AHIP FINAL EXAM (LATEST UPDATE
2026/2027) | QUESTIONS AND ANSWERS |
GRADE A | 100% CORRECT (VERIFIED
SOLUTIONS)
AMERICA’S HEALTH INSURANCE PLANS
(AHIP)
1. Which types of Medicare Advantage (MA) plans are available to eligible Medicare
beneficiaries?
A) Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), Medical Savings
Account (MSA), Medicare Cost Plans, and Private Fee-for-Service (PFFS)
B) Health Maintenance Organization (HMO) plans only
C) Preferred Provider Organization (PPO) and Medical Savings Account (MSA) plans only
D) Medicare Cost Plans and Private Fee-for-Service (PFFS) plans only
Correct Answer: A) Health Maintenance Organization (HMO), Preferred Provider Organization (PPO),
Medical Savings Account (MSA), Medicare Cost Plans, and Private Fee-for-Service (PFFS)
Rationale:
Medicare Advantage, also known as Medicare Part C, includes several plan types approved by CMS to meet
different beneficiary needs. These include HMOs, PPOs, MSAs, PFFS plans, and Medicare Cost Plans
(available in limited areas). Each plan type differs in provider access, referral requirements, and cost-sharing
structure. CMS allows these options to give beneficiaries flexibility in choosing coverage that best fits their
healthcare usage and financial situation.
2. Who is eligible to enroll in a Medicare-Medicaid Plan (MMP)?
A) Individuals enrolled in Medicare Part A only
B) Individuals who are dually eligible for Medicare and Medicaid, including Part D prescription drug
,coverage
C) Individuals under age 65 without a qualifying disability
D) Individuals who have only employer-sponsored health insurance
Correct Answer: B) Individuals who are dually eligible for Medicare and Medicaid, including Part D
prescription drug coverage
Rationale:
Medicare-Medicaid Plans (MMPs) are specifically designed for individuals who qualify for both Medicare
and Medicaid, often referred to as “dual eligibles.” These plans integrate Medicare Parts A, B, and D with
Medicaid benefits into one coordinated plan. The goal is to improve care coordination, reduce fragmentation,
‘?and simplify coverage for beneficiaries with complex healthcare needs. Individuals who do not have both
Medicare and Medicaid are not eligible for MMPs.
3. What is a key characteristic of a Medicare Cost Plan?
A) It requires enrollment in Medicare Part A only
B) It allows beneficiaries to receive services outside the plan’s network, with Original Medicare covering
those services
C) It limits enrollment to the Annual Enrollment Period only
D) It excludes prescription drug coverage entirely
Correct Answer: B) It allows beneficiaries to receive services outside the plan’s network, with Original
Medicare covering those services
Rationale:
Medicare Cost Plans combine features of Original Medicare and Medicare Advantage plans. Beneficiaries
may receive care from in-network providers through the plan, but if they choose to go out-of-network,
Original Medicare pays for covered services. This flexibility distinguishes Cost Plans from HMOs. However,
Cost Plans are only available in certain geographic areas and are being phased out in many counties.
4. When are individuals diagnosed with End-Stage Renal Disease (ESRD) eligible to enroll
in Medicare?
A) Only during the Annual Enrollment Period (AEP)
B) At any time, with Medicare coverage typically beginning in the fourth month of dialysis
C) Only during a Special Enrollment Period related to employment
D) Only upon reaching age 65
Correct Answer: B) At any time, with Medicare coverage typically beginning in the fourth month of
dialysis
Rationale:
Individuals with ESRD qualify for Medicare regardless of age once they meet medical eligibility
,requirements. In most cases, Medicare coverage begins in the fourth month of regular dialysis treatments,
although earlier coverage may apply in certain situations, such as home dialysis. CMS provides this
eligibility to ensure access to life-sustaining treatment. ESRD beneficiaries also now have expanded access
to Medicare Advantage plans under updated regulations.
5. What are the dates of the General Enrollment Period (GEP) for individuals who did not
enroll in Medicare Part B when first eligible?
A) April 1 to June 30, with coverage beginning July 1
B) January 1 to March 31, with coverage beginning July 1
C) October 15 to December 7, with coverage beginning January 1
D) July 1 to September 30, with coverage beginning October 1
Correct Answer: B) January 1 to March 31, with coverage beginning July 1
Rationale:
The General Enrollment Period allows individuals who missed their Initial Enrollment Period and did not
qualify for a Special Enrollment Period to enroll in Medicare Part B. The GEP runs annually from January 1
through March 31. Coverage does not begin immediately; instead, it starts on July 1 of the same year. Late
enrollment penalties may apply depending on circumstances.
