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AHIP MEDICARE TRAINING 2026–2027 FINAL EXAM | 160+ VERIFIED
QUESTIONS & ANSWERS | 100% PASS GUARANTEED
1. A 67-year-old client recently retired and wants to enroll in Medicare
coverage. They have group insurance that will end next month and ask how to
avoid a late enrollment penalty for Part B. What should the licensed agent
advise this client to do?
A. Wait until the General Enrollment Period in January
B. Enroll in Part B during their Special Enrollment Period after employer coverage
ends
C. Delay enrollment for six months to see if they need coverage
D. Purchase a private plan without enrolling in Part B
Correct Answer: B. Enroll in Part B during their Special Enrollment Period after
employer coverage ends
Rationale: Clients leaving employer coverage can enroll in Part B within 8 months
without penalty, using the Special Enrollment Period (SEP).
2. An agent meets a Medicare beneficiary who takes multiple prescriptions
and is struggling with costs. The client is considering a Part D plan but is
unsure how it differs from other coverage. What should the agent explain
about Medicare Part D?
A. It only covers inpatient hospital medications
B. It helps pay for prescription drugs through private insurance companies
approved by Medicare
C. It replaces all other types of Medicare coverage automatically
D. It is available only to people with Medicare Advantage
Correct Answer: B. It helps pay for prescription drugs through private insurance
companies approved by Medicare
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Rationale: Part D provides outpatient prescription drug coverage offered through
CMS-approved private insurers.
3. During an appointment, an agent tells a client that if they enroll today, the
plan will send them a $100 gift card as a thank-you. Which compliance rule
applies in this case?
A. Offering nominal gifts is permitted if worth $75 or more
B. Monetary gifts or cash equivalents for enrollment are prohibited
C. Any gift is acceptable if disclosed in writing
D. Gifts are allowed only if approved by CMS after enrollment
Correct Answer: B. Monetary gifts or cash equivalents for enrollment are
prohibited
Rationale: CMS marketing guidelines forbid agents from offering or promising
cash or cash equivalents to influence enrollment decisions.
4. A Medicare Advantage (MA) enrollee contacts their agent to ask about
switching to another MA plan because they moved to a different county
within the same state. What should the agent tell them about their options?
A. They must wait until the next Annual Enrollment Period to make changes
B. They qualify for a Special Enrollment Period due to change in residence
C. They can only switch if their plan offers a relocation benefit
D. They will automatically be reassigned to a new plan by CMS
Correct Answer: B. They qualify for a Special Enrollment Period due to change
in residence
Rationale: A change in permanent address triggers an SEP, allowing the
beneficiary to switch plans or return to Original Medicare.
5. A client newly eligible for Medicare has chronic kidney disease and requires
regular dialysis. They ask if they can enroll in a Medicare Advantage plan.
Which explanation is correct?
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A. All individuals with ESRD are permanently excluded from MA plans
B. They can enroll in any MA plan available in their area
C. ESRD patients may join an MA plan if one is offered in their service area
D. They can only enroll after receiving a kidney transplant
Correct Answer: C. ESRD patients may join an MA plan if one is offered in their
service area
Rationale: Since 2021, individuals with ESRD are eligible to enroll in MA plans
that accept beneficiaries in their county or region.
6. A 72-year-old beneficiary enrolled in a Medicare Advantage Prescription
Drug (MA-PD) plan decides they no longer want drug coverage. They ask
their agent if they can drop Part D while staying in the MA plan. What should
the agent explain?
A. They can drop Part D anytime without affecting their MA plan
B. Dropping Part D will automatically disenroll them from their MA-PD plan
C. They can keep the MA plan without prescription coverage
D. They can suspend Part D coverage for up to 6 months
Correct Answer: B. Dropping Part D will automatically disenroll them from their
MA-PD plan
Rationale: In an MA-PD plan, medical and drug benefits are combined; dropping
Part D means the entire MA-PD plan ends, reverting the beneficiary to Original
Medicare.
