care in a skilled nursing facility?
Medicare will cover Mrs. Foster's skilled nursing services provided during the first 20 days of her stay,
after which she would have a copay until she has been in the facility for 100 days.
Mr. Wu is eligible for Medicare. He has limited financial resources but failed to qualify for the Part D
low-income subsidy. Where might he turn for help with his prescription drug costs?
Mr. Wu may still qualify for help in paying Part D costs through his State Pharmaceutical Assistance
Program (SPAP).
Mr. Singh would like drug coverage but does not want to be enrolled in a Medicare Advantage plan.
What should you tell him?
