Accurate AHIP Final Exam Solutions for 2024/2025
– Updated Guide with 100% Expert-Checked
Answers
Introduction
This guide provides 80 expert-reviewed practice questions for the America’s Health Insur-
ance Plans (AHIP) Final Exam for the 2024/2025 plan year, designed to certify insurance
agents for selling Medicare Advantage (MA) and Part D plans. Each question aligns with
the latest AHIP training modules, covering Medicare eligibility, enrollment, plan types,
marketing rules, and Fraud, Waste, and Abuse (FWA) compliance. Detailed answers and
explanations ensure accuracy and clarity, reflecting the 2024/2025 exam content. This
document is formatted for professional PDF export to support effective study.
Practice Test Questions
Question 1
What is the primary purpose of the AHIP certification?
A) To certify agents for selling life insurance
B) To certify agents for selling Medicare Advantage and Part D plans
C) To provide medical training for healthcare providers
D) To certify financial advisors
Answer: B) To certify agents for selling Medicare Advantage and Part D plans
Explanation: AHIP certification ensures agents understand Medicare regulations, plan
options, and compliance requirements for selling MA and Part D plans.[](https://www.stuvia.com/en-
us/search?s=ahip
Question 2
Mr. Smith, age 65, has not enrolled in Part B because he has employer coverage. What
must he do to join a Medicare Advantage plan?
A) Enroll in Part A only
B) Enroll in Part B
C) Disenroll from employer coverage
D) Apply for a Medigap plan
Answer: B) Enroll in Part B
Explanation: Enrollment in both Part A and Part B is required to join a Medicare Ad-
vantage plan, as these plans replace Original Medicare coverage.[](https://www.stuvia.com/en-
us/doc/4064625/ahip-2024-final-exam-test-updated-questions-and-answers-verified-answers)
Question 3
Which Medicare plan allows beneficiaries to see non-network providers with higher cost-
sharing?
A) HMO
B) PPO
C) PFFS
1
,D) MSA
Answer: B) PPO
Explanation: Preferred Provider Organization (PPO) plans allow beneficiaries to use
non-network providers, but with higher coinsurance and deductibles compared to in-
network providers.[](https://www.stuvia.com/en-us/doc/4833103/ahip-2025-final-exam-
questions-and-answers-2024-2025-verified-answers)
Question 4
When can individuals with ESRD enroll in Medicare Part A and Part B?
A) Only during the Annual Election Period
B) Anytime, with coverage starting the fourth month after dialysis begins
C) Only during the General Enrollment Period
D) After a 12-month waiting period
Answer: B) Anytime, with coverage starting the fourth month after dialysis begins
Explanation: Individuals with End-Stage Renal Disease (ESRD) can enroll in Medicare
anytime, with coverage effective the fourth month after dialysis starts.[](https://www.stuvia.com/en-
us/doc/4833103/ahip-2025-final-exam-questions-and-answers-2024-2025-verified-answers)
Question 5
What is the General Enrollment Period for Medicare Part B?
A) October 15 – December 7
B) January 1 – March 31
C) April 1 – June 30
D) July 1 – September 30
Answer: B) January 1 – March 31
Explanation: The General Enrollment Period for Part B runs from January 1 to March
31 each year, with coverage starting July 1.[](https://www.stuvia.com/en-us/doc/4833103/ahip-
2025-final-exam-questions-and-answers-2024-2025-verified-answers)
Question 6
Mr. Rainey requires inpatient psychiatric care. What is Medicare’s lifetime limit for this
care?
A) 90 days
B) 190 days
C) 365 days
D) Unlimited
Answer: B) 190 days
Explanation: Medicare covers up to 190 days of inpatient psychiatric hospital care over a
beneficiary’s lifetime.[](https://www.stuvia.com/en-us/doc/2526561/ahip-final-exam-test-
questions-en-answers-latest-2024-2025)
Question 7
Mrs. Lopez is an independent agent contracted with a third-party marketing organiza-
tion. What must she comply with?
