Agents need to stay up-to-date on their certifications because the insurance industry’s rules and requirements are constantly changing. So which certifications do you need? AHIP? Gorman? Pinpoint? We’ll explore the options so you know which you’ll need to stay compliant with Medicare + Fraud, Waste and Abuse (MFWA) training.

When the Health Insurance Association of America (HIAA) and the American Association of Health Plans (AAHP) merged in 2013, the America’s Health Insurance Plans (AHIP) was formed. Through research and policy formation, AHIP lobbies to create a more affordable health care system. The training AHIP has created is goaled at rewarding ethical agents who do what’s right, while protecting the best interest of seniors. AHIP training and certification is required by most carriers in order for agents to sell Medicare Advantage Plans during fall AEP, and the following year.

AHIP certification is a one-stop training that meets CMS requirements. It is updated annually in order to stay current and relevant. This training offers a portal that allows agents to send their completed certification to multiple insurance carriers, to assist in obtaining contracts. It is the most widely recognized MFWA training in the industry, as AHIP is committed to training in the insurance industry. Becoming and staying certified is another way to help sustain and grow your business.

When you obtain an AHIP certification, you will learn about the different types of Medicare Advantage and Part D plans. You will also learn the basics of medicare benefits and fee-for-service eligibility, as well as the marketing and enrollment requirements under Medicare Advantage (MA) & Part D program. This will also provide you with nondiscrimination training.

More importantly; the education and training for Medicare Part C & D Fraud, Waste, & Abuse (FWA) and General Compliance requirements. These are tools that will teach you how to legally combat FWA. There are industry efforts in place in detecting fraud, including proper training of agents and HI staff. AHIP certification helps to identify FWA. This includes who commits FWA, the human and financial cost of FWA, how to report FWA loopholes and obligations.

AHIP training is not just for agents and brokers. Certification is also for health insurance providers, HI sponsors and staff, sales and marketing personnel, as well as financial planners. The certification test is not free; the test costs around $125-$175 to take. It is also a timed exam, so studying and quizzing yourself would be in your best interest. But be wary, if you fail (score less than 90%) the exam 3 times in a given year, most carriers will not allow you to sell their MA plans for that year.

The Gorman Health Group (GHG) is a software solutions and consulting firm that specializes in US government health plans. This includes Medicare and Medicaid, so they also offer a Medicare and FWA training course. Gorman Health Group strives to offer efficient and compliant solutions to their clients. Their website claims that their extremely seasoned staff collectively has a complete comprehensive view of the insurance industry. GHG has been providing clinical, operations, financial, and strategic services to the industry for over 20 years.

The Gorman certification covers the same material as the AHIP certification, and is also timed like the AHIP certification exam. There are many carriers that will not accept any other certifications other than Gorman or AHIP. So it would be wise to take these certification tests first, then take any additional certifications as extra education. The Gorman certification requires its tester to pass with an 85% or higher, with only 2 attempts. If you fail the exam both times, you will be unable to test for another year. So again, it is in your best interest to study and be prepared for your exam.

As it stands, Pinpoint Global offers more than 30 health plan solutions. These solutions automate as well as integrate the Medicare Advantage training and certification processes. Pinpoint claims that their certification process is the “industry’s most cost-effective, highest value-added online Medicare training and certification solution” The software solutions offered by Pinpoint are both reliable and efficient. Much so, that BlueCross BlueShield of Minnesota authored and created the Pinpoint National Medicare training. This software solution allows agents to integrate their AHIP and Gorman training certifications.

Agents can fulfill National Medicare certifications all in one place with the Pinpoint certification solution. The Pinpoint Medicare Certification System allows agents to become certified in CMS compliancies, and satisfy internal guidelines all in one step. Pinpoint claims that agents can become certified in half the time, for less than the cost of other certifications. Training encompassed in the Pinpoint certification modules can also be modified based on the person’s role, experience, competency, and licensing requirements. This ensures that HI teams can get relevant training and education, no matter their role. This certification process also includes compliance forms such as W9, EFT, and Errors and Omissions; all completely online.

Now, don’t be mistaken, Pinpoint training and certification does not replace having an AHIP or Gorman certification. Pinpoint simply consolidates training and certification to an all-in-one Software as a Service (SaaS). This software puts all of the necessary certifications in one place, so that agents and staff can easily access compliance certifications. AHIP and Gorman exam certifications must still be uploaded into the system, or taken through Pinpoint. It encompases an all-in-one training platform that allows users to view and download PowerPoint presentations, articles, audio clips, and video to accommodate how users learn and retain information best. Pinpoint’s target audience is not individual agents, but agencies and companies. This allows everyone under the company roof to become certified, no matter their role within the company.

Depending on your knowledge and skill level, you have options. The benefits of AHIP over Gorman certification are that AHIP certifications are the most widely and accepted across carriers. AHIP certification also allows you to take the exam a total of 3 times for your one-time fee, if you don’t pass with 90% or higher each time. You are also allowed to retest within the year, however be aware that some insurance carriers might not accept your certification if you took 5 attempts to pass.

Gorman certification is essentially the same as the AHIP certification because the same material is covered. Gorman certifications are accepted by nearly all insurance carriers. The main difference is the limitations in exam accessibility. Gorman certification exams are timed like AHIP exams, but will only allow the user to take the exam 2 times within the year to get a passing score of 85% or higher. If the user does not pass the exam by the second try, they will not be able to retake the certification exam until the following year. This means the user (agent) will not be able to sell MA plans with Part C and Part D Prescription Drug plans for that year.

Pinpoint Solutions is exactly what it implies; a solution. Pinpoint offers a software solution that allows agents and other Health Insurance (HI) industry staff to take exams and certifications based on their educational needs. The software consolidates certifications all in one platform and allows users to upload, take, and submit certifications.

So if you’re an agent that is looking to take multiple certification courses because you want to be the most educated in your area, then Pinpoint would be a great place to start. However, if you’re an experienced agent who has been in the industry for years, and have been taking and retaking certifications over those years, then both AHIP and Gorman certifications will be a piece of cake. But if you’re a newer agent to the industry, start with AHIP.  Reason being, it is the most widely recognized and accepted certification. There are also many websites that offer information and study materials that will help you become the most prepared for your test. With all of the information online, you’ll be able to pass your exam on the first try with flying colors.