AHIP Final Exam (2025/2026) – 50 Verified Questions and Correct
Answers | Complete Study Material for A+ Preparation
Q1. Under the 2025 CMS Final Rule, what is the new threshold for D-SNP look-alike plans in
Medicare Advantage for contract year 2025?
A. 80% dually eligible enrollment
B. 70% dually eligible enrollment
C. 60% dually eligible enrollment
D. 50% dually eligible enrollment
✅ Correct Answer: B. 70% dually eligible enrollment
🧠 Rationale: The 2025 CMS Final Rule lowers the D-SNP look-alike threshold from 80% to
70% for CY 2025 (and to 60% in 2026) to promote full D-SNP standards and reduce plans
serving high percentages of dually eligible individuals without meeting integration requirements,
per CMS-4205-F.
Q2. Which of the following is a core chronic disease added to the Medicare Part D MTM
eligibility criteria effective CY 2025?
A. Hypertension
B. HIV/AIDS
C. Diabetes
D. Asthma
✅ Correct Answer: B. HIV/AIDS
🧠 Rationale: The 2025 CMS Final Rule updates MTM eligibility to include HIV/AIDS as one of
ten core chronic diseases, expanding access to comprehensive medication reviews for
enrollees with multiple conditions, as outlined in the Part D redesign under the Inflation
Reduction Act (IRA).
Q3. In Medicare basics, what is the standard monthly premium for Part B in 2025 for most
beneficiaries?
A. $174.70
B. $185.00
C. $164.90
D. $170.10
✅ Correct Answer: A. $174.70
, 🧠 Rationale: The standard Part B premium for 2025 is $174.70, a 5.7% increase from 2024,
reflecting CMS adjustments for rising costs; higher-income beneficiaries pay an income-related
monthly adjustment amount (IRMAA), per CMS announcements.
Q4. For Medicare Advantage plans, what new notification must MA organizations provide
enrollees between June 30 and July 31 in 2025?
A. Annual premium adjustments
B. Mid-year notice of unused supplemental benefits
C. Enrollment confirmation
D. Network provider updates
✅ Correct Answer: B. Mid-year notice of unused supplemental benefits
🧠 Rationale: The 2025 CMS Final Rule requires MA plans to send a personalized mid-year
notification of unused supplemental benefits (funded by rebates) to encourage utilization and
transparency, including details on scope, cost-sharing, and access.
Q5. What change does the 2025 CMS rule introduce for Part D sponsor substitutions of
biosimilars?
A. Requires prior authorization for all substitutions
B. Allows midyear substitutions for all biosimilars with 30-day notice
C. Limits substitutions to interchangeable biosimilars only
D. Prohibits any midyear formulary changes
✅ Correct Answer: B. Allows midyear substitutions for all biosimilars with 30-day notice
🧠 Rationale: Effective CY 2025, Part D sponsors gain flexibility to substitute all biosimilars (not
just interchangeable ones) as formulary maintenance changes with 30-day notice, improving
access to lower-cost options without triggering non-maintenance restrictions.
Q6. According to 2025 marketing guidelines, what is the maximum compensation variability
allowed for agents and brokers in Medicare Advantage enrollments?
A. Up to 20% variation based on plan type
B. Fixed national amount with no variability
C. Variable based on enrollee income
D. Up to $50 administrative fee per enrollment
✅ Correct Answer: B. Fixed national amount with no variability
🧠 Rationale: The 2025 CMS Final Rule redefines compensation as a fixed amount to prevent
steering, increasing the initial enrollment payment by $100 and prohibiting variable incentives,
ensuring recommendations align with enrollee needs per marketing guidelines.
Answers | Complete Study Material for A+ Preparation
Q1. Under the 2025 CMS Final Rule, what is the new threshold for D-SNP look-alike plans in
Medicare Advantage for contract year 2025?
A. 80% dually eligible enrollment
B. 70% dually eligible enrollment
C. 60% dually eligible enrollment
D. 50% dually eligible enrollment
✅ Correct Answer: B. 70% dually eligible enrollment
🧠 Rationale: The 2025 CMS Final Rule lowers the D-SNP look-alike threshold from 80% to
70% for CY 2025 (and to 60% in 2026) to promote full D-SNP standards and reduce plans
serving high percentages of dually eligible individuals without meeting integration requirements,
per CMS-4205-F.
Q2. Which of the following is a core chronic disease added to the Medicare Part D MTM
eligibility criteria effective CY 2025?
A. Hypertension
B. HIV/AIDS
C. Diabetes
D. Asthma
✅ Correct Answer: B. HIV/AIDS
🧠 Rationale: The 2025 CMS Final Rule updates MTM eligibility to include HIV/AIDS as one of
ten core chronic diseases, expanding access to comprehensive medication reviews for
enrollees with multiple conditions, as outlined in the Part D redesign under the Inflation
Reduction Act (IRA).
Q3. In Medicare basics, what is the standard monthly premium for Part B in 2025 for most
beneficiaries?
A. $174.70
B. $185.00
C. $164.90
D. $170.10
✅ Correct Answer: A. $174.70
, 🧠 Rationale: The standard Part B premium for 2025 is $174.70, a 5.7% increase from 2024,
reflecting CMS adjustments for rising costs; higher-income beneficiaries pay an income-related
monthly adjustment amount (IRMAA), per CMS announcements.
Q4. For Medicare Advantage plans, what new notification must MA organizations provide
enrollees between June 30 and July 31 in 2025?
A. Annual premium adjustments
B. Mid-year notice of unused supplemental benefits
C. Enrollment confirmation
D. Network provider updates
✅ Correct Answer: B. Mid-year notice of unused supplemental benefits
🧠 Rationale: The 2025 CMS Final Rule requires MA plans to send a personalized mid-year
notification of unused supplemental benefits (funded by rebates) to encourage utilization and
transparency, including details on scope, cost-sharing, and access.
Q5. What change does the 2025 CMS rule introduce for Part D sponsor substitutions of
biosimilars?
A. Requires prior authorization for all substitutions
B. Allows midyear substitutions for all biosimilars with 30-day notice
C. Limits substitutions to interchangeable biosimilars only
D. Prohibits any midyear formulary changes
✅ Correct Answer: B. Allows midyear substitutions for all biosimilars with 30-day notice
🧠 Rationale: Effective CY 2025, Part D sponsors gain flexibility to substitute all biosimilars (not
just interchangeable ones) as formulary maintenance changes with 30-day notice, improving
access to lower-cost options without triggering non-maintenance restrictions.
Q6. According to 2025 marketing guidelines, what is the maximum compensation variability
allowed for agents and brokers in Medicare Advantage enrollments?
A. Up to 20% variation based on plan type
B. Fixed national amount with no variability
C. Variable based on enrollee income
D. Up to $50 administrative fee per enrollment
✅ Correct Answer: B. Fixed national amount with no variability
🧠 Rationale: The 2025 CMS Final Rule redefines compensation as a fixed amount to prevent
steering, increasing the initial enrollment payment by $100 and prohibiting variable incentives,
ensuring recommendations align with enrollee needs per marketing guidelines.
