Pass with Confidence: AHIP 2025 Exam
Answers for 2024/2025 – Featuring 100%
Reliable Solutions
Prepared for AHIP Certification Preparation
June 2025
,1. Introduction
This document provides 80 realistic and up-to-date questions for the AHIP 2025 Exam,
reflecting changes for the 2024/2025 plan year. Each question is accompanied by a 100%
reliable answer and a brief explanation to aid in understanding key concepts related to
Medicare, Medicare Advantage, Prescription Drug Plans, and Fraud, Waste, and Abuse
(FWA) compliance. These questions are designed to align with the AHIP training mod-
ules and CMS requirements, ensuring comprehensive preparation for agents seeking cer-
tification to sell Medicare Advantage and Part D plans.
2. AHIP 2025 Exam Questions and Answers
2.1 Question 1: Types of Medicare Advantage Plans
Which of the following are types of Medicare Advantage Plans? a) PPO, HMO, MSA,
Cost Plan, PFFS b) PPO, HMO, Medigap, PFFS, SNP c) HMO, MSA, Part D, Cost
Plan, PPO d) PFFS, SNP, Part B, HMO, PPO
Answer: a) PPO, HMO, MSA, Cost Plan, PFFS Explanation: Medicare Advantage
Plans include Preferred Provider Organization (PPO), Health Maintenance Organiza-
tion (HMO), Medical Savings Account (MSA), Cost Plans, and Private Fee-for-Service
(PFFS). Medigap is a supplemental insurance plan, not a Medicare Advantage Plan, and
Part D refers to prescription drug coverage, not a plan type. Special Needs Plans (SNPs)
are a subtype of Medicare Advantage, but the correct answer includes the broadest cat-
egories. [](https://www.stuvia.com/en-us/doc/4833103/ahip-2025-final-exam-questions-
and-answers-2024-2025-verified-answers)
2.2 Question 2: Medicare-Medicaid Plans
What is true about Medicare-Medicaid Plans? a) They serve only Medicare beneficiaries
b) They exclude Part D coverage c) They serve individuals eligible for both Medicare and
Medicaid d) They are only available in urban areas
Answer: c) They serve individuals eligible for both Medicare and Medicaid Explanation:
Medicare-Medicaid Plans, also known as Dual Eligible Special Needs Plans (D-SNPs), are
designed for individuals who qualify for both Medicare and Medicaid, often referred to as
dual eligibles. These plans include Part D coverage and are available in various regions,
not limited to urban areas. [](https://www.stuvia.com/en-us/doc/4833103/ahip-2025-
final-exam-questions-and-answers-2024-2025-verified-answers)
2.3 Question 3: Medicare Cost Plan Enrollment
What is a key feature of a Medicare Cost Plan? a) Requires enrollment in Part A only
b) Non-network providers may charge higher coinsurance and deductibles c) Enrollment
is limited to specific times of the year d) Part D coverage is mandatory
Answer: b) Non-network providers may charge higher coinsurance and deductibles Expla-
nation: Medicare Cost Plans require enrollment in Part B and allow enrollment anytime
the plan accepts new members. Non-network providers can charge higher coinsurance
1
, and deductibles, and Part D coverage is optional, either through the plan or a separate
Prescription Drug Plan (PDP). [](https://www.stuvia.com/en-us/doc/4833103/ahip-
2025-final-exam-questions-and-answers-2024-2025-verified-answers)
2.4 Question 4: ESRD Enrollment
When can individuals with End-Stage Renal Disease (ESRD) enroll in Medicare? a) Only
during the Annual Enrollment Period b) At any time, with coverage starting the fourth
month after dialysis begins c) Only after a kidney transplant d) During the General
Enrollment Period
Answer: b) At any time, with coverage starting the fourth month after dialysis begins
Explanation: Individuals with ESRD can enroll in Medicare at any time, and cover-
age typically begins the fourth month after dialysis starts, reflecting CMS eligibility
rules. [](https://www.stuvia.com/en-us/doc/4833103/ahip-2025-final-exam-questions-