7. During an educational event, an agent distributes plan brochures and
collects attendee names for future follow-up. Which CMS rule applies to this
situation?
A. Agents may freely collect contact information at educational events
B. Educational events must remain non-sales, and collecting contact data is
prohibited
C. Agents must obtain CMS approval before any data collection
D. Agents may only distribute brochures with no follow-up intent
Correct Answer: B. Educational events must remain non-sales, and collecting
contact data is prohibited
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Rationale: CMS defines educational events as informational only; no personal
data may be collected for marketing or sales purposes.
8. A client asks whether Medicare covers routine vision and dental care. The
agent should clarify that:
A. Original Medicare covers both vision and dental exams annually
B. Only Medicare Advantage plans may include vision and dental benefits
C. Original Medicare and all MA plans cover these automatically
D. Coverage depends entirely on the client’s state of residence
Correct Answer: B. Only Medicare Advantage plans may include vision and
dental benefits
Rationale: Original Medicare (Parts A & B) generally excludes routine dental and
vision, though many MA plans offer them as supplemental benefits.
9. A licensed agent accidentally discusses a plan benefit that has not been
approved by CMS marketing review. What should the agent do immediately?
A. Continue marketing since it was unintentional
B. Notify their compliance officer or plan sponsor as soon as possible
C. Correct it privately with the client but avoid reporting
D. Ignore it unless CMS contacts them
Correct Answer: B. Notify their compliance officer or plan sponsor as soon as
possible
Rationale: Agents must report compliance breaches to the plan sponsor promptly
to ensure corrective actions and maintain CMS compliance standards.
10. When explaining Medicare Supplement (Medigap) plans, which point
should the agent emphasize to a client considering one alongside a Medicare
Advantage plan?
A. Medigap can be used to cover MA plan copayments
B. It is illegal to sell a Medigap policy to someone in a Medicare Advantage plan
AHIP MEDICARE TRAINING 2026–2027 FINAL EXAM | 160+ VERIFIED
QUESTIONS & ANSWERS | 100% PASS GUARANTEED
1. A 67-year-old client recently retired and wants to enroll in Medicare
coverage. They have group insurance that will end next month and ask how to
avoid a late enrollment penalty for Part B. What should the licensed agent
advise this client to do?
A. Wait until the General Enrollment Period in January
B. Enroll in Part B during their Special Enrollment Period after employer coverage
ends
C. Delay enrollment for six months to see if they need coverage
D. Purchase a private plan without enrolling in Part B
Correct Answer: B. Enroll in Part B during their Special Enrollment Period after
employer coverage ends
Rationale: Clients leaving employer coverage can enroll in Part B within 8 months
without penalty, using the Special Enrollment Period (SEP).
2. An agent meets a Medicare beneficiary who takes multiple prescriptions
and is struggling with costs. The client is considering a Part D plan but is
unsure how it differs from other coverage. What should the agent explain
about Medicare Part D?
A. It only covers inpatient hospital medications
B. It helps pay for prescription drugs through private insurance companies
approved by Medicare
C. It replaces all other types of Medicare coverage automatically
D. It is available only to people with Medicare Advantage
Correct Answer: B. It helps pay for prescription drugs through private insurance
companies approved by Medicare
,2 | Page
Rationale: Part D provides outpatient prescription drug coverage offered through
CMS-approved private insurers.
3. During an appointment, an agent tells a client that if they enroll today, the
plan will send them a $100 gift card as a thank-you. Which compliance rule
applies in this case?
A. Offering nominal gifts is permitted if worth $75 or more
B. Monetary gifts or cash equivalents for enrollment are prohibited
C. Any gift is acceptable if disclosed in writing
D. Gifts are allowed only if approved by CMS after enrollment
Correct Answer: B. Monetary gifts or cash equivalents for enrollment are
prohibited
Rationale: CMS marketing guidelines forbid agents from offering or promising
cash or cash equivalents to influence enrollment decisions.
