AHIP Final Exam | Medicare Advantage & Part D Certification | 2026/2027 Update
AHIP FINAL
EXAM
America's Health Insurance Plans — Certification Training
GUIDING GREATER HEALTH
AHIP Final Exam
QUESTIONS WITH VERIFIED ANSWERS | 100% CORRECT | ALREADY GRADED A
ORGANIZATION AHIP (America's Health COURSE CODE AHIP-CERT
Insurance Plans)
PROGRAM Medicare Advantage & Part ACADEMIC YEAR Update
D Certification
EXAM TITLE AHIP Final Exam — Verified TOTAL QUESTIONS 50 Questions
Answers
COURSE TITLE Medicare Advantage / Part FORMAT Multiple Choice — Select
D Agent Certification the Single Best Answer
EXAMINATION INSTRUCTIONS
▶ Select the single best answer for each question.
▶ This exam covers Medicare Advantage (Part C), Part D prescription drug plans, Original Medicare,
enrollment periods, and agent compliance/marketing rules.
▶ Scenario-based questions and conceptual applications are all testable content.
▶ Correct answers and rationales appear below each question for review purposes.
Page 1 • AHIP • 2026/2027 Update
, AHIP Final Exam | Medicare Advantage & Part D Certification | 2026/2027 Update
① 🏥 Medicare Advantage Plan Types & Eligibility Questions 1–
10
1. Mrs. Robles is considering a Medicare Advantage PPO and has questions about which
providers she can go to for her health care. What should you tell her?
A. She may only see providers within the PPO network under any circumstances
B. She can obtain care from any provider who participates in Original Medicare, but will generally
have higher cost-sharing if the provider is out-of-network
C. She must obtain a referral from her PCP before seeing any specialist, in or out of network
D. PPO plans do not allow any out-of-network care except in emergencies
CORRECT ANSWER B — She can obtain care from any provider who participates in Original
Medicare, but will generally have higher cost-sharing if the provider is out-of-network
RATIONALE PPO plans, unlike HMOs, allow members to see out-of-network providers who participate in
Original Medicare. However, cost-sharing (copays/coinsurance) is typically higher for out-of-network care,
which is the key distinguishing feature of PPO flexibility compared to HMO network restrictions.
2. Mrs. Lester is age 75, has a comfortable income, and wishes to enroll in an MA MSA
plan she heard about from her neighbor. She also wants prescription drug coverage and
is currently enrolled in Original Medicare and a standalone Part D plan. How would you
advise her?
A. She cannot enroll in an MA MSA plan because she already has Part D coverage
B. She must drop her standalone Part D plan before enrolling in an MA MSA plan
C. She may enroll in an MA MSA plan and remain in her current standalone Part D prescription
drug plan
D. MA MSA plans automatically include Part D coverage, so a separate PDP is unnecessary
CORRECT ANSWER C — She may enroll in an MA MSA plan and remain in her current standalone
Part D prescription drug plan
RATIONALE MA MSA plans do not include Part D prescription drug coverage. Because of this, MSA
enrollees are permitted to keep or enroll in a standalone Part D plan (PDP) to maintain drug coverage,
unlike most other MA plan types which would cause automatic disenrollment from a standalone PDP.
3. Mr. Dalton is in excellent health, lives in his own home, and has a sizeable income
from his investments. His friend is enrolled in a Medicare Advantage Special Needs Plan
(SNP) with low cost-sharing, and Mr. Dalton wants to join. What should you tell him?
A. He can enroll in any SNP regardless of his health status or income
B. SNPs limit enrollment to certain subpopulations of beneficiaries, and given his situation, he is
unlikely to qualify
C. SNPs are open enrollment plans available to all Medicare beneficiaries each year
D. He must first enroll in Original Medicare for one year before becoming SNP-eligible
CORRECT ANSWER B — SNPs limit enrollment to certain subpopulations of beneficiaries, and given
his situation, he is unlikely to qualify
RATIONALE Special Needs Plans (SNPs) are restricted to specific subpopulations: chronic condition SNPs
(C-SNPs), dual-eligible SNPs (D-SNPs), or institutional SNPs (I-SNPs). Since Mr. Dalton is in excellent
Page 2 • AHIP • 2026/2027 Update
, AHIP Final Exam | Medicare Advantage & Part D Certification | 2026/2027 Update
health with no qualifying chronic condition, dual-eligibility, or institutional status, he would not meet SNP
eligibility criteria.
4. Mr. Anderson wants to know whether he is eligible to sign up for a Private Fee-for-
Service (PFFS) plan. What questions would you need to ask to determine his eligibility?
