What is the AHIP?

You may have heard your Medicare advisor talk about the AHIP. Or, maybe you’ve seen the term online when researching your Medicare options. While there is nothing you need to do as a consumer, it is important that any Medicare advisor you work with have their AHIP certification.

Let’s talk a little bit about what the AHIP is and what it requires of Medicare advisors.

AHIP: America’s Health Insurance Plans

The AHIP was formed in 2013 upon the merging of the Health Insurance Association of America (HIAA) and the American Association of Health Plans (AAHP). AHIP is a national trade association in the health insurance industry whose goal is to create a more affordable healthcare system by using research and modifying policies. It represents about 1300 insurance companies that provide coverage for over 200 million individuals.

AHIP requires all insurance agents who sell Medicare Advantage plans (Part C of Medicare) to complete their training courses. The training courses ensure that the agents are compliant with CMS regulations and guidelines. This certification process helps protect Medicare beneficiaries.

AHIP Certification Process

The AHIP certification process requires agents to complete two courses. The first course covers the basics of the Medicare program. Agents will need to have an understanding of Medicare eligibility and benefits and also understand the different types of Medicare Advantage and Part D plans. The first course will also discuss marketing guidelines and compliance as well as proper enrollment procedures.

The word Fraud typed out on a sheet of notebook paper referring the second AHIP Certification course
This course discusses the efforts and tools used by the industry to detect Medicare program fraud.

The second AHIP course is Fraud, Waste, and Abuse (FWA). This course discusses the efforts and tools used by the industry to detect Medicare program fraud. Medicare is a federal program, so the government takes fraud seriously. FWA informs the agent about the financial and human cost of fraud and how to report suspected fraud.

Once an agent has reviewed the modules in each AHIP course, they can take practice quizzes to test their knowledge. The final exam is open-book, but it does have time limits, so agents cannot rely on being able to look up every answer.

All agents must complete the AHIP certification annually. Since CMS often updates its guidelines, the AHIP helps agents stay up-to-date on the current information. Once an agent has passed their first AHIP exam, it should be easy to complete the annual renewals since they have already demonstrated their knowledge of the Medicare program.

The AHIP must be completed prior to the Annual Enrollment Period (AEP). AEP happens every year, beginning on October 15 and lasts through December 7. During this time, Medicare beneficiaries can make changes to their Medicare Advantage and/or Part D prescription drug plans.

Carrier Certifications

In addition to the AHIP, some insurance carriers require certification for their own products. It will focus mostly on the carrier’s specific plans and can usually be done through the broker portals online. Each company has

Once the agent has received their AHIP certification, they’ll need to follow directions given by all the carriers they are contracted with. They may need to submit their AHIP certification to an online portal. Every carrier has its own requirements.