Do You Have to Have Your AHIP Certification to Sell Medicare?

Posted: October 17, 2019 - By: The Quotit Team - Selling Insurance

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As a health insurance broker or agent, your job is to sell health insurance to as many people as possible. 

To do that, you target all kinds of people—young millennials, small-business owners, HR administrators at larger organizations, self-employed individuals, and even seniors.

According to the Kaiser Family Foundation (KFF), in 2018, some 20.4 million Medicare beneficiaries (34 percent) were members of Medicare Advantage plans—which are plans offered by private insurers that receive compensation from the Medicare program. KFF data also suggests that program enrollment figures have nearly doubled over the last decade.

In order for your brokerage or agency to reach its full potential, you need to be able to offer Medicare Advantage plans to your clients—it’s that simple. 

Yet most private insurers that sell these plans will work only with brokerages and agencies that have completed certification and training courses administered by a trade association called America’s Health Insurance Plans (AHIP), which focuses on helping to create a more cost-effective healthcare system.

Keep reading to learn more about AHIP and what you need to do to ensure you’re able to sell one of the fastest-growing insurance products to your clientele.

What Is AHIP?

AHIP was formed in 2003, when two trade groups with similar missions—the Health Insurance Association of America and the American Association of Health Plans—joined forces. 

Today, AHIP is focused on improving and protecting the health and financial security of folks around the country. To fulfill its mission, AHIP seeks to build partnerships between governments and private organizations to deliver a more valuable and cost-effective health insurance experience.

According to AHIP’s website, the group will achieve its objectives by:

  • Advancing consumer choice and encouraging more competition in the market
  • Simplifying healthcare for individuals, families, and other entities
  • Pursuing constructive public-private partnerships
  • Partnering with healthcare providers to create better health insurance outcomes
  • Improving the social factors that impact health and understanding the burden of chronic disease
  • Supporting clinical innovations while ensuring value
  • Leveraging data and technology to improve quality, efficiency, and patient satisfaction

Now that you have a better understanding of what AHIP is and what it does, let’s turn our attention to the hoops you need to jump through in order to become an approved Medicare Advantage vendor.

What Are the Requirements for Getting Certified by AHIP?

Health insurance changes every year, and AHIP certification evolves right alongside it.

AHIP recently published the guidelines for its 2020 certification program, which includes two courses:

  • Medicare. This class covers the basics of Medicare eligibility and benefits; the different types of Medicare Advantage and Part D prescription drug plans; eligibility and coverage; nondiscrimination training; and marketing and enrollment guidelines under the Medicare Advantage and Part D program.

  • Fraud, Waste & Abuse (FWA). This class teaches you how to identify FWA; what the industry is doing to improve fraud detection; which legal tools are available to combat FWA; what the human and financial costs of FWA are; what the Medicare Parts C and D FWA and general compliance requirements look like; the individuals most likely to commit FWA; and what you need to do when reporting an FWA incident.

Beyond these general requirements, many insurers require brokerages and agencies to obtain additional certifications, which tend to vary on a carrier-to-carrier basis.

How Do You Get Certified by AHIP?

To get certified by AHIP, you need to complete the two courses above. Once that’s done, you need to complete a certification exam, which typically costs $175. Many insurers, however, offer a $50 discount if you sign up to take the exam through their company-branded portal.

The certification exam is a timed test. But if you complete the two courses, you should have a relatively easy time passing the exam. There are also a number of resources available on the internet designed to help people like you master AHIP material.

Additionally, AHIP itself offers several other courses that are designed to help agents and brokers become more effective—which, in turn, helps the organization achieve its goal of creating a better healthcare marketplace.

Are You Ready to Complete Your AHIP Certification?

In order for your brokerage or agency to reach its full potential, you need to be AHIP-certified. Otherwise, you won’t be able to sell insurance to more than 20 million potential clients during the annual enrollment period.

Although it may take some time and cost a little bit of money to pass the certification exam, these resources are well spent. Not only are brokerages and agencies that have AHIP certifications able to sell to more customers, but they are also well-positioned to help improve the overall health insurance landscape for every stakeholder involved.

The sooner you get certified, the better. Start preparing for certification today so you are ready to sell Medicare Advantage plans during the upcoming enrollment period. Good luck!


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