4. A Medicare Advantage (MA) enrollee contacts their agent to ask about
switching to another MA plan because they moved to a different county
within the same state. What should the agent tell them about their options?
A. They must wait until the next Annual Enrollment Period to make changes
B. They qualify for a Special Enrollment Period due to change in residence
C. They can only switch if their plan offers a relocation benefit
D. They will automatically be reassigned to a new plan by CMS
Correct Answer: B. They qualify for a Special Enrollment Period due to change
in residence
Rationale: A change in permanent address triggers an SEP, allowing the
beneficiary to switch plans or return to Original Medicare.
5. A client newly eligible for Medicare has chronic kidney disease and requires
regular dialysis. They ask if they can enroll in a Medicare Advantage plan.
Which explanation is correct?
,3 | Page
A. All individuals with ESRD are permanently excluded from MA plans
B. They can enroll in any MA plan available in their area
C. ESRD patients may join an MA plan if one is offered in their service area
D. They can only enroll after receiving a kidney transplant
Correct Answer: C. ESRD patients may join an MA plan if one is offered in their
service area
Rationale: Since 2021, individuals with ESRD are eligible to enroll in MA plans
that accept beneficiaries in their county or region.
6. A 72-year-old beneficiary enrolled in a Medicare Advantage Prescription
Drug (MA-PD) plan decides they no longer want drug coverage. They ask
their agent if they can drop Part D while staying in the MA plan. What should
the agent explain?
A. They can drop Part D anytime without affecting their MA plan
B. Dropping Part D will automatically disenroll them from their MA-PD plan
C. They can keep the MA plan without prescription coverage
D. They can suspend Part D coverage for up to 6 months
Correct Answer: B. Dropping Part D will automatically disenroll them from their
MA-PD plan
Rationale: In an MA-PD plan, medical and drug benefits are combined; dropping
Part D means the entire MA-PD plan ends, reverting the beneficiary to Original
Medicare.
7. During an educational event, an agent distributes plan brochures and
collects attendee names for future follow-up. Which CMS rule applies to this
situation?
A. Agents may freely collect contact information at educational events
B. Educational events must remain non-sales, and collecting contact data is
prohibited
C. Agents must obtain CMS approval before any data collection
D. Agents may only distribute brochures with no follow-up intent
Correct Answer: B. Educational events must remain non-sales, and collecting
contact data is prohibited
, 4 | Page
Rationale: CMS defines educational events as informational only; no personal
data may be collected for marketing or sales purposes.
8. A client asks whether Medicare covers routine vision and dental care. The
agent should clarify that:
A. Original Medicare covers both vision and dental exams annually
B. Only Medicare Advantage plans may include vision and dental benefits
C. Original Medicare and all MA plans cover these automatically
D. Coverage depends entirely on the client’s state of residence
Correct Answer: B. Only Medicare Advantage plans may include vision and
dental benefits
Rationale: Original Medicare (Parts A & B) generally excludes routine dental and
vision, though many MA plans offer them as supplemental benefits.
9. A licensed agent accidentally discusses a plan benefit that has not been
approved by CMS marketing review. What should the agent do immediately?
A. Continue marketing since it was unintentional
B. Notify their compliance officer or plan sponsor as soon as possible
C. Correct it privately with the client but avoid reporting
D. Ignore it unless CMS contacts them
Correct Answer: B. Notify their compliance officer or plan sponsor as soon as
possible
Rationale: Agents must report compliance breaches to the plan sponsor promptly
to ensure corrective actions and maintain CMS compliance standards.
10. When explaining Medicare Supplement (Medigap) plans, which point
should the agent emphasize to a client considering one alongside a Medicare
Advantage plan?
A. Medigap can be used to cover MA plan copayments
B. It is illegal to sell a Medigap policy to someone in a Medicare Advantage plan
