AHIP is the annual, CMS-compliant Medicare + FWA training and exam that agents must pass before a carrier will grant Ready-to-Sell status for Medicare Advantage and Part D plans. Pass it once, certify with your carriers, and you're cleared for AEP.
Part 1 Medicare
The fundamentals and the sales rules: Medicare basics (Parts A–D), Medicare Advantage and Part D plan requirements, eligibility and enrollment periods, and the CMS marketing & compliance standards that govern how you can talk to beneficiaries.
Part 2 Fraud, Waste & Abuse
The FWA + General Compliance training: what fraud, waste, and abuse are, the laws behind them, real examples agents run into, and how to report. This portion is required by CMS for everyone in the Medicare program.
The exam is open-book and open-note, but it's timed and the 90% bar is unforgiving — you can miss only 5 of 50. Know the mechanics before you start the clock.
NABIP (formerly NAHU) offers a CMS-accepted alternative that some agents prefer — but confirm your carriers accept it before choosing.
- AHIP: 90% to pass, ~$175, the most widely accepted by carriers
- NABIP: 85% to pass, starts ~$100, includes 8 CE credits and unlimited retakes
- Both open June 22, 2026 and both satisfy the 2027 CMS Medicare/MA/Compliance requirements
The exam assumes you know the program cold. Here's the compressed version of the fundamentals the Medicare portion leans on.
A Hospital
Inpatient hospital, skilled nursing, hospice, some home health. Premium-free for most (40+ work quarters).
B Medical
Doctor visits, outpatient, preventive care, durable medical equipment. Monthly premium; 20% coinsurance after the deductible. A + B = "Original Medicare."
C Medicare Advantage
Private plans that bundle A & B (usually D), with networks and an out-of-pocket max. The plans you need AHIP to sell. Cannot be paired with Medigap.
D Prescription Drugs
Stand-alone (PDP) or built into an MA plan. The other product line AHIP certifies. Coverage gap ("donut hole") eliminated since 2025.
- Eligibility: age 65+, or under 65 after 24 months of SSDI, or with ESRD or ALS
- Medigap: supplements Original Medicare only — never sold alongside a Medicare Advantage plan
- Part D out-of-pocket cap: a hard annual ceiling, after which covered drugs cost $0 (the structure that replaced the donut hole)
- IRMAA: high-income surcharge on Part B and Part D, based on income from two years prior
- Late penalties: Part B adds 10% per 12 months missed; Part D adds 1% of the base premium per month without creditable coverage
Enrollment periods are heavily tested — and easy to mix up. The MA-specific ones (ICEP, MA OEP) trip up agents who only think in Original-Medicare terms.
IEP 7 months around 65
Initial Enrollment Period for Parts A, B, and D: the 3 months before the birthday month, that month, and the 3 months after.
ICEP First eligible for MA
Initial Coverage Election Period — the window to join a Medicare Advantage plan when first eligible (generally aligned with having both Part A and Part B). Don't confuse it with the IEP.
AEP Oct 15 – Dec 7
Annual Enrollment Period. Anyone can join, switch, or drop MA and Part D plans. Changes take effect Jan 1. The main selling season.
MA OEP Jan 1 – Mar 31
Medicare Advantage Open Enrollment. Someone already in an MA plan gets one change — to another MA plan, or back to Original Medicare with a PDP. Cannot be used to switch from Original Medicare into MA.
GEP Jan 1 – Mar 31
General Enrollment Period for those who missed their IEP for Part B. Coverage now starts the first of the month after enrollment. Late penalties may apply.
SEPs Life events
Special Enrollment Periods from qualifying events — losing employer coverage, a permanent move, gaining/losing Medicaid or Extra Help, and more. There's also a 5-star SEP to move into a 5-star plan.
This is where AHIP fails people. The CMS marketing rules are detailed, and 2027 brings the biggest set of changes in years — the exam will test the new versions, not last year's.
What a TPMO is
A Third-Party Marketing Organization is any entity or person compensated — directly or indirectly — to perform lead generation, marketing, sales, or enrollment-related activities for MA/Part D plans. As an independent agent, you are a TPMO.
You must read the standardized TPMO disclaimer (the exact wording depends on whether you represent all plans in an area or only some). The "fewer than all plans" version reads, in substance:
Scope of Appointment
Document a SOA before any personal sales/marketing appointment, specifying which product types may be discussed. You can't pivot to a product the SOA didn't cover.
Call recording
Marketing, sales, and enrollment calls with beneficiaries must be recorded in their entirety — the full "chain of enrollment." A prior refusal can't serve as a blanket refusal for future calls.
- Educational vs marketing events: educational events inform without steering to a specific plan; marketing/sales events present and enroll
- No unsolicited contact: no uninvited door-to-door, and no cold-calling without prior permission to contact
- Gifts: only nominal value, and never tied to enrolling (verify the current nominal-value threshold)
- Say "$0," not "free": describe no-premium plans as $0 — "free" is not permitted
- No misuse of the Medicare name/logo or anything implying government endorsement
The FWA portion is required of everyone in the Medicare program. The exam tests the definitions, the laws, and — most often — whether you can recognize FWA in an agent scenario and know to report it.
Fraud
Knowingly and willfully deceiving to gain an unauthorized benefit. Intent is the defining feature. Example: enrolling someone who never agreed, or forging a signature.
Waste
Overuse or careless use of resources that needlessly costs the program — generally not intentional. Example: unnecessary services driving up cost.
Abuse
Practices inconsistent with sound fiscal, business, or medical standards that result in improper payment — may fall short of the intent required for fraud. The line between abuse and fraud often comes down to intent and knowledge.
- False Claims Act: liability for knowingly submitting false claims to the government
- Anti-Kickback Statute: bars paying or receiving anything of value to induce Medicare referrals or business
- Stark Law: restricts physician self-referral to entities they have a financial relationship with
- Exclusion lists (OIG LEIE): excluded individuals/entities can't participate in federal health programs — check them
- HIPAA: protects beneficiaries' health information and PII
Self-Quiz
Fourteen questions across exam mechanics, enrollment, the 2027 marketing rules, and FWA. Tap to lock an answer — green if right — and the explanation appears either way. Score tallies live. Refresh the page to retake.
To reset your answers and retake the quiz, just refresh the page.