A) CMS marketing requirements
2
, B) State licensing laws only
C) Employer health plan rules
D) Private insurance regulations
Answer: A) CMS marketing requirements
Explanation: Agents contracted with Medicare Advantage organizations must follow
CMS marketing rules, including using approved scripts.[](https://www.stuvia.com/doc/7572680/ahip-
final-exam-400-questions-and-answers-exam-2024-2025-actual-exam-with-a-study-guide-and-
practice-ex4am-accurate-real-exam-questions-and-answers-guaranteed-pass-latest-update)
Question 8
Mr. Wu does not qualify for the Part D low-income subsidy. What alternative can he
explore for drug cost assistance?
A) Medicaid
B) State Pharmaceutical Assistance Program
C) Employer-sponsored insurance
D) Medigap plan
Answer: B) State Pharmaceutical Assistance Program
Explanation: State Pharmaceutical Assistance Programs can help cover Part D costs
for those who don’t qualify for the low-income subsidy.[](https://www.stuvia.com/en-
us/doc/6173919/ahip-final-exam-test-questions-en-answers-latest-2024-2025)
Question 9
What should you tell a client who wants to submit an enrollment form before the Annual
Election Period (AEP)?
A) You can accept the form and process it immediately
B) The form cannot be accepted until the AEP begins
C) The form can be submitted to the plan for processing
D) The client must wait until the Open Enrollment Period
Answer: B) The form cannot be accepted until the AEP begins
Explanation: Agents cannot accept enrollment forms before the AEP (October 15 – De-
cember 7), but clients can send forms directly to the plan for processing on the AEP start
date.[](https://www.stuvia.com/en-us/doc/8121357/2020-ahip-questions-verified-correct-
answers-latest-update-already-pass-100-accurate)
Question 10
Which type of Medicare plan serves both Medicare and Medicaid individuals?
A) HMO
B) Dual Eligible Special Needs Plan (D-SNP)
C) PPO
D) PFFS
Answer: B) Dual Eligible Special Needs Plan (D-SNP)
Explanation: D-SNPs are designed for individuals eligible for both Medicare and Med-
icaid, coordinating benefits for dual-eligible beneficiaries.[](https://www.stuvia.com/en-
us/doc/4833103/ahip-2025-final-exam-questions-and-answers-2024-2025-verified-answers)
3
– Updated Guide with 100% Expert-Checked
Answers
Introduction
This guide provides 80 expert-reviewed practice questions for the America’s Health Insur-
ance Plans (AHIP) Final Exam for the 2024/2025 plan year, designed to certify insurance
agents for selling Medicare Advantage (MA) and Part D plans. Each question aligns with
the latest AHIP training modules, covering Medicare eligibility, enrollment, plan types,
marketing rules, and Fraud, Waste, and Abuse (FWA) compliance. Detailed answers and
explanations ensure accuracy and clarity, reflecting the 2024/2025 exam content. This
document is formatted for professional PDF export to support effective study.
Practice Test Questions
Question 1
What is the primary purpose of the AHIP certification?
A) To certify agents for selling life insurance
B) To certify agents for selling Medicare Advantage and Part D plans
C) To provide medical training for healthcare providers
D) To certify financial advisors
Answer: B) To certify agents for selling Medicare Advantage and Part D plans
Explanation: AHIP certification ensures agents understand Medicare regulations, plan
options, and compliance requirements for selling MA and Part D plans.[](https://www.stuvia.com/en-
us/search?s=ahip
Question 2
Mr. Smith, age 65, has not enrolled in Part B because he has employer coverage. What
must he do to join a Medicare Advantage plan?
A) Enroll in Part A only
B) Enroll in Part B
C) Disenroll from employer coverage
D) Apply for a Medigap plan
Answer: B) Enroll in Part B
Explanation: Enrollment in both Part A and Part B is required to join a Medicare Ad-
vantage plan, as these plans replace Original Medicare coverage.[](https://www.stuvia.com/en-
us/doc/4064625/ahip-2024-final-exam-test-updated-questions-and-answers-verified-answers)
Question 3
Which Medicare plan allows beneficiaries to see non-network providers with higher cost-
sharing?
