AHIP FINAL
AHIP FINAL EXAM QUESTIONS AND 100% VERIFIED
ANSWERS COMPLETE EXAM GRADED A+
\Q\.Types of Medicare Advantage Plans ANS >>PPO, HMO, MSA, Cost Plan, PFFS
\Q\.Medicare-Medicaid plans ANS >>Serve both Medicare and Medicaid
individuals.
Include Part D coverage. Individuals sometimes referred to as dual eligibles
\Q\.Medicare Cost Plan ANS >>Type of Medicare health plan. Have Part B to
enroll. Can join anytime plan is accepting new members. A non-network
provider will can charge higher coinsurances and deductibles. Different
enrollment/disenrollment periods apply. Can get Part D Rx coverage if available,
or apply for a separate PDP.
\Q\.Medicare Entitlement/Enrollment - Part A & Part B ANS >>Individuals with
ESRD may sign up at any time. Date on which coverage begins is the fourth
month after dialysis begins.
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\Q\.Medicare Enrollment Period ANS >>Individuals who do not enroll in Part B
when first eligible can enroll during a General Enrollment Period, Jan 1st to Mar
31st each year. Coverage begins July 1st of that year.
\Q\.Medicare Enrollment Period - Group Health Coverage ANS >> Individuals
who have group health coverage through employer may enroll in Part A and/or
Part B anytime while on group coverage during a Special Enrollment Period.
Occurs during the 8-month period following last month of group
coverage.
\Q\.Medicare Part A Premium ANS >>Free if worked 40 quarters of your life and
paid Medicare taxes. Premium is $240.00 for individuals or spouses who paid
Medicare taxes for 30 - 39 quarters. Premium is $437.00 for less than 30
quarters.
\Q\.Medicare Part A Penalty ANS >>Don't enroll in Part A when fist
eligible, will pay a late penalty of up to 10% unless enroll during a Special
Enrollment Period.
\Q\.Medicare Part B Premium ANS >>In 2019, the standard monthly
premium is $135.50 or higher depending on income. Deducted from S.S. check or
Railroad Retirement check. Do not enroll when first eligible, premium is
increased 10% for each 12-month period not enrolled. Deductible for 2019 is
$185.00
\Q\.Part C Medicare Advantage plans ANS >>Entailed to benefits under Part A AND
enrolled in Part B.
\Q\.Part D Prescription Drug benefits ANS >>Entitled to benefits under Part A but
not enrolled in Part B. Must be entitled to Part A AND/OR enrolled in Part B.
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\Q\.Part D Low Income Subsidy ANS >>Do not qualify for Part D Low Income
Subsidy, but are of limited means, may qualify for help in Part D costs through
State Pharmaceutical Assistance Program.
\Q\.Part A Benefits ANS >>$1364.00 deductible for each benefit period. Days 1 -
60: $0 coinsurance. Days 61 - 90: $341.00 coinsurance per day. days 91 and
beyond: $682.00 coinsurance per each "lifetime reserve day" after day 90 for
each benefit period (up to 60 days over a beneficiary’s lifetime. Beyond lifetime
reserve days, all costs.
\Q\.Part A Benefits ANS >>Blood, hospice, home health care, skilled
nursing and rehabilitative care only after a 3-day hospital stay up to 100 days in a
benefit period. In 2019, will pay $170.50 coinsurance for days 21 - 100 each
benefit period. Inpatient psychiatric care is 190 lifetime days. Does not cover
custodial or long-term care.
\Q\.Part D Prescription Drug Coverage ANS >>Late enrollment penalty of 1% of
national standard premium for every month that beneficiary could have had Part
D but didn't enroll. No penalty for beneficiaries with low-income assistance or
who join a Part D within 63 days of losing creditable coverage.
\Q\.Medigap Prescription Drug Coverage ANS >>If coverage is not
creditable, individual dropping coverage and enrolling in Part D coverage will pay
a late enrollment penalty, unless they qualify for "Extra Help" or enroll in Part D
during Special Enrollment Period for loss of creditable coverage. If informed
non-Medicare is no longer creditable, will have an SEP to enroll without penalty.