6. When may individuals with active employer group health coverage enroll in Medicare
Part A and/or Part B without penalty?
A) Only during the Initial Enrollment Period
B) At any time while covered under an employer group health plan, during a Special Enrollment Period
C) Only after reaching age 70
D) Only during the Annual Enrollment Period
Correct Answer: B) At any time while covered under an employer group health plan, during a Special
Enrollment Period
Rationale:
Individuals who are actively working and covered by an employer-sponsored group health plan may delay
enrolling in Medicare Part B without penalty. CMS grants a Special Enrollment Period (SEP) that allows
enrollment during employment or within eight months after coverage ends. This protects beneficiaries from
late enrollment penalties. The SEP is tied to current employment, not retiree or COBRA coverage.
7. How many questions are included in the AHIP final certification exam?
A) 25
B) 50
, C) 75
D) 100
Correct Answer: B) 50
Rationale:
The AHIP final exam consists of 50 multiple-choice questions covering Medicare basics, compliance,
enrollment rules, and marketing guidelines. The exam is open-book but closely timed, requiring familiarity
with course material. Agents must demonstrate a strong understanding of CMS regulations. The standardized
format ensures consistency across certification cycles.
8. What is the minimum passing score required to successfully complete the AHIP exam?
A) 70%
B) 80%
C) 90%
D) 95%
Correct Answer: C) 90%
Rationale:
AHIP requires a minimum passing score of 90% to ensure agents meet high compliance and knowledge
standards. This strict requirement reflects the importance of accurate Medicare education and ethical sales
practices. Because agents advise vulnerable populations, CMS and AHIP emphasize mastery of content.
Failing to meet this threshold requires retesting.
9. How many attempts are permitted to pass the AHIP certification exam before
repurchase is required?
A) One attempt
B) Two attempts
C) Three attempts
D) Unlimited attempts
Correct Answer: C) Three attempts
Rationale:
Candidates are allowed up to three attempts to pass the AHIP exam after completing the course. If all three
attempts are unsuccessful, the candidate must repurchase the training and exam package. This policy
encourages adequate preparation before testing. It also maintains the integrity of the certification process.
10. When does the AHIP 2026 certification exam officially open?
2026/2027) | QUESTIONS AND ANSWERS |
GRADE A | 100% CORRECT (VERIFIED
SOLUTIONS)
AMERICA’S HEALTH INSURANCE PLANS
(AHIP)
1. Which types of Medicare Advantage (MA) plans are available to eligible Medicare
beneficiaries?
A) Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), Medical Savings
Account (MSA), Medicare Cost Plans, and Private Fee-for-Service (PFFS)
B) Health Maintenance Organization (HMO) plans only
C) Preferred Provider Organization (PPO) and Medical Savings Account (MSA) plans only
D) Medicare Cost Plans and Private Fee-for-Service (PFFS) plans only
Correct Answer: A) Health Maintenance Organization (HMO), Preferred Provider Organization (PPO),
Medical Savings Account (MSA), Medicare Cost Plans, and Private Fee-for-Service (PFFS)
Rationale:
Medicare Advantage, also known as Medicare Part C, includes several plan types approved by CMS to meet
different beneficiary needs. These include HMOs, PPOs, MSAs, PFFS plans, and Medicare Cost Plans
(available in limited areas). Each plan type differs in provider access, referral requirements, and cost-sharing
structure. CMS allows these options to give beneficiaries flexibility in choosing coverage that best fits their
healthcare usage and financial situation.
2. Who is eligible to enroll in a Medicare-Medicaid Plan (MMP)?
A) Individuals enrolled in Medicare Part A only
B) Individuals who are dually eligible for Medicare and Medicaid, including Part D prescription drug
,coverage
C) Individuals under age 65 without a qualifying disability
D) Individuals who have only employer-sponsored health insurance
Correct Answer: B) Individuals who are dually eligible for Medicare and Medicaid, including Part D
prescription drug coverage
Rationale:
Medicare-Medicaid Plans (MMPs) are specifically designed for individuals who qualify for both Medicare
and Medicaid, often referred to as “dual eligibles.” These plans integrate Medicare Parts A, B, and D with
Medicaid benefits into one coordinated plan. The goal is to improve care coordination, reduce fragmentation,
‘?and simplify coverage for beneficiaries with complex healthcare needs. Individuals who do not have both
Medicare and Medicaid are not eligible for MMPs.
