AHIP 2025 Final Exam Answer Key
ACTUAL EXAM 2026/2027 | AHIP 2025
Answer Key Complete | Verified Q&A |
Pass Guaranteed - A+ Graded
Q1: An agent is presenting Medicare Advantage plans at a community center. A beneficiary asks about
coverage for a routine eye exam. Original Medicare does not cover this. The agent should:
A. Tell the beneficiary that no Medicare plan covers routine eye exams.
B. Explain that some MA plans offer routine vision benefits, but the beneficiary must review plan
Evidence of Coverage. [CORRECT]
C. Recommend a standalone vision discount plan immediately.
D. State that Medicare Part B covers routine eye exams for all beneficiaries over 65.
Correct Answer: B
Rationale: Original Medicare (Parts A & B) does not cover routine eye exams, but Medicare Advantage
plans may offer supplemental benefits including routine vision. Agents must direct beneficiaries to the
plan's Evidence of Coverage rather than making blanket statements (eliminates A). Option C is
inappropriate without needs assessment. Option D is false — Part B covers diagnostic eye exams only
(e.g., diabetes, glaucoma).
Q2: During a sales presentation, a beneficiary says they have had a Medicare Supplement (Medigap)
Plan G for 3 years and want to switch to an MA plan. The agent must:
A. Enroll them immediately because they have a guaranteed issue right.
B. Inform them that they can only switch during the Medicare Advantage Open Enrollment Period (OEP)
Jan 1–Mar 31.
C. Verify if they have a valid enrollment period (e.g., Annual Enrollment Period Oct 15–Dec 7 or a Special
Enrollment Period). [CORRECT]
D. Tell them they must drop Medigap before discussing MA plans.
Correct Answer: C
Rationale: Switching from Medigap to MA generally requires an enrollment period (AEP or SEP). There is
no automatic "guaranteed issue" for switching from Medigap to MA (eliminates A). MA OEP (Jan–Mar) is
for MA-to-MA or MA-to-Original Medicare changes, not Medigap-to-MA (eliminates B). Option D is
incorrect — you cannot require dropping existing coverage before a discussion.
Q3: A beneficiary qualifies for a Special Needs Plan (SNP) because they have both Medicare and
Medicaid. This type of SNP is known as a:
, A. Chronic Condition SNP (C-SNP)
B. Institutional SNP (I-SNP)
C. Dual Eligible SNP (D-SNP) [CORRECT]
D. Special Enrollment SNP (SE-SNP)
Correct Answer: C
Rationale: SNPs are tailored for specific groups. D-SNPs are for those eligible for both Medicare and
Medicaid (dual eligibles). C-SNPs are for specific chronic conditions, and I-SNPs are for institutionalized
individuals. "SE-SNP" is not a valid plan type.
Q4: A beneficiary is enrolled in a Medicare Advantage HMO plan. They decide to see a specialist who is
not in the plan’s network without a referral. The plan will likely:
A. Pay 80% of the cost after the deductible.
B. Pay 100% of the cost because it is an emergency.
C. Pay nothing, and the beneficiary will be responsible for the full cost. [CORRECT]
D. Automatically switch the beneficiary to a PPO plan for that month.
Correct Answer: C
Rationale: HMOs generally require members to use network providers and obtain referrals. Except for
emergencies or urgent care, out-of-network care is typically not covered, leaving the beneficiary
financially responsible.
Q5: A beneficiary wants to disenroll from their Medicare Advantage plan and return to Original
Medicare. When is the specific Annual Enrollment Period (AEP) for this action?
A. January 1 – March 31
B. October 15 – December 7 [CORRECT]
C. April 1 – June 30
D. Anytime during the year
Correct Answer: B
Rationale: The Annual Enrollment Period (AEP) runs from October 15 to December 7. During this time,
beneficiaries can switch from MA to Original Medicare (and join a standalone PDP). The Jan 1–Mar 31
period is the Medicare Advantage Open Enrollment Period (MA OEP), which has different rules (mostly
for MA-to-MA switches).
Q6: A 5-star Medicare Advantage plan is available in the beneficiary's area. What special enrollment
right does this provide?