\Q\.Medicare Advantage Eligibility ANS >>Not eligible if have ESRD unless: MA
Plan is a SNP plan for people with ESRD, OR person developed ESRD after
enrolling in MA plan.
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\Q\.Medicare Advantage Special Needs Plans ANS >>Three types. Chronic
Condition (CSNP) for specific severe or disabling conditions. Dual Eligible (DSNP)
for entitlement to both Medicare and Medicaid. Institutionalized (ISNP) for
individuals who need services in skilled nursing facility for 90 days or longer. All
SNP plans include prescription drug coverage.
\Q\.MA Plan Types - Coordinated Care Plans - HMO’s ANS >>Some HMO's offer
Point of Service option. Allows enrollees to go to no plan doctors/hospitals
without prior approval for certain services. HMO-POS may limit services out of
network or put cap on out of network coverage. Cost sharing is generally higher
than from network providers
\Q\.MA Plan Types - Coordinated Care Plans - PPO’s ANS >>Do not need referral
for out of network providers. May pay higher cost sharing amount.
\Q\.MA Plan Types - Private Fee for Service plans - PFFS ANS >>Individuals in PFFS
plan may receive covered services from any provider who is eligible to provide
Medicare services, and agrees to the plan’s terms and conditions of
payment. Enrollees must inform provider they are a PFFS member, so the
provider can decide whether to accept terms and conditions. Not permitted to
charge more than cost sharing specified in plan. Cost sharing may include
balance billing up to 15%.
\Q\.MA Plan Types - Medical Savings Account - MSA plan ANS >>High-deductible
plan.
Medicare makes contribution to beneficiary’s savings account. Max deductible in
2019 is $12,650.00. In 2020, $13,400.00. Do not cover Part D prescription drug
benefits. Must enroll in standalone Part D PDP.
\Q\.MA Plan Types - Medical Savings Account - MSA plan ANS >>May not have
network. May have partial or full network. No network providers must
accept amount Medicare pays them as payment in full.
AHIP FINAL EXAM QUESTIONS AND 100% VERIFIED
ANSWERS COMPLETE EXAM GRADED A+
\Q\.Types of Medicare Advantage Plans ANS >>PPO, HMO, MSA, Cost Plan, PFFS
\Q\.Medicare-Medicaid plans ANS >>Serve both Medicare and Medicaid
individuals.
Include Part D coverage. Individuals sometimes referred to as dual eligibles
\Q\.Medicare Cost Plan ANS >>Type of Medicare health plan. Have Part B to
enroll. Can join anytime plan is accepting new members. A non-network
provider will can charge higher coinsurances and deductibles. Different
enrollment/disenrollment periods apply. Can get Part D Rx coverage if available,
or apply for a separate PDP.
\Q\.Medicare Entitlement/Enrollment - Part A & Part B ANS >>Individuals with
ESRD may sign up at any time. Date on which coverage begins is the fourth
month after dialysis begins.
,AHIP FINAL
\Q\.Medicare Enrollment Period ANS >>Individuals who do not enroll in Part B
when first eligible can enroll during a General Enrollment Period, Jan 1st to Mar
31st each year. Coverage begins July 1st of that year.
\Q\.Medicare Enrollment Period - Group Health Coverage ANS >> Individuals
who have group health coverage through employer may enroll in Part A and/or
Part B anytime while on group coverage during a Special Enrollment Period.
Occurs during the 8-month period following last month of group
coverage.
\Q\.Medicare Part A Premium ANS >>Free if worked 40 quarters of your life and
paid Medicare taxes. Premium is $240.00 for individuals or spouses who paid
Medicare taxes for 30 - 39 quarters. Premium is $437.00 for less than 30
quarters.
\Q\.Medicare Part A Penalty ANS >>Don't enroll in Part A when fist
eligible, will pay a late penalty of up to 10% unless enroll during a Special
Enrollment Period.