3. What is a key characteristic of a Medicare Cost Plan?
A) It requires enrollment in Medicare Part A only
B) It allows beneficiaries to receive services outside the plan’s network, with Original Medicare covering
those services
C) It limits enrollment to the Annual Enrollment Period only
D) It excludes prescription drug coverage entirely
Correct Answer: B) It allows beneficiaries to receive services outside the plan’s network, with Original
Medicare covering those services
Rationale:
Medicare Cost Plans combine features of Original Medicare and Medicare Advantage plans. Beneficiaries
may receive care from in-network providers through the plan, but if they choose to go out-of-network,
Original Medicare pays for covered services. This flexibility distinguishes Cost Plans from HMOs. However,
Cost Plans are only available in certain geographic areas and are being phased out in many counties.
4. When are individuals diagnosed with End-Stage Renal Disease (ESRD) eligible to enroll
in Medicare?
A) Only during the Annual Enrollment Period (AEP)
B) At any time, with Medicare coverage typically beginning in the fourth month of dialysis
C) Only during a Special Enrollment Period related to employment
D) Only upon reaching age 65
Correct Answer: B) At any time, with Medicare coverage typically beginning in the fourth month of
dialysis
Rationale:
Individuals with ESRD qualify for Medicare regardless of age once they meet medical eligibility
,requirements. In most cases, Medicare coverage begins in the fourth month of regular dialysis treatments,
although earlier coverage may apply in certain situations, such as home dialysis. CMS provides this
eligibility to ensure access to life-sustaining treatment. ESRD beneficiaries also now have expanded access
to Medicare Advantage plans under updated regulations.
5. What are the dates of the General Enrollment Period (GEP) for individuals who did not
enroll in Medicare Part B when first eligible?
A) April 1 to June 30, with coverage beginning July 1
B) January 1 to March 31, with coverage beginning July 1
C) October 15 to December 7, with coverage beginning January 1
D) July 1 to September 30, with coverage beginning October 1
Correct Answer: B) January 1 to March 31, with coverage beginning July 1
Rationale:
The General Enrollment Period allows individuals who missed their Initial Enrollment Period and did not
qualify for a Special Enrollment Period to enroll in Medicare Part B. The GEP runs annually from January 1
through March 31. Coverage does not begin immediately; instead, it starts on July 1 of the same year. Late
enrollment penalties may apply depending on circumstances.
6. When may individuals with active employer group health coverage enroll in Medicare
Part A and/or Part B without penalty?
A) Only during the Initial Enrollment Period
B) At any time while covered under an employer group health plan, during a Special Enrollment Period
C) Only after reaching age 70
D) Only during the Annual Enrollment Period
Correct Answer: B) At any time while covered under an employer group health plan, during a Special
Enrollment Period
Rationale:
Individuals who are actively working and covered by an employer-sponsored group health plan may delay
enrolling in Medicare Part B without penalty. CMS grants a Special Enrollment Period (SEP) that allows
enrollment during employment or within eight months after coverage ends. This protects beneficiaries from
late enrollment penalties. The SEP is tied to current employment, not retiree or COBRA coverage.
7. How many questions are included in the AHIP final certification exam?
A) 25
B) 50
, C) 75
D) 100
Correct Answer: B) 50
Rationale:
The AHIP final exam consists of 50 multiple-choice questions covering Medicare basics, compliance,
enrollment rules, and marketing guidelines. The exam is open-book but closely timed, requiring familiarity
with course material. Agents must demonstrate a strong understanding of CMS regulations. The standardized
format ensures consistency across certification cycles.
8. What is the minimum passing score required to successfully complete the AHIP exam?
A) 70%
B) 80%
C) 90%
D) 95%
Correct Answer: C) 90%
Rationale:
AHIP requires a minimum passing score of 90% to ensure agents meet high compliance and knowledge
standards. This strict requirement reflects the importance of accurate Medicare education and ethical sales
practices. Because agents advise vulnerable populations, CMS and AHIP emphasize mastery of content.
Failing to meet this threshold requires retesting.
9. How many attempts are permitted to pass the AHIP certification exam before
repurchase is required?
A) One attempt
B) Two attempts
C) Three attempts
D) Unlimited attempts
Correct Answer: C) Three attempts
Rationale:
Candidates are allowed up to three attempts to pass the AHIP exam after completing the course. If all three
attempts are unsuccessful, the candidate must repurchase the training and exam package. This policy
encourages adequate preparation before testing. It also maintains the integrity of the certification process.
10. When does the AHIP 2026 certification exam officially open?