and-answers-2024-2025-verified-answers)
2.5 Question 5: General Enrollment Period
When can individuals who missed their Initial Enrollment Period for Part B enroll? a)
January 1 to March 31, with coverage starting July 1 b) October 15 to December 7, with
coverage starting January 1 c) Anytime, with immediate coverage d) April 1 to June 30,
with coverage starting July 1
Answer: a) January 1 to March 31, with coverage starting July 1 Explanation: The
General Enrollment Period for Medicare Part B runs from January 1 to March 31 each
year, with coverage beginning on July 1 of that year. [](https://www.stuvia.com/en-
us/doc/4833103/ahip-2025-final-exam-questions-and-answers-2024-2025-verified-answers)
2.6 Question 6: Special Enrollment Period
Who qualifies for a Special Enrollment Period for Medicare Part A or B? a) Individuals
under 65 with no health coverage b) Individuals with employer group health coverage c)
Individuals enrolled in a Medicare Advantage Plan d) Individuals who move to a new
state
Answer: b) Individuals with employer group health coverage Explanation: Individuals
with employer group health coverage can enroll in Part A or B during a Special Enrollment
Period without penalty, typically when their group coverage ends. [](https://www.stuvia.com/en-
us/doc/4833103/ahip-2025-final-exam-questions-and-answers-2024-2025-verified-answers)
2.7 Question 7: Inpatient Psychiatric Care
What is the Medicare coverage limit for inpatient psychiatric hospital stays? a) 90 days
per year b) 190 days over a lifetime c) Unlimited days with prior authorization d) 30 days
per benefit period
Answer: b) 190 days over a lifetime Explanation: Medicare covers a total of 190 days of in-
patient psychiatric care over a beneficiary’s lifetime in a psychiatric hospital. [](https://www.stuvia.com/
us/doc/2526561/ahip-final-exam-test-questions-en-answers-latest-2024-2025)
2
Answers for 2024/2025 – Featuring 100%
Reliable Solutions
Prepared for AHIP Certification Preparation
June 2025
,1. Introduction
This document provides 80 realistic and up-to-date questions for the AHIP 2025 Exam,
reflecting changes for the 2024/2025 plan year. Each question is accompanied by a 100%
reliable answer and a brief explanation to aid in understanding key concepts related to
Medicare, Medicare Advantage, Prescription Drug Plans, and Fraud, Waste, and Abuse
(FWA) compliance. These questions are designed to align with the AHIP training mod-
ules and CMS requirements, ensuring comprehensive preparation for agents seeking cer-
tification to sell Medicare Advantage and Part D plans.
2. AHIP 2025 Exam Questions and Answers
2.1 Question 1: Types of Medicare Advantage Plans
Which of the following are types of Medicare Advantage Plans? a) PPO, HMO, MSA,
Cost Plan, PFFS b) PPO, HMO, Medigap, PFFS, SNP c) HMO, MSA, Part D, Cost
Plan, PPO d) PFFS, SNP, Part B, HMO, PPO
Answer: a) PPO, HMO, MSA, Cost Plan, PFFS Explanation: Medicare Advantage
Plans include Preferred Provider Organization (PPO), Health Maintenance Organiza-
tion (HMO), Medical Savings Account (MSA), Cost Plans, and Private Fee-for-Service
(PFFS). Medigap is a supplemental insurance plan, not a Medicare Advantage Plan, and
Part D refers to prescription drug coverage, not a plan type. Special Needs Plans (SNPs)
are a subtype of Medicare Advantage, but the correct answer includes the broadest cat-
egories. [](https://www.stuvia.com/en-us/doc/4833103/ahip-2025-final-exam-questions-
and-answers-2024-2025-verified-answers)
2.2 Question 2: Medicare-Medicaid Plans
What is true about Medicare-Medicaid Plans? a) They serve only Medicare beneficiaries
b) They exclude Part D coverage c) They serve individuals eligible for both Medicare and
Medicaid d) They are only available in urban areas
