Social Sciences Business Insurance
AHIP FINAL EXAM QUESTIONS EXAM QUESTIONS WITH COMPLETE
SOLUTION
Types of Medicare Advantage Plans PPO, HMO, MSA, Cost Plan, PFFS
Medicare-Medicaid plans Serve both Medicare and Medicaid individuals. Include Part D coverage.
Individuals sometimes referred to as dual eligibles
Medicare Cost Plan 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 deuctibles. Different
enrollment/disenrollment periods apply. Can get Part D Rx coverage if
available, or apply for a separate PDP.
Medicare Entitlement/Enrollment - Part A & Part B Individuals with ESRD may sign up at anytime. Date on which coverage
begins is the fourth month after dialysis begins.
Medicare Enrollment Period 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.
Medicare Enrollment Period - Group Health Individuals who have group health coveage through employer may
Coverage 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.
Medicare Part A Premium 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.
Medicare Part A Penalty 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.
Medicare Part B Premium 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
Part C Medicare Advantage plans Entiled to benefits under Part A AND enrolled in Part B.
Part D Prescription Drug benefits Entitled to benefits under Part A but not enrolled in Part B. Must be
entitled to Part A AND/OR enrolled in Part B.
Part D Low Income Subsidy 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.
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AHIP FINAL EXAM QUESTIONS EXAM QUESTIONS WITH COMPLETE
SOLUTION
Types of Medicare Advantage Plans PPO, HMO, MSA, Cost Plan, PFFS
Medicare-Medicaid plans Serve both Medicare and Medicaid individuals. Include Part D coverage.
Individuals sometimes referred to as dual eligibles
Medicare Cost Plan 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 deuctibles. Different
enrollment/disenrollment periods apply. Can get Part D Rx coverage if
available, or apply for a separate PDP.
Medicare Entitlement/Enrollment - Part A & Part B Individuals with ESRD may sign up at anytime. Date on which coverage
begins is the fourth month after dialysis begins.
Medicare Enrollment Period 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.
Medicare Enrollment Period - Group Health Individuals who have group health coveage through employer may
Coverage 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.
Medicare Part A Premium 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.
Medicare Part A Penalty 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.
Medicare Part B Premium 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
Part C Medicare Advantage plans Entiled to benefits under Part A AND enrolled in Part B.
Part D Prescription Drug benefits Entitled to benefits under Part A but not enrolled in Part B. Must be
entitled to Part A AND/OR enrolled in Part B.
Part D Low Income Subsidy 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.
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