AHIP Final Exam Questions
Study online at https://quizlet.com/_6z5ryu
1. Types of Medicare Advantage Plans: PPO, HMO, MSA, Cost Plan, PFFS
2. Medicare-Medicaid plans: Serve both Medicare and Medicaid individuals. In-
clude Part D coverage. Individuals sometimes referred to as dual eligibles
3. 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 ap-
ply. Can get Part D Rx coverage if available, or apply for a separate PDP.
4. 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.
5. 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.
6. Medicare Enrollment Period - Group Health Coverage: Individuals who have
group health coveage 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.
7. 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.
8. 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.
9. 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
10. Part C Medicare Advantage plans: Entiled to benefits under Part A AND
enrolled in Part B.
11. 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.
12. 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 Pharma-
ceutical Assistance Program.
13. Part A Benefits: $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 beneficiarys lifetime. Beyond lifetime reserve days, all
costs.
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1/3
https://www.coursehero.com/file/250042568/AHIP-Final-Exam-Questionspdf/
Study online at https://quizlet.com/_6z5ryu
1. Types of Medicare Advantage Plans: PPO, HMO, MSA, Cost Plan, PFFS
2. Medicare-Medicaid plans: Serve both Medicare and Medicaid individuals. In-
clude Part D coverage. Individuals sometimes referred to as dual eligibles
3. 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 ap-
ply. Can get Part D Rx coverage if available, or apply for a separate PDP.
4. 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.
5. 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.
6. Medicare Enrollment Period - Group Health Coverage: Individuals who have
group health coveage 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.
7. 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.
8. 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.
9. 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
10. Part C Medicare Advantage plans: Entiled to benefits under Part A AND
enrolled in Part B.
11. 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.
12. 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 Pharma-
ceutical Assistance Program.
13. Part A Benefits: $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 beneficiarys lifetime. Beyond lifetime reserve days, all
costs.
This study source was downloaded by 100000899511392 from CourseHero.com on 06-08-2025 15:31:24 GMT -05:00
1/3
https://www.coursehero.com/file/250042568/AHIP-Final-Exam-Questionspdf/
