AHIP Annual Recertification Exam | Complete Medicare Certification Review, CMS Regulations, Compliance Updates, Fraud Waste and Abuse Prevention, Beneficiary Rights, Plan Rules, and Practical Strategies for Annual Certification Success | Updated 2026 Edit

• AHIP Annual Recertification Exam | Complete
Medicare Certification Review, CMS Regulations,
Compliance Updates, Fraud Waste and Abuse
Prevention, Beneficiary Rights, Plan Rules, and
Practical Strategies for Annual Certification
Success | Updated 2026 Edition for Insurance
Agents and Healthcare Professionals
Question 1: What is the primary purpose of Medicare Advantage plans?
• A) To provide supplemental coverage to Medicare
• B) To replace Original Medicare
• C) To offer lower premiums than Original Medicare
• D) To deliver Medicare benefits through private insurance companies
Correct Option: D
Rationale:
Medicare Advantage plans (Part C) are designed to provide all the benefits of Original
Medicare (Parts A and B) and often additional services through private insurance
companies. They may include extra perks such as vision or dental coverage. While some
beneficiaries find lower premiums or additional services appealing, the primary role of
these plans is to deliver Medicare's benefits efficiently through private entities.


Question 2: Which of the following is NOT a requirement for Medicare to cover a
service?
• A) The service must be medically necessary
• B) The service must be covered by private insurance
• C) The service must be provided by an approved provider
• D) The service must meet Medicare guidelines
Correct Option: B
Rationale:
Medicare does not require a service to be covered by private insurance to be eligible for
coverage; instead, it must be deemed medically necessary and meet specific
guidelines. Medicare has its own criteria for determining what constitutes medical
necessity and coverage, independent of private insurance standards.


Question 3: Which group is responsible for overseeing insurance company
compliance with Medicare regulations?

, • A) Center for Disease Control (CDC)
• B) Centers for Medicare & Medicaid Services (CMS)
• C) Food and Drug Administration (FDA)
• D) National Institute of Health (NIH)
Correct Option: B
Rationale:
The Centers for Medicare & Medicaid Services (CMS) is the federal agency responsible
for administration and oversight of Medicare programs, including ensuring insurance
companies comply with Medicare regulations. They regulate Medicare Advantage plans
and Part D prescription drug plans to protect beneficiaries and uphold the integrity of
the program.


Question 4: What is the annual enrollment period for Medicare Advantage plans?
• A) October 15 - December 7
• B) January 1 - March 31
• C) April 1 - June 30
• D) October 15 - December 7
Correct Option: D
Rationale:
The annual enrollment period for Medicare Advantage and Medicare prescription drug
plans is indeed from October 15 to December 7. During this time, beneficiaries can
enroll in, switch, or drop their plans. It's a critical period that allows beneficiaries to
reassess their healthcare needs and options on an annual basis.
Question 1: What is the primary purpose of Medicare Advantage plans?
• A) To provide supplemental coverage to Medicare
• B) To replace Original Medicare
• C) To offer lower premiums than Original Medicare
• D) To deliver Medicare benefits through private insurance companies
Correct Option: D
Rationale:
Medicare Advantage plans provide all benefits of Original Medicare (Parts A and B)
through private insurance companies. They often include additional services, such as
vision or dental, to enhance coverage.

,Question 2: Which of the following is NOT a requirement for Medicare to cover a
service?
• A) The service must be medically necessary
• B) The service must be covered by private insurance
• C) The service must be provided by an approved provider
• D) The service must meet Medicare guidelines
Correct Option: B
Rationale:
Coverage by private insurance is irrelevant; Medicare has specific standards to
determine coverage eligibility based on medical necessity and provider qualifications.


Question 3: Which group is responsible for overseeing insurance company
compliance with Medicare regulations?
• A) Center for Disease Control (CDC)
• B) Centers for Medicare & Medicaid Services (CMS)
• C) Food and Drug Administration (FDA)
• D) National Institute of Health (NIH)
Correct Option: B
Rationale:
CMS ensures compliance with federal Medicare regulations, monitoring plans for
adherence to standards and protecting beneficiary interests.


Question 4: What is the annual enrollment period for Medicare Advantage plans?
• A) October 15 - December 7
• B) January 1 - March 31
• C) April 1 - June 30
• D) October 15 - December 7
Correct Option: D
Rationale:
This period allows beneficiaries to enroll in, switch, or drop their Medicare Advantage or
prescription drug plans annually.

, Question 5: What element is NOT typically included in Medicare Part B coverage?
• A) Doctor visits
• B) Outpatient therapy
• C) Long-term care
• D) Preventive services
Correct Option: C
Rationale:
Medicare Part B does not cover long-term care, which is generally not considered
medically necessary under Medicare's guidelines.


Question 6: How often is the Medicare Wellness Visit covered?
• A) Once a month
• B) Once a year
• C) Once every 12 months
• D) Every two years
Correct Option: C
Rationale:
The Medicare Annual Wellness Visit is covered once every 12 months to allow
beneficiaries to identify potential health issues proactively.


Question 7: Which of the following types of Medicare plans typically offer the most
flexibility in choosing healthcare providers?
• A) HMO plans
• B) PPO plans
• C) PFFS plans
• D) SNP plans
Correct Option: C
Rationale:
PFFS (Private Fee-for-Service) plans provide beneficiaries with the freedom to see any
provider who accepts the plan's terms, making them more flexible than HMO or SNP
plans, which have stricter network rules.