A) HMO
B) PPO
C) PFFS
1
,D) MSA
Answer: B) PPO
Explanation: Preferred Provider Organization (PPO) plans allow beneficiaries to use
non-network providers, but with higher coinsurance and deductibles compared to in-
network providers.[](https://www.stuvia.com/en-us/doc/4833103/ahip-2025-final-exam-
questions-and-answers-2024-2025-verified-answers)
Question 4
When can individuals with ESRD enroll in Medicare Part A and Part B?
A) Only during the Annual Election Period
B) Anytime, with coverage starting the fourth month after dialysis begins
C) Only during the General Enrollment Period
D) After a 12-month waiting period
Answer: B) Anytime, with coverage starting the fourth month after dialysis begins
Explanation: Individuals with End-Stage Renal Disease (ESRD) can enroll in Medicare
anytime, with coverage effective the fourth month after dialysis starts.[](https://www.stuvia.com/en-
us/doc/4833103/ahip-2025-final-exam-questions-and-answers-2024-2025-verified-answers)
Question 5
What is the General Enrollment Period for Medicare Part B?
A) October 15 – December 7
B) January 1 – March 31
C) April 1 – June 30
D) July 1 – September 30
Answer: B) January 1 – March 31
Explanation: The General Enrollment Period for Part B runs from January 1 to March
31 each year, with coverage starting July 1.[](https://www.stuvia.com/en-us/doc/4833103/ahip-
2025-final-exam-questions-and-answers-2024-2025-verified-answers)
Question 6
Mr. Rainey requires inpatient psychiatric care. What is Medicare’s lifetime limit for this
care?
A) 90 days
B) 190 days
C) 365 days
D) Unlimited
Answer: B) 190 days
Explanation: Medicare covers up to 190 days of inpatient psychiatric hospital care over a
beneficiary’s lifetime.[](https://www.stuvia.com/en-us/doc/2526561/ahip-final-exam-test-
questions-en-answers-latest-2024-2025)
Question 7
Mrs. Lopez is an independent agent contracted with a third-party marketing organiza-
tion. What must she comply with?
A) CMS marketing requirements
2
, B) State licensing laws only
C) Employer health plan rules
D) Private insurance regulations
Answer: A) CMS marketing requirements
Explanation: Agents contracted with Medicare Advantage organizations must follow
CMS marketing rules, including using approved scripts.[](https://www.stuvia.com/doc/7572680/ahip-
final-exam-400-questions-and-answers-exam-2024-2025-actual-exam-with-a-study-guide-and-
practice-ex4am-accurate-real-exam-questions-and-answers-guaranteed-pass-latest-update)
Question 8
Mr. Wu does not qualify for the Part D low-income subsidy. What alternative can he
explore for drug cost assistance?
A) Medicaid
B) State Pharmaceutical Assistance Program
C) Employer-sponsored insurance
D) Medigap plan
Answer: B) State Pharmaceutical Assistance Program
Explanation: State Pharmaceutical Assistance Programs can help cover Part D costs
for those who don’t qualify for the low-income subsidy.[](https://www.stuvia.com/en-
us/doc/6173919/ahip-final-exam-test-questions-en-answers-latest-2024-2025)
Question 9
What should you tell a client who wants to submit an enrollment form before the Annual
Election Period (AEP)?
A) You can accept the form and process it immediately
B) The form cannot be accepted until the AEP begins
C) The form can be submitted to the plan for processing
D) The client must wait until the Open Enrollment Period
Answer: B) The form cannot be accepted until the AEP begins
Explanation: Agents cannot accept enrollment forms before the AEP (October 15 – De-
cember 7), but clients can send forms directly to the plan for processing on the AEP start
date.[](https://www.stuvia.com/en-us/doc/8121357/2020-ahip-questions-verified-correct-
answers-latest-update-already-pass-100-accurate)
Question 10
Which type of Medicare plan serves both Medicare and Medicaid individuals?
A) HMO
B) Dual Eligible Special Needs Plan (D-SNP)
C) PPO
D) PFFS
Answer: B) Dual Eligible Special Needs Plan (D-SNP)
Explanation: D-SNPs are designed for individuals eligible for both Medicare and Med-
icaid, coordinating benefits for dual-eligible beneficiaries.[](https://www.stuvia.com/en-
us/doc/4833103/ahip-2025-final-exam-questions-and-answers-2024-2025-verified-answers)
3
