AHIP Final Exam – Medicare Certification
Practice Questions & Verified Answers 2026-2027
1. Which of the following individuals is generally eligible to enroll
in a Medicare Advantage (Part C) plan?
A) Anyone aged 62 or older.
B) A person entitled to Medicare Part A and enrolled in Part B,
who lives in the plan’s service area.
C) A person who has dropped their Medicare Part B coverage.
D) A person enrolled only in Medicare Part D.
Answer: B) A person entitled to Medicare Part A and enrolled in
Part B, who lives in the plan’s service area.
Rationale: To enroll in an MA plan, a beneficiary must have both
Part A and Part B, live in the plan's service area, and not have End-Stage
Renal Disease (ESRD), with a few specific exceptions.
2. Under the Annual Election Period (AEP), a beneficiary can make
which of the following changes?
A) Switch from a Medicare Advantage plan back to Original
Medicare.
B) Enroll in Medicare Part A for the first time.
C) Drop Medicare Part B completely.
D) Change their Medigap plan without medical underwriting.
, Answer: A) Switch from a Medicare Advantage plan back to
Original Medicare.
Rationale: The AEP (Oct 15 – Dec 7) allows beneficiaries to switch
between MA and Original Medicare, switch MA plans, or enroll/drop
Part D. It does not affect initial Part A/B enrollment or guarantee
Medigap issuance.
3. When does the Annual Election Period (AEP) occur, and when
do the coverage changes take effect?
A) January 1 to March 31; changes effective the first of the
following month.
B) October 15 to December 7; changes effective January 1 of the
following year.
C) November 1 to December 15; changes effective February 1.
D) October 1 to November 30; changes effective December 1.
Answer: B) October 15 to December 7; changes effective January 1
of the following year.
Rationale: The AEP runs from October 15 to December 7 annually.
Any enrollment changes made during this window become effective on
January 1 of the upcoming year.
4. A beneficiary calls you on March 10th. They are currently
enrolled in a Medicare Advantage plan and want to switch to a different
,Medicare Advantage plan. Can they do this, and if so, under what
period?
A) No, they must wait until the AEP.
B) Yes, under the Open Enrollment Period (OEP).
C) Yes, under the Initial Enrollment Period (IEP).
D) Yes, under the Special Enrollment Period (SEP) for moving.
Answer: B) Yes, under the Open Enrollment Period (OEP).
Rationale: The Medicare Advantage Open Enrollment Period (OEP)
runs from January 1 to March 31. During this time, a beneficiary
enrolled in an MA plan can switch to another MA plan or return to
Original Medicare.
5. CMS requires agents to complete a Scope of Appointment (SOA)
form. When must this form be obtained from the beneficiary?
A) Within 48 hours after the sales presentation.
B) Anytime during the first week of January.
C) Before any personal benefit information is collected or before
the sales presentation begins.
D) Only when enrolling a beneficiary in a Special Needs Plan (SNP).
Answer: C) Before any personal benefit information is collected or
before the sales presentation begins.
, Rationale: The SOA must be documented prior to the
appointment to verify that the beneficiary consented to discuss specific
Medicare products.
6. An agent offers a beneficiary a $50 gift card to attend a
Medicare Advantage sales presentation. Is this permissible?
A) Yes, as long as the gift card is to a grocery store.
B) Yes, if the beneficiary ultimately enrolls in a plan.
C) No, offering cash or cash equivalents as an inducement to
attend a presentation is prohibited.
D) No, unless the agent files the gift card value with CMS.
Answer: C) No, offering cash or cash equivalents as an inducement
to attend a presentation is prohibited.
Rationale: CMS strictly prohibits offering cash or cash equivalents
(like gift cards) to induce attendance at a sales event, enrollment in a
plan, or providing contact information. Promotional items must be
nominal (under $15 value) and not tied to enrollment.
7. Which of the following best describes the primary difference
between a Medicare Advantage HMO and a PPO plan?
A) HMOs generally require beneficiaries to select a Primary Care
Physician (PCP) and get referrals, while PPOs usually do not.
B) HMOs cover out-of-network care, while PPOs do not.
C) PPOs require referrals to see specialists, while HMOs do not.