A. Whether he has a chronic condition and qualifies for Medicaid
B. Whether he is entitled to Part A, enrolled in Part B, and lives in the PFFS plan's service area
C. Whether he has a referral from his primary care provider
D. Whether he is under age 65 and disabled
CORRECT ANSWER B — Whether he is entitled to Part A, enrolled in Part B, and lives in the PFFS
plan's service area
RATIONALE Like most Medicare Advantage plan types, PFFS plan eligibility requires the beneficiary to be
entitled to Part A, enrolled in Part B, and reside within the plan's defined service area. These are the
baseline eligibility criteria across nearly all MA plan types, not specific to chronic conditions or referrals.
5. Herber Noble is turning 65 next month. He legally entered the United States over 20
years ago but is not a citizen. He has worked and contributed to Medicare and suffers
from diabetes. He asks if he can enroll in a Medicare Advantage plan. How would you
respond?
A. He is ineligible for Medicare Advantage because he is not a U.S. citizen
B. He must wait until he becomes a naturalized citizen to enroll
C. He is eligible as long as he is entitled to Part A and enrolled in Part B, regardless of citizenship
status
D. He can only enroll in Original Medicare, not Medicare Advantage, due to his immigration status
CORRECT ANSWER C — He is eligible as long as he is entitled to Part A and enrolled in Part B,
regardless of citizenship status
RATIONALE U.S. citizenship is not required for Medicare eligibility. Lawfully present immigrants who meet
work history and contribution requirements (or other qualifying criteria) can become entitled to Part A and
enroll in Part B, after which they are eligible to choose a Medicare Advantage plan just like any other
eligible beneficiary.
6. Which of the following individuals is most likely to be eligible to enroll in a Part D
Plan?
A. An individual who has illegally crossed the border and has no legal status
B. A grandfather who was granted asylum and has worked in the United States for many years
C. An individual who has overstayed a tourist visa
D. An individual residing outside the United States who previously worked in the U.S.
CORRECT ANSWER B — A grandfather who was granted asylum and has worked in the United
States for many years
RATIONALE To enroll in Part D, an individual must be entitled to Medicare and lawfully present in the
United States. A person granted asylum has lawful immigration status, distinguishing him from individuals
without legal status, who do not meet Medicare eligibility requirements regardless of work history.
Page 3 • AHIP • 2026/2027 Update
AHIP FINAL
EXAM
America's Health Insurance Plans — Certification Training
GUIDING GREATER HEALTH
AHIP Final Exam
QUESTIONS WITH VERIFIED ANSWERS | 100% CORRECT | ALREADY GRADED A
ORGANIZATION AHIP (America's Health COURSE CODE AHIP-CERT
Insurance Plans)
PROGRAM Medicare Advantage & Part ACADEMIC YEAR Update
D Certification
EXAM TITLE AHIP Final Exam — Verified TOTAL QUESTIONS 50 Questions
Answers
COURSE TITLE Medicare Advantage / Part FORMAT Multiple Choice — Select
D Agent Certification the Single Best Answer
EXAMINATION INSTRUCTIONS
▶ Select the single best answer for each question.
▶ This exam covers Medicare Advantage (Part C), Part D prescription drug plans, Original Medicare,
enrollment periods, and agent compliance/marketing rules.
▶ Scenario-based questions and conceptual applications are all testable content.
▶ Correct answers and rationales appear below each question for review purposes.
Page 1 • AHIP • 2026/2027 Update
, AHIP Final Exam | Medicare Advantage & Part D Certification | 2026/2027 Update
① 🏥 Medicare Advantage Plan Types & Eligibility Questions 1–
10
1. Mrs. Robles is considering a Medicare Advantage PPO and has questions about which
providers she can go to for her health care. What should you tell her?
A. She may only see providers within the PPO network under any circumstances
B. She can obtain care from any provider who participates in Original Medicare, but will generally
have higher cost-sharing if the provider is out-of-network
C. She must obtain a referral from her PCP before seeing any specialist, in or out of network
D. PPO plans do not allow any out-of-network care except in emergencies
CORRECT ANSWER B — She can obtain care from any provider who participates in Original
Medicare, but will generally have higher cost-sharing if the provider is out-of-network
RATIONALE PPO plans, unlike HMOs, allow members to see out-of-network providers who participate in
Original Medicare. However, cost-sharing (copays/coinsurance) is typically higher for out-of-network care,
which is the key distinguishing feature of PPO flexibility compared to HMO network restrictions.
