AHIP Medicare study guide
AHIP Medicare · Work through your exam, one topic at a time.
The AHIP Medicare certification is the industry-recognized credential that agents and brokers complete before selling Medicare Advantage and Part D plans. AHIP describes it as its "Medicare + Fraud, Waste, and Abuse Training," and the homepage notes that "More than 100,000 agents and brokers choose AHIP each year for training that respects their time and supports their business." It is aimed at licensed agents, brokers, and plan staff who need annual Medicare and FWA training, and it is also relevant to compliance and operations staff who support enrollment. The AHIP Medicare study guide has 5 sections and about 1,351 words.
01Medicare Program Basics
The exam treats Medicare as four parts plus a set of eligibility rules. Part A is hospital insurance (inpatient, skilled nursing after a qualifying stay, hospice, some home health); most people get it premium-free with 40 quarters of Medicare-taxed work.
316 words, about 2 min02Medicare Advantage and Other Medicare Health Plans
Medicare Advantage (Part C) plans are offered by private insurers under contract with CMS and must provide all Part A and Part B benefits (except hospice, which stays under Part A). Plans may be HMOs, PPOs, PFFS, or SNPs (special needs plans for dual-eligible, institutionalized, or chronic-condition beneficiaries).
288 words, about 1 min03Prescription Drug Coverage (Part D)
Part D is outpatient prescription drug coverage delivered by private stand-alone PDPs or MA-PDs. Plans must meet CMS standards: a formulary, pharmacy network, and coverage of at least two drugs per class (with exceptions for protected classes).
255 words, about 1 min04Medicare Marketing and Enrollment Compliance
CMS marketing rules exist to protect beneficiaries from confusion and high-pressure sales. Agents must be licensed and appointed, complete required training (including AHIP and product-specific training), and follow rules on unsolicited contact.
253 words, about 1 min05Fraud, Waste, and Abuse
Fraud is intentional deception for gain; waste is misuse of resources without intent; abuse is practices that cause unnecessary cost. Medicare requires plans and first-tier entities to maintain a compliance program with written policies, a compliance officer, training, and a reporting mechanism.
239 words, about 1 min