Answer: c) They serve individuals eligible for both Medicare and Medicaid Explanation:
Medicare-Medicaid Plans, also known as Dual Eligible Special Needs Plans (D-SNPs), are
designed for individuals who qualify for both Medicare and Medicaid, often referred to as
dual eligibles. These plans include Part D coverage and are available in various regions,
not limited to urban areas. [](https://www.stuvia.com/en-us/doc/4833103/ahip-2025-
final-exam-questions-and-answers-2024-2025-verified-answers)
2.3 Question 3: Medicare Cost Plan Enrollment
What is a key feature of a Medicare Cost Plan? a) Requires enrollment in Part A only
b) Non-network providers may charge higher coinsurance and deductibles c) Enrollment
is limited to specific times of the year d) Part D coverage is mandatory
Answer: b) Non-network providers may charge higher coinsurance and deductibles Expla-
nation: Medicare Cost Plans require enrollment in Part B and allow enrollment anytime
the plan accepts new members. Non-network providers can charge higher coinsurance
1
, and deductibles, and Part D coverage is optional, either through the plan or a separate
Prescription Drug Plan (PDP). [](https://www.stuvia.com/en-us/doc/4833103/ahip-
2025-final-exam-questions-and-answers-2024-2025-verified-answers)
2.4 Question 4: ESRD Enrollment
When can individuals with End-Stage Renal Disease (ESRD) enroll in Medicare? a) Only
during the Annual Enrollment Period b) At any time, with coverage starting the fourth
month after dialysis begins c) Only after a kidney transplant d) During the General
Enrollment Period
Answer: b) At any time, with coverage starting the fourth month after dialysis begins
Explanation: Individuals with ESRD can enroll in Medicare at any time, and cover-
age typically begins the fourth month after dialysis starts, reflecting CMS eligibility
rules. [](https://www.stuvia.com/en-us/doc/4833103/ahip-2025-final-exam-questions-
and-answers-2024-2025-verified-answers)
2.5 Question 5: General Enrollment Period
When can individuals who missed their Initial Enrollment Period for Part B enroll? a)
January 1 to March 31, with coverage starting July 1 b) October 15 to December 7, with
coverage starting January 1 c) Anytime, with immediate coverage d) April 1 to June 30,
with coverage starting July 1
Answer: a) January 1 to March 31, with coverage starting July 1 Explanation: The
General Enrollment Period for Medicare Part B runs from January 1 to March 31 each
year, with coverage beginning on July 1 of that year. [](https://www.stuvia.com/en-
us/doc/4833103/ahip-2025-final-exam-questions-and-answers-2024-2025-verified-answers)
2.6 Question 6: Special Enrollment Period
Who qualifies for a Special Enrollment Period for Medicare Part A or B? a) Individuals
under 65 with no health coverage b) Individuals with employer group health coverage c)
Individuals enrolled in a Medicare Advantage Plan d) Individuals who move to a new
state
Answer: b) Individuals with employer group health coverage Explanation: Individuals
with employer group health coverage can enroll in Part A or B during a Special Enrollment
Period without penalty, typically when their group coverage ends. [](https://www.stuvia.com/en-
us/doc/4833103/ahip-2025-final-exam-questions-and-answers-2024-2025-verified-answers)
2.7 Question 7: Inpatient Psychiatric Care
What is the Medicare coverage limit for inpatient psychiatric hospital stays? a) 90 days
per year b) 190 days over a lifetime c) Unlimited days with prior authorization d) 30 days
per benefit period
Answer: b) 190 days over a lifetime Explanation: Medicare covers a total of 190 days of in-
patient psychiatric care over a beneficiary’s lifetime in a psychiatric hospital. [](https://www.stuvia.com/
us/doc/2526561/ahip-final-exam-test-questions-en-answers-latest-2024-2025)
2
