What AHIP Is

AHIP Medicare Certification is the annual, standardized compliance and product training required for anyone who sells, markets, enrolls, or services Medicare Advantage (MA) and/or Part D Prescription Drug Plans (PDP) plans.

It is not optional.

It is not carrier specific.

It is the baseline credential for Medicare producers.

Think of AHIP as the industry’s gatekeeper to Medicare plan activity.

What AHIP Covers

1. Medicare Program Basics

• Medicare eligibility
• Enrollment periods (IEP, AEP, OEP, SEP)
• Coordination with Medicaid and employer coverage

2. Medicare Products

• Original Medicare (Parts A & B)
• Medicare Advantage (Part C)
• Prescription Drug Plans (Part D)
• Medigap (Med Sup)

3. Compliance & CMS Rules

• Marketing vs. educational activities
• Scope of Appointment (SOA) rules
• Prohibited sales practices
• Cold calling restrictions
• Permission-to-contact standards
• Data privacy (HIPAA, PHI handling)
• Documentation and record retention

4. Ethics & Fraud, Waste, and Abuse (FWA)

• Identifying improper inducements
• Detecting fraudulent enrollments
• Reporting obligations
• Agent accountability and penalties

Testing & Certification Mechanics

• 50–60 question timed exam
• Minimum passing score: typically, 90%
• Limited retakes
• Certification is valid for one plan year
• Must be completed every year.
• Course is 175.00 every year. (MHC has a discount link for $125)
• Open book exam as long as it is not used for continuing education credits.

If an agent fails:

• They cannot sell/write Medicare Advantage or PDP plans
• FMOs and carriers cannot appoint Agents for MAPD or PDP products

AHIP is step one, not the end.

Who Needs AHIP?

AHIP is required for:

• Independent agents
• Captive agents
• Call center agents
• Enrollment and tele sales
• Anyone who discusses plan-specific benefits or assists with enrollment

It is not required for:

• Pure referral partners (if no plan details are discussed)
• Financial advisors who only provide general education (with strict guardrails)