Practice Questions & Verified Answers 2026-2027
1. Which of the following individuals is generally eligible to enroll
in a Medicare Advantage (Part C) plan?
A) Anyone aged 62 or older.
B) A person entitled to Medicare Part A and enrolled in Part B,
who lives in the plan’s service area.
C) A person who has dropped their Medicare Part B coverage.
D) A person enrolled only in Medicare Part D.
Answer: B) A person entitled to Medicare Part A and enrolled in
Part B, who lives in the plan’s service area.
Rationale: To enroll in an MA plan, a beneficiary must have both
Part A and Part B, live in the plan's service area, and not have End-Stage
Renal Disease (ESRD), with a few specific exceptions.
2. Under the Annual Election Period (AEP), a beneficiary can make
which of the following changes?
A) Switch from a Medicare Advantage plan back to Original
Medicare.
B) Enroll in Medicare Part A for the first time.
C) Drop Medicare Part B completely.
D) Change their Medigap plan without medical underwriting.
, Answer: A) Switch from a Medicare Advantage plan back to
Original Medicare.
Rationale: The AEP (Oct 15 – Dec 7) allows beneficiaries to switch
between MA and Original Medicare, switch MA plans, or enroll/drop
Part D. It does not affect initial Part A/B enrollment or guarantee
Medigap issuance.
3. When does the Annual Election Period (AEP) occur, and when
do the coverage changes take effect?
A) January 1 to March 31; changes effective the first of the
following month.
B) October 15 to December 7; changes effective January 1 of the
following year.
C) November 1 to December 15; changes effective February 1.
D) October 1 to November 30; changes effective December 1.
Answer: B) October 15 to December 7; changes effective January 1
of the following year.
Rationale: The AEP runs from October 15 to December 7 annually.
Any enrollment changes made during this window become effective on
January 1 of the upcoming year.
4. A beneficiary calls you on March 10th. They are currently
enrolled in a Medicare Advantage plan and want to switch to a different
,Medicare Advantage plan. Can they do this, and if so, under what
period?
A) No, they must wait until the AEP.
B) Yes, under the Open Enrollment Period (OEP).
C) Yes, under the Initial Enrollment Period (IEP).
D) Yes, under the Special Enrollment Period (SEP) for moving.
Answer: B) Yes, under the Open Enrollment Period (OEP).
Rationale: The Medicare Advantage Open Enrollment Period (OEP)
runs from January 1 to March 31. During this time, a beneficiary
enrolled in an MA plan can switch to another MA plan or return to
Original Medicare.
5. CMS requires agents to complete a Scope of Appointment (SOA)
form. When must this form be obtained from the beneficiary?
A) Within 48 hours after the sales presentation.
B) Anytime during the first week of January.
C) Before any personal benefit information is collected or before
the sales presentation begins.
D) Only when enrolling a beneficiary in a Special Needs Plan (SNP).
Answer: C) Before any personal benefit information is collected or
before the sales presentation begins.
, Rationale: The SOA must be documented prior to the
appointment to verify that the beneficiary consented to discuss specific
Medicare products.
6. An agent offers a beneficiary a $50 gift card to attend a
Medicare Advantage sales presentation. Is this permissible?
A) Yes, as long as the gift card is to a grocery store.
B) Yes, if the beneficiary ultimately enrolls in a plan.
C) No, offering cash or cash equivalents as an inducement to
attend a presentation is prohibited.
D) No, unless the agent files the gift card value with CMS.
Answer: C) No, offering cash or cash equivalents as an inducement
to attend a presentation is prohibited.
Rationale: CMS strictly prohibits offering cash or cash equivalents
(like gift cards) to induce attendance at a sales event, enrollment in a
plan, or providing contact information. Promotional items must be
nominal (under $15 value) and not tied to enrollment.
7. Which of the following best describes the primary difference
between a Medicare Advantage HMO and a PPO plan?
A) HMOs generally require beneficiaries to select a Primary Care
Physician (PCP) and get referrals, while PPOs usually do not.
B) HMOs cover out-of-network care, while PPOs do not.
C) PPOs require referrals to see specialists, while HMOs do not.