A. The beneficiary can enroll only during AEP.
B. The beneficiary can enroll once between December 8 and November 30. [CORRECT]
C. The beneficiary can enroll anytime during the year without restriction.
D. The beneficiary must wait for the General Enrollment Period.
ACTUAL EXAM 2026/2027 | AHIP 2025
Answer Key Complete | Verified Q&A |
Pass Guaranteed - A+ Graded
Q1: An agent is presenting Medicare Advantage plans at a community center. A beneficiary asks about
coverage for a routine eye exam. Original Medicare does not cover this. The agent should:
A. Tell the beneficiary that no Medicare plan covers routine eye exams.
B. Explain that some MA plans offer routine vision benefits, but the beneficiary must review plan
Evidence of Coverage. [CORRECT]
C. Recommend a standalone vision discount plan immediately.
D. State that Medicare Part B covers routine eye exams for all beneficiaries over 65.
Correct Answer: B
Rationale: Original Medicare (Parts A & B) does not cover routine eye exams, but Medicare Advantage
plans may offer supplemental benefits including routine vision. Agents must direct beneficiaries to the
plan's Evidence of Coverage rather than making blanket statements (eliminates A). Option C is
inappropriate without needs assessment. Option D is false — Part B covers diagnostic eye exams only
(e.g., diabetes, glaucoma).
Q2: During a sales presentation, a beneficiary says they have had a Medicare Supplement (Medigap)
Plan G for 3 years and want to switch to an MA plan. The agent must:
A. Enroll them immediately because they have a guaranteed issue right.
B. Inform them that they can only switch during the Medicare Advantage Open Enrollment Period (OEP)
Jan 1–Mar 31.
C. Verify if they have a valid enrollment period (e.g., Annual Enrollment Period Oct 15–Dec 7 or a Special
Enrollment Period). [CORRECT]
D. Tell them they must drop Medigap before discussing MA plans.
Correct Answer: C
Rationale: Switching from Medigap to MA generally requires an enrollment period (AEP or SEP). There is
no automatic "guaranteed issue" for switching from Medigap to MA (eliminates A). MA OEP (Jan–Mar) is
for MA-to-MA or MA-to-Original Medicare changes, not Medigap-to-MA (eliminates B). Option D is
incorrect — you cannot require dropping existing coverage before a discussion.
Q3: A beneficiary qualifies for a Special Needs Plan (SNP) because they have both Medicare and
Medicaid. This type of SNP is known as a:
, A. Chronic Condition SNP (C-SNP)
B. Institutional SNP (I-SNP)
C. Dual Eligible SNP (D-SNP) [CORRECT]
D. Special Enrollment SNP (SE-SNP)
Correct Answer: C
Rationale: SNPs are tailored for specific groups. D-SNPs are for those eligible for both Medicare and
Medicaid (dual eligibles). C-SNPs are for specific chronic conditions, and I-SNPs are for institutionalized
individuals. "SE-SNP" is not a valid plan type.
Q4: A beneficiary is enrolled in a Medicare Advantage HMO plan. They decide to see a specialist who is
not in the plan’s network without a referral. The plan will likely:
A. Pay 80% of the cost after the deductible.
B. Pay 100% of the cost because it is an emergency.
C. Pay nothing, and the beneficiary will be responsible for the full cost. [CORRECT]
D. Automatically switch the beneficiary to a PPO plan for that month.
Correct Answer: C
Rationale: HMOs generally require members to use network providers and obtain referrals. Except for
emergencies or urgent care, out-of-network care is typically not covered, leaving the beneficiary
financially responsible.
Q5: A beneficiary wants to disenroll from their Medicare Advantage plan and return to Original
Medicare. When is the specific Annual Enrollment Period (AEP) for this action?
A. January 1 – March 31
B. October 15 – December 7 [CORRECT]
C. April 1 – June 30
D. Anytime during the year
Correct Answer: B
Rationale: The Annual Enrollment Period (AEP) runs from October 15 to December 7. During this time,
beneficiaries can switch from MA to Original Medicare (and join a standalone PDP). The Jan 1–Mar 31
period is the Medicare Advantage Open Enrollment Period (MA OEP), which has different rules (mostly
for MA-to-MA switches).
Q6: A 5-star Medicare Advantage plan is available in the beneficiary's area. What special enrollment
right does this provide?
A. The beneficiary can enroll only during AEP.
B. The beneficiary can enroll once between December 8 and November 30. [CORRECT]
C. The beneficiary can enroll anytime during the year without restriction.
D. The beneficiary must wait for the General Enrollment Period.
