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. What penalty may apply if a Medicare-eligible person delays enrolling in Part B without qualifying coverage? → 10% premium increase per year of delay
3. 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
4. Which of the following is TRUE about Medigap policies? → Each policy covers only one person — spouses each need their own policy
5. 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
6. What is the 'national base beneficiary premium' for Part D? → A benchmark CMS calculates annually used to determine premium subsidies and late penalties
7. What does the term 'slamming' refer to in Medicare sales compliance? → Enrolling a beneficiary in a plan without their knowledge or consent
8. Under CMS rules, agents selling Medicare plans are required to complete training and certification: → Annually for each carrier whose products they sell
9. What is 'identity theft' in the context of Medicare fraud? → Using someone else's Medicare number to obtain healthcare services or bill for services
10. What is 'upcoding' in healthcare billing? → Billing for a more complex or expensive service than was actually provided
11. A Medicare Medical Savings Account (MSA) plan combines: → A high-deductible MA plan with a CMS-funded savings account
12. What is 'waste' in the context of Medicare FWA? → Overutilization or misuse of resources without intent to defraud
13. Medicare Part D prescription drug coverage is provided through: → Private insurers approved by CMS
14. CMS requires that all marketing materials used by Medicare Advantage and Part D plans be: → Submitted to CMS for review and approval before distribution
15. Which document defines the products and benefits an agent agreed to discuss with a beneficiary before a sales meeting? → Scope of Appointment (SOA)
16. The Anti-Kickback Statute (AKS) prohibits: → Offering or receiving anything of value to induce referrals for Medicare/Medicaid services
17. Which type of Medicare Advantage plan typically requires members to use a specific network of providers and get referrals? → HMO
18. 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
19. 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
20. A person under 65 may qualify for Medicare if they have received Social Security Disability Insurance (SSDI) for how long? → 24 months
21. What is 'phantom billing' in healthcare fraud? → Billing for services that were never actually rendered
22. Under CMS marketing guidelines, when can an agent conduct a marketing/sales event at a healthcare facility such as a hospital or skilled nursing facility? → Never — CMS prohibits marketing events at healthcare facilities
23. An agent who misrepresents the benefits of a Medicare Advantage plan to persuade a beneficiary to enroll may face: → Suspension of certification, fines, and potential exclusion from Medicare programs
24. Which of the following is a beneficiary's right when a Part D plan denies coverage of a drug? → Request an exception or file an appeal
25. Every time Maverick visits a doctor, he must pay $15 under his primary medical insurance. What is the name of this payment? → the co-payment
26. How do Medigap insurers structure their premium pricing methodologies? → Community-rated, issue-age-rated, and attained-age-rated are the three recognized methods
27. What is 'catastrophic coverage' in Medicare Part D? → Coverage that begins after very high out-of-pocket drug costs are met
28. Can a Medigap insurer cancel a beneficiary's policy because the beneficiary develops a serious illness? → No — Medigap policies are guaranteed renewable as long as premiums are paid on time
29. Under CMS rules, unsolicited contact with Medicare beneficiaries via telephone (cold calling) is: → Prohibited unless the beneficiary has given prior permission
30. How many standardized Medigap plan types are available to most Medicare beneficiaries in the United States? → 10