\Q\.Medicare Part B Premium ANS >>In 2019, the standard monthly
premium is $135.50 or higher depending on income. Deducted from S.S. check or
Railroad Retirement check. Do not enroll when first eligible, premium is
increased 10% for each 12-month period not enrolled. Deductible for 2019 is
$185.00
\Q\.Part C Medicare Advantage plans ANS >>Entailed to benefits under Part A AND
enrolled in Part B.
\Q\.Part D Prescription Drug benefits ANS >>Entitled to benefits under Part A but
not enrolled in Part B. Must be entitled to Part A AND/OR enrolled in Part B.
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\Q\.Part D Low Income Subsidy ANS >>Do not qualify for Part D Low Income
Subsidy, but are of limited means, may qualify for help in Part D costs through
State Pharmaceutical Assistance Program.
\Q\.Part A Benefits ANS >>$1364.00 deductible for each benefit period. Days 1 -
60: $0 coinsurance. Days 61 - 90: $341.00 coinsurance per day. days 91 and
beyond: $682.00 coinsurance per each "lifetime reserve day" after day 90 for
each benefit period (up to 60 days over a beneficiary’s lifetime. Beyond lifetime
reserve days, all costs.
\Q\.Part A Benefits ANS >>Blood, hospice, home health care, skilled
nursing and rehabilitative care only after a 3-day hospital stay up to 100 days in a
benefit period. In 2019, will pay $170.50 coinsurance for days 21 - 100 each
benefit period. Inpatient psychiatric care is 190 lifetime days. Does not cover
custodial or long-term care.
\Q\.Part D Prescription Drug Coverage ANS >>Late enrollment penalty of 1% of
national standard premium for every month that beneficiary could have had Part
D but didn't enroll. No penalty for beneficiaries with low-income assistance or
who join a Part D within 63 days of losing creditable coverage.
\Q\.Medigap Prescription Drug Coverage ANS >>If coverage is not
creditable, individual dropping coverage and enrolling in Part D coverage will pay
a late enrollment penalty, unless they qualify for "Extra Help" or enroll in Part D
during Special Enrollment Period for loss of creditable coverage. If informed
non-Medicare is no longer creditable, will have an SEP to enroll without penalty.
\Q\.Medicare Advantage Eligibility ANS >>Not eligible if have ESRD unless: MA
Plan is a SNP plan for people with ESRD, OR person developed ESRD after
enrolling in MA plan.
, AHIP FINAL
\Q\.Medicare Advantage Special Needs Plans ANS >>Three types. Chronic
Condition (CSNP) for specific severe or disabling conditions. Dual Eligible (DSNP)
for entitlement to both Medicare and Medicaid. Institutionalized (ISNP) for
individuals who need services in skilled nursing facility for 90 days or longer. All
SNP plans include prescription drug coverage.
\Q\.MA Plan Types - Coordinated Care Plans - HMO’s ANS >>Some HMO's offer
Point of Service option. Allows enrollees to go to no plan doctors/hospitals
without prior approval for certain services. HMO-POS may limit services out of
network or put cap on out of network coverage. Cost sharing is generally higher
than from network providers
\Q\.MA Plan Types - Coordinated Care Plans - PPO’s ANS >>Do not need referral
for out of network providers. May pay higher cost sharing amount.
\Q\.MA Plan Types - Private Fee for Service plans - PFFS ANS >>Individuals in PFFS
plan may receive covered services from any provider who is eligible to provide
Medicare services, and agrees to the plan’s terms and conditions of
payment. Enrollees must inform provider they are a PFFS member, so the
provider can decide whether to accept terms and conditions. Not permitted to
charge more than cost sharing specified in plan. Cost sharing may include
balance billing up to 15%.
\Q\.MA Plan Types - Medical Savings Account - MSA plan ANS >>High-deductible
plan.
Medicare makes contribution to beneficiary’s savings account. Max deductible in
2019 is $12,650.00. In 2020, $13,400.00. Do not cover Part D prescription drug
benefits. Must enroll in standalone Part D PDP.
\Q\.MA Plan Types - Medical Savings Account - MSA plan ANS >>May not have
network. May have partial or full network. No network providers must
accept amount Medicare pays them as payment in full.
