Social Science Business Insurance
AHIP Final Exam Questions
C C
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 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.
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.
AHIP Final Exam Questions
C C
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 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.
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.
