AHIP Medicare 2027 Cheat Sheet

Cheat sheet AHIP Medicare 2027 Cheat Sheet Practice Questions Study Guide Print / Save PDF

Medicare Basics Not published of exam Medicare Parts Enrollment Windows Penalties + Costs AEP vs MA OEP Enrollment Window Picker

Medicare Advantage Plans Not published of exam MA Plan Types SNPs + MOOP HMO vs PPO MA Plan Type Picker

Part D Drug Plans Not published of exam Part D Basics 2027 Part D Benefit PDP vs MA-PD 2027 Part D Numbers

Marketing & Sales Compliance Not published of exam Marketing Rules Events + Disclaimers Educational vs Sales Event Marketing Compliance Picker

Fraud, Waste & Abuse Not published of exam FWA Definitions Compliance Laws Fraud vs Abuse Anti-Kickback vs Stark Law FWA Triangle

Quick Facts Exam AHIP Medicare Availability Available now Plan year 2027 Questions 50, not open-book Pass 90% (45/50) Time 2 hours Fee $175 standard; carrier rates vary Renewal Annual, every plan year

Enrollment Period Order ME IEP then AEP then MA OEP then SEP IEP: turning 65 AEP: Oct-Dec switch MA OEP: MA-only Jan-Mar SEP: life event trigger

AEP vs MA OEP ME

AEP Oct 15-Dec 7 Any plan switch OM to MA allowed

MA OEP Jan 1-Mar 31 MA plan only No OM to MA All beneficiaries vs MA enrollees

Enrollment Window Picker ME Turning 65 soon → IEP ( 7-month window ) Switch Oct 15-Dec 7 → AEP ( Any plan change ) Already in MA plan → MA OEP ( Jan-Mar only ) Moved out of area → SEP ( Life event ) Lost employer coverage → SEP ( 60-day window ) Newly Medicare eligible via MA → ICEP ( Aligns with IEP )

Medicare Parts ME Part A Hospital, SNF, hospice Part B Medical + outpatient care Part C Medicare Advantage alternative Part D Prescription drug coverage Medigap Fills Original Medicare gaps Original Medicare Parts A+B only IRMAA Income-based premium surcharge Work credits 40 quarters = premium-free A

Medigap vs Medicare Advantage ME

Medigap Works with Original Medicare Pays cost-sharing gaps Cannot pair with MA

Medicare Advantage Replaces Original Medicare Uses provider networks Caps yearly out-of-pocket Supplement vs replacement plan

Enrollment Windows ME IEP 7-month window at 65 AEP Oct 15-Dec 7 switch MA OEP Jan 1-Mar 31, MA only SEP Triggered by life event ICEP Initial MA coverage window SSDI wait 24 months, then Medicare ESRD Immediate dialysis eligibility ALS No waiting period

Penalties + Costs ME Part B LEP 10% per 12 months late Part D LEP 63+ day coverage gap 2027 Part B premium Not published yet for 2027 2027 Part B deductible Not published yet for 2027 Creditable coverage Delays Part D penalty Guaranteed issue No underwriting, limited window

SNP Types Memory Line ME D dual, C chronic, I institutional D-SNP: Medicare + Medicaid C-SNP: one chronic condition I-SNP: long-term care facility

HMO vs PPO ME

HMO In-network only care Referral required Lower premium

PPO Out-of-network allowed No referral needed Higher premium Network strict vs flexible

MA Plan Type Picker ME Wants lowest premium → HMO ( Network required ) Wants no referrals → PPO ( Higher premium ) Wants flexible providers → PFFS ( No fixed network ) Wants HSA-like account → MSA ( High deductible ) Dual Medicare + Medicaid → D-SNP ( Coordinates benefits ) Has chronic condition → C-SNP ( Condition-specific ) Lives in nursing facility → I-SNP ( 90+ days )

MA Plan Types ME HMO Network + referral required HMO-POS HMO + limited out-of-network PPO Out-of-network allowed, no referral PFFS Insurer sets own terms MSA High deductible + savings account

SNPs + MOOP ME D-SNP Dual Medicare + Medicaid C-SNP Chronic condition restricted I-SNP Institutional, nursing-home level Model of Care Required SNP care plan MOOP Annual in-network cost cap

2027 Part D Numbers PA Deductible 700 then threshold 2400 then zero $700 max deductible $2,400 out-of-pocket threshold $0 after threshold

