AHIP Cheat Sheet 2026

The 30 highest-yield AHIP facts, distilled from real exam questions. Print it, save it as a PDF, or study it here — free, no sign-up.

1. If a beneficiary requests information about a Medicare plan online or via an enrollment form, an agent may follow up by telephone: → Immediately, as the request constitutes prior permission
2. A North Carolina beneficiary loses employer group health coverage mid-year. What type of Medicare enrollment period does this trigger? → Special Enrollment Period
3. What penalty may apply if a Medicare-eligible person delays enrolling in Part B without qualifying coverage? → 10% premium increase per year of delay
4. To enroll in a Medicare Advantage plan, a beneficiary must: → Have both Part A and Part B and live in the plan's service area
5. What does the term 'creditable coverage' mean in the context of Medicare Part D? → Drug coverage that is at least as good as the standard Medicare Part D benefit
6. Which of the following is TRUE about Medigap policies? → Each policy covers only one person — spouses each need their own policy
7. A health plan's 'days cash on hand' metric measures: → How many days the plan can cover operating expenses with available liquid assets
8. Which of the following is a characteristic of a Preferred Provider Organization (PPO) health plan? → Members can see out-of-network providers at higher cost-sharing
9. A COBRA qualifying event occurs when an employee is terminated for gross misconduct. Which of the following is correct? → COBRA coverage is not available because gross misconduct disqualifies the employee
10. An agent receives a referral lead from a friend who is a doctor. Under the Anti-Kickback Statute, what must the agent be careful about? → Avoiding providing any compensation or anything of value to the doctor for the referral
11. What is the 'national base beneficiary premium' for Part D? → A benchmark CMS calculates annually used to determine premium subsidies and late penalties
12. What does the term 'slamming' refer to in Medicare sales compliance? → Enrolling a beneficiary in a plan without their knowledge or consent
13. Under CMS rules, agents selling Medicare plans are required to complete training and certification: → Annually for each carrier whose products they sell
14. What is 'identity theft' in the context of Medicare fraud? → Using someone else's Medicare number to obtain healthcare services or bill for services
15. What is 'upcoding' in healthcare billing? → Billing for a more complex or expensive service than was actually provided
16. A Medicare Medical Savings Account (MSA) plan combines: → A high-deductible MA plan with a CMS-funded savings account
17. North Carolina's Medicaid managed care program that coordinates services for dually eligible Medicare beneficiaries is known as: → Carolina Complete Health
18. What is 'waste' in the context of Medicare FWA? → Overutilization or misuse of resources without intent to defraud
19. Medicare Part D prescription drug coverage is provided through: → Private insurers approved by CMS
20. CMS requires that all marketing materials used by Medicare Advantage and Part D plans be: → Submitted to CMS for review and approval before distribution
21. Which document defines the products and benefits an agent agreed to discuss with a beneficiary before a sales meeting? → Scope of Appointment (SOA)
22. The Anti-Kickback Statute (AKS) prohibits: → Offering or receiving anything of value to induce referrals for Medicare/Medicaid services
23. Which type of Medicare Advantage plan typically requires members to use a specific network of providers and get referrals? → HMO
24. Which of the following is a key difference between Medicare Supplement (Medigap) and Medicare Advantage plans? → Medigap plans work alongside Original Medicare; Medicare Advantage replaces it
25. A North Carolina resident turns 65 and enrolls in Medicare Part B. How long is their guaranteed issue window for a Medicare Supplement plan? → 6 months
26. A Medicare Advantage PFFS (Private Fee-for-Service) plan is characterized by: → Setting its own payment rates; any provider who accepts the terms can treat the member
27. When it comes to going-concern accounting under GAAP, the Ascot health plan's accountants probably → Assume that Ascot is not about to be liquidated, unless there is evidence to the contrary
28. A person under 65 may qualify for Medicare if they have received Social Security Disability Insurance (SSDI) for how long? → 24 months
29. When calculating an ACA marketplace subsidy (Premium Tax Credit), which income benchmark is used? → Modified Adjusted Gross Income (MAGI)
30. What is 'phantom billing' in healthcare fraud? → Billing for services that were never actually rendered