AHIP - 2026 - Modules 1-5
Exam Coverage
The exam coverage includes the core health insurance and Medicare-
related knowledge assessed in AHIP Certification Exam 2026
(Modules 1-5), administered by America's Health Insurance Plans
(AHIP). It focuses on the structure of the U.S. healthcare system,
including Medicare Parts A, B, C (Medicare Advantage), and D
(prescription drug coverage). The exam also evaluates understanding
of eligibility, enrollment periods, plan benefits, cost-sharing, and
coordination of benefits. Emphasis is placed on compliance, fraud and
abuse prevention, marketing guidelines, beneficiary protections, and
ethical practices required for professionals selling or managing
Medicare-related health plans.
,Mr. Capadona would like to purchase a Medicare Advantage (MA)
plan and a Medigap plan to pick up costs not covered by that plan.
What should you tell him?
It is illegal for you to sell Mr. Capadona a Medigap plan if he is
enrolled in an MA plan, and besides, Medigap only works with
Original Medicare.
,Agent John Miller is meeting with Jerry Smith, a new prospect. Jerry is
currently enrolled in Medicare Parts A and B. Jerry has also purchased
a Medicare Supplement (Medigap) plan which he has had for several
years. However, the plan does not provide drug benefits. How would
you advise Agent John Miller to proceed?
Tell prospect Jerry Smith that he should consider adding a standalone
Part D prescription drug coverage policy to his present coverage.
, Mr. Wu is eligible for Medicare. He has limited financial resources but
failed to qualify for the Part D low-income subsidy. Where might he
turn for help with his prescription drug costs?
Mr. Wu may still qualify for help in paying Part D costs through his
State Pharmaceutical Assistance Program (SPAP).
Exam Coverage
The exam coverage includes the core health insurance and Medicare-
related knowledge assessed in AHIP Certification Exam 2026
(Modules 1-5), administered by America's Health Insurance Plans
(AHIP). It focuses on the structure of the U.S. healthcare system,
including Medicare Parts A, B, C (Medicare Advantage), and D
(prescription drug coverage). The exam also evaluates understanding
of eligibility, enrollment periods, plan benefits, cost-sharing, and
coordination of benefits. Emphasis is placed on compliance, fraud and
abuse prevention, marketing guidelines, beneficiary protections, and
ethical practices required for professionals selling or managing
Medicare-related health plans.
,Mr. Capadona would like to purchase a Medicare Advantage (MA)
plan and a Medigap plan to pick up costs not covered by that plan.
What should you tell him?
It is illegal for you to sell Mr. Capadona a Medigap plan if he is
enrolled in an MA plan, and besides, Medigap only works with
Original Medicare.
,Agent John Miller is meeting with Jerry Smith, a new prospect. Jerry is
currently enrolled in Medicare Parts A and B. Jerry has also purchased
a Medicare Supplement (Medigap) plan which he has had for several
years. However, the plan does not provide drug benefits. How would
you advise Agent John Miller to proceed?
Tell prospect Jerry Smith that he should consider adding a standalone
Part D prescription drug coverage policy to his present coverage.
, Mr. Wu is eligible for Medicare. He has limited financial resources but
failed to qualify for the Part D low-income subsidy. Where might he
turn for help with his prescription drug costs?
Mr. Wu may still qualify for help in paying Part D costs through his
State Pharmaceutical Assistance Program (SPAP).