PDP vs MA-PD PA

PDP Stand-alone drug plan Pairs with Original Medicare Separate premium

MA-PD Bundled into MA plan One combined premium Includes medical + drug Separate vs bundled coverage

Part D Basics PA Formulary Plan's covered drug list Drug tiers Cost-sharing levels by drug LIS / Extra Help Income-based Part D subsidy PDP Stand-alone drug plan MA-PD MA plan + drug coverage Prior authorization Pre-approval before plan pays Step therapy Try cheaper drug first

2027 Part D Benefit PA OOP threshold $2,400 in 2027 Deductible cap $700 maximum in 2027 M3P Spreads costs into monthly payments Donut hole Eliminated by IRA redesign Catastrophic phase $0 after OOP cap

Educational vs Sales Event MA

Educational Objective plan information only No applications collected No follow-up scheduling

Sales Can take applications Can schedule follow-ups Stricter marketing rules apply Separate phases with notice and break

Marketing Compliance Picker MA Scheduling a home visit → SOA before discussion ( No fixed CY2027 wait ) Beneficiary walks in same day → Same-day SOA ( Complete before discussion ) No beneficiary contact yet → Stop, no outreach ( Unsolicited contact banned ) Wants to discuss life insurance too → Separate SOA ( No cross-selling ) Offering a thank-you gift → $15 item limit ( $75 yearly cap ) Hosting a public seminar → Educational rules ( No enrollment forms ) Sales event follows education → Give notice and a real break ( Allow attendees to leave )

Marketing Rules MA SOA Form naming products to discuss CY2027 SOA timing Complete before appointment; no fixed wait 48-hour wait Eliminated for CY2027 marketing Unsolicited contact Banned without beneficiary permission Cross-selling Needs a separate appointment/SOA Gift limit $15 per item cap Gift aggregate $75 per person yearly PEC Pre-enrollment costs/network checklist Call recording Full call must record Personal appointment One-on-one or small household

Events + Disclaimers MA Educational event No enrollment forms allowed Sales event Can take applications CY2027 event transition Notice, break, and opportunity to leave 12-hour event delay Eliminated for CY2027 marketing TPMO Compensated third-party marketer TPMO disclaimer Required on materials/calls

FWA Triangle FW Fraud is intent, Waste is carelessness, Abuse is unsound Fraud: intentional deception Waste: careless overuse Abuse: unsound but unintentional

Fraud vs Abuse FW

Fraud Intentional deception Personal financial gain Requires proof of intent

Abuse No intent needed Unsound business practices Still costs programs money Intent is the difference

FWA Definitions FW Fraud Intentional deception for gain Waste Careless overuse of resources Abuse Unsound practice, no intent Reporting duty Mandatory for all agents Compliance training Required annually for agents

Anti-Kickback vs Stark Law FW

Anti-Kickback Any referral source Requires intent to induce Criminal + civil penalties

Stark Law Physician self-referral only Strict liability, no intent Civil penalties only Intent required vs strict liability

Compliance Laws FW False Claims Act Treble damages, false claims Anti-Kickback Statute Bars payment for referrals Stark Law Self-referral ban, no intent HIPAA Protects health information privacy OIG exclusion list Barred providers registry Compliance elements 7 required CMS program parts

Common Traps

Fraud vs abuse Fraud needs intent ≠ Abuse needs no intent

AEP vs MA OEP AEP is open to all ≠ MA OEP is MA-only

Educational vs sales event Educational cannot enroll ≠ Sales event can enroll

CY2027 event timing No fixed 12-hour delay ≠ Notify, pause, let attendees leave

Part B LEP vs Part D LEP Part B penalty is 10% year ≠ Part D penalty is per-gap

SOA required vs waiting period SOA still required before discussion ≠ CY2027 has no fixed 48-hour wait

Anti-Kickback vs Stark Law Anti-Kickback needs intent ≠ Stark Law is strict liability

Original Medicare vs Medicare Advantage Original Medicare has no network ≠ Medicare Advantage uses networks

Last Minute 1 . Pass score is 90%, not lower 2 . Verify attempt terms in portal 3 . Final is not open-book 4 . SOA required; no 48-hour wait 5 . Gift cap: $15 item, $75 year 6 . 2027 Part D: $700 / $2,400 7 . AHIP recertification is required every year 8 . Fraud requires intent; abuse does not 9 . Educational events cannot collect applications 10 . Notify, pause, allow attendees to leave 11 . MA OEP switches MA plans only

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