AHIP FINAL EXAM 2026
1. Which of the following is the primary purpose of Medicare Advantage (Part
C)?
A. To provide prescription drug coverage only
B. To offer a private alternative to Original Medicare
C. To replace Medicaid for low-income beneficiaries
D. To provide supplemental coverage only
Answer: B
Rationale: Medicare Advantage plans are private health plan alternatives to
Original Medicare, often including additional benefits like dental, vision, and
hearing.
2. A beneficiary enrolls in a Medicare Advantage plan during the Annual
Enrollment Period. When does coverage typically begin?
A. Immediately
B. January 1 of the following year
C. The first day of the month after enrollment
D. The first day of the month after the plan receives the enrollment request
,Answer: D
Rationale: Coverage begins the first day of the month after the plan receives the
enrollment request, per CMS rules.
3. Which Medicare Part covers prescription drugs when enrolled in Original
Medicare?
A. Part A
B. Part B
C. Part C
D. Part D
Answer: D
Rationale: Medicare Part D provides prescription drug coverage for beneficiaries
in Original Medicare and is also included in most Medicare Advantage plans.
4. A beneficiary calls to enroll in a Medicare Advantage plan but has limited
English proficiency. What is the most compliant way for the agent to proceed?
A. Proceed with the enrollment and document the call
B. Provide translated materials or offer an interpreter
C. Ask the beneficiary to call back with a family member
D. Decline the enrollment due to language barriers
Answer: B
Rationale: CMS requires culturally competent communication and access to
translation services for LEP beneficiaries. Agents must provide appropriate
support.
,5. A Medicare Advantage plan offers a “free” gift card to anyone who attends
a sales presentation. This is:
A. Allowed if the gift card is under $25
B. Allowed only if the beneficiary signs up
C. Prohibited under CMS marketing guidelines
D. Allowed if it is disclosed in writing
Answer: C
Rationale: CMS prohibits providing gifts or incentives to induce enrollment or
attendance at sales events.
6. Which of the following is considered a “Marketing Event” under CMS
guidelines?
A. One-on-one appointment
B. Community seminar with plan comparison
C. Enrollment assistance at a pharmacy
D. All of the above
Answer: D
Rationale: All these are considered marketing events and must comply with CMS
rules, including proper documentation and materials.
7. Which of the following is a key indicator of potential Medicare fraud?
A. Beneficiary requests additional information
B. Provider submits claims for services not rendered
C. Beneficiary changes doctors frequently
D. Provider uses electronic medical records
Answer: B
Rationale: Claims for services not rendered are a classic fraud indicator and
should be reported.
, 8. A beneficiary is in a Medicare Advantage plan and wants to switch to
Original Medicare mid-year without qualifying for a Special Enrollment
Period. What is the correct response?
A. They can switch anytime
B. They must wait until Annual Enrollment Period
C. They can switch during the Initial Enrollment Period
D. They must enroll in Part D immediately
Answer: B
Rationale: Switching from Medicare Advantage to Original Medicare outside
designated periods is generally not allowed unless a Special Enrollment Period
applies.
9. In Medicare Part D, which phase begins after a beneficiary meets the
deductible and ends when they reach the initial coverage limit?
A. Coverage Gap
B. Catastrophic Coverage
C. Initial Coverage Phase
D. Donut Hole Phase
Answer: C
Rationale: The initial coverage phase begins after the deductible and continues
until the beneficiary reaches the coverage limit.
1. Which of the following is the primary purpose of Medicare Advantage (Part
C)?
A. To provide prescription drug coverage only
B. To offer a private alternative to Original Medicare
C. To replace Medicaid for low-income beneficiaries
D. To provide supplemental coverage only
Answer: B
Rationale: Medicare Advantage plans are private health plan alternatives to
Original Medicare, often including additional benefits like dental, vision, and
hearing.
2. A beneficiary enrolls in a Medicare Advantage plan during the Annual
Enrollment Period. When does coverage typically begin?
A. Immediately
B. January 1 of the following year
C. The first day of the month after enrollment
D. The first day of the month after the plan receives the enrollment request
,Answer: D
Rationale: Coverage begins the first day of the month after the plan receives the
enrollment request, per CMS rules.
3. Which Medicare Part covers prescription drugs when enrolled in Original
Medicare?
A. Part A
B. Part B
C. Part C
D. Part D
Answer: D
Rationale: Medicare Part D provides prescription drug coverage for beneficiaries
in Original Medicare and is also included in most Medicare Advantage plans.
4. A beneficiary calls to enroll in a Medicare Advantage plan but has limited
English proficiency. What is the most compliant way for the agent to proceed?
A. Proceed with the enrollment and document the call
B. Provide translated materials or offer an interpreter
C. Ask the beneficiary to call back with a family member
D. Decline the enrollment due to language barriers
Answer: B
Rationale: CMS requires culturally competent communication and access to
translation services for LEP beneficiaries. Agents must provide appropriate
support.
,5. A Medicare Advantage plan offers a “free” gift card to anyone who attends
a sales presentation. This is:
A. Allowed if the gift card is under $25
B. Allowed only if the beneficiary signs up
C. Prohibited under CMS marketing guidelines
D. Allowed if it is disclosed in writing
Answer: C
Rationale: CMS prohibits providing gifts or incentives to induce enrollment or
attendance at sales events.
6. Which of the following is considered a “Marketing Event” under CMS
guidelines?
A. One-on-one appointment
B. Community seminar with plan comparison
C. Enrollment assistance at a pharmacy
D. All of the above
Answer: D
Rationale: All these are considered marketing events and must comply with CMS
rules, including proper documentation and materials.
7. Which of the following is a key indicator of potential Medicare fraud?
A. Beneficiary requests additional information
B. Provider submits claims for services not rendered
C. Beneficiary changes doctors frequently
D. Provider uses electronic medical records
Answer: B
Rationale: Claims for services not rendered are a classic fraud indicator and
should be reported.
, 8. A beneficiary is in a Medicare Advantage plan and wants to switch to
Original Medicare mid-year without qualifying for a Special Enrollment
Period. What is the correct response?
A. They can switch anytime
B. They must wait until Annual Enrollment Period
C. They can switch during the Initial Enrollment Period
D. They must enroll in Part D immediately
Answer: B
Rationale: Switching from Medicare Advantage to Original Medicare outside
designated periods is generally not allowed unless a Special Enrollment Period
applies.
9. In Medicare Part D, which phase begins after a beneficiary meets the
deductible and ends when they reach the initial coverage limit?
A. Coverage Gap
B. Catastrophic Coverage
C. Initial Coverage Phase
D. Donut Hole Phase
Answer: C
Rationale: The initial coverage phase begins after the deductible and continues
until the beneficiary reaches the coverage limit.