2. Mrs. Lester is age 75, has a comfortable income, and wishes to enroll in an MA MSA
plan she heard about from her neighbor. She also wants prescription drug coverage and
is currently enrolled in Original Medicare and a standalone Part D plan. How would you
advise her?
A. She cannot enroll in an MA MSA plan because she already has Part D coverage
B. She must drop her standalone Part D plan before enrolling in an MA MSA plan
C. She may enroll in an MA MSA plan and remain in her current standalone Part D prescription
drug plan
D. MA MSA plans automatically include Part D coverage, so a separate PDP is unnecessary
CORRECT ANSWER C — She may enroll in an MA MSA plan and remain in her current standalone
Part D prescription drug plan
RATIONALE MA MSA plans do not include Part D prescription drug coverage. Because of this, MSA
enrollees are permitted to keep or enroll in a standalone Part D plan (PDP) to maintain drug coverage,
unlike most other MA plan types which would cause automatic disenrollment from a standalone PDP.
3. Mr. Dalton is in excellent health, lives in his own home, and has a sizeable income
from his investments. His friend is enrolled in a Medicare Advantage Special Needs Plan
(SNP) with low cost-sharing, and Mr. Dalton wants to join. What should you tell him?
A. He can enroll in any SNP regardless of his health status or income
B. SNPs limit enrollment to certain subpopulations of beneficiaries, and given his situation, he is
unlikely to qualify
C. SNPs are open enrollment plans available to all Medicare beneficiaries each year
D. He must first enroll in Original Medicare for one year before becoming SNP-eligible
CORRECT ANSWER B — SNPs limit enrollment to certain subpopulations of beneficiaries, and given
his situation, he is unlikely to qualify
RATIONALE Special Needs Plans (SNPs) are restricted to specific subpopulations: chronic condition SNPs
(C-SNPs), dual-eligible SNPs (D-SNPs), or institutional SNPs (I-SNPs). Since Mr. Dalton is in excellent
Page 2 • AHIP • 2026/2027 Update
, AHIP Final Exam | Medicare Advantage & Part D Certification | 2026/2027 Update
health with no qualifying chronic condition, dual-eligibility, or institutional status, he would not meet SNP
eligibility criteria.
4. Mr. Anderson wants to know whether he is eligible to sign up for a Private Fee-for-
Service (PFFS) plan. What questions would you need to ask to determine his eligibility?
A. Whether he has a chronic condition and qualifies for Medicaid
B. Whether he is entitled to Part A, enrolled in Part B, and lives in the PFFS plan's service area
C. Whether he has a referral from his primary care provider
D. Whether he is under age 65 and disabled
CORRECT ANSWER B — Whether he is entitled to Part A, enrolled in Part B, and lives in the PFFS
plan's service area
RATIONALE Like most Medicare Advantage plan types, PFFS plan eligibility requires the beneficiary to be
entitled to Part A, enrolled in Part B, and reside within the plan's defined service area. These are the
baseline eligibility criteria across nearly all MA plan types, not specific to chronic conditions or referrals.
5. Herber Noble is turning 65 next month. He legally entered the United States over 20
years ago but is not a citizen. He has worked and contributed to Medicare and suffers
from diabetes. He asks if he can enroll in a Medicare Advantage plan. How would you
respond?
A. He is ineligible for Medicare Advantage because he is not a U.S. citizen
B. He must wait until he becomes a naturalized citizen to enroll
C. He is eligible as long as he is entitled to Part A and enrolled in Part B, regardless of citizenship
status
D. He can only enroll in Original Medicare, not Medicare Advantage, due to his immigration status
CORRECT ANSWER C — He is eligible as long as he is entitled to Part A and enrolled in Part B,
regardless of citizenship status
RATIONALE U.S. citizenship is not required for Medicare eligibility. Lawfully present immigrants who meet
work history and contribution requirements (or other qualifying criteria) can become entitled to Part A and
enroll in Part B, after which they are eligible to choose a Medicare Advantage plan just like any other
eligible beneficiary.
6. Which of the following individuals is most likely to be eligible to enroll in a Part D
Plan?
A. An individual who has illegally crossed the border and has no legal status
B. A grandfather who was granted asylum and has worked in the United States for many years
C. An individual who has overstayed a tourist visa
D. An individual residing outside the United States who previously worked in the U.S.
CORRECT ANSWER B — A grandfather who was granted asylum and has worked in the United
States for many years
RATIONALE To enroll in Part D, an individual must be entitled to Medicare and lawfully present in the
United States. A person granted asylum has lawful immigration status, distinguishing him from individuals
without legal status, who do not meet Medicare eligibility requirements regardless of work history.
Page 3 • AHIP • 2026/2027 Update
