AHIP Final Exam Questions And
100% Verified Answers Complete
Exam 2026.27
\Q\.Types of Medicare Advantage Plans - ANSWERS✔-PPO, HMO,
MSA, Cost Plan, PFFS
\Q\.Medicare-Medicaid plans - ANSWERS✔-Serve both Medicare and
Medicaid individuals.
Include Part D coverage. Individuals sometimes referred to as dual
eligibles
\Q\.Medicare Cost Plan - ANSWERS✔-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.
\Q\.Medicare Entitlement/Enrollment - Part A & Part B - ANSWERS✔-
Individuals with ESRD may sign up at anytime. Date on which coverage
begins is the fourth month after dialysis begins.
\Q\.Medicare Enrollment Period - ANSWERS✔-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 -
ANSWERS✔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.
\Q\.Medicare Part A Premium - ANSWERS✔-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 - ANSWERS✔-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 - ANSWERS✔-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 - ANSWERS✔-Entiled to benefits
under Part A AND enrolled in Part B.
\Q\.Part D Prescription Drug benefits - ANSWERS✔-Entitled to benefits
under Part A but not enrolled in Part B. Must be entitled to Part A
AND/OR enrolled in Part B.
,\Q\.Part D Low Income Subsidy - ANSWERS✔-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 - ANSWERS✔-$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.
\Q\.Part A Benefits - ANSWERS✔-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. In patient psychiatric care is 190 lifetime
days. Does not cover custodial or long term care.
\Q\.Part D Prescription Drug Coverage - ANSWERS✔-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 - ANSWERS✔-If coverage is
not creditable, individual dropping coverage and enrolling in Part D
coverage will pay a late enrollment penalty, unless they qualify for
"ExtraHelp" 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 - ANSWERS✔-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.
\Q\.Medicare Advantage Special Needs Plans - ANSWERS✔-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 - ANSWERS✔-
Some HMO's offer Point Of Service option. Allows enrollees to go to no
plan doctors/hospitals without prior approval for sertain 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 - ANSWERS✔-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 - ANSWERS✔-
Individuals in PFFS plan may receive covered services from any provider
who is eligible to provide Medicare services, and agrees to the plans 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%.
100% Verified Answers Complete
Exam 2026.27
\Q\.Types of Medicare Advantage Plans - ANSWERS✔-PPO, HMO,
MSA, Cost Plan, PFFS
\Q\.Medicare-Medicaid plans - ANSWERS✔-Serve both Medicare and
Medicaid individuals.
Include Part D coverage. Individuals sometimes referred to as dual
eligibles
\Q\.Medicare Cost Plan - ANSWERS✔-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.
\Q\.Medicare Entitlement/Enrollment - Part A & Part B - ANSWERS✔-
Individuals with ESRD may sign up at anytime. Date on which coverage
begins is the fourth month after dialysis begins.
\Q\.Medicare Enrollment Period - ANSWERS✔-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 -
ANSWERS✔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.
\Q\.Medicare Part A Premium - ANSWERS✔-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 - ANSWERS✔-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 - ANSWERS✔-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 - ANSWERS✔-Entiled to benefits
under Part A AND enrolled in Part B.
\Q\.Part D Prescription Drug benefits - ANSWERS✔-Entitled to benefits
under Part A but not enrolled in Part B. Must be entitled to Part A
AND/OR enrolled in Part B.
,\Q\.Part D Low Income Subsidy - ANSWERS✔-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 - ANSWERS✔-$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.
\Q\.Part A Benefits - ANSWERS✔-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. In patient psychiatric care is 190 lifetime
days. Does not cover custodial or long term care.
\Q\.Part D Prescription Drug Coverage - ANSWERS✔-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 - ANSWERS✔-If coverage is
not creditable, individual dropping coverage and enrolling in Part D
coverage will pay a late enrollment penalty, unless they qualify for
"ExtraHelp" 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 - ANSWERS✔-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.
\Q\.Medicare Advantage Special Needs Plans - ANSWERS✔-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 - ANSWERS✔-
Some HMO's offer Point Of Service option. Allows enrollees to go to no
plan doctors/hospitals without prior approval for sertain 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 - ANSWERS✔-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 - ANSWERS✔-
Individuals in PFFS plan may receive covered services from any provider
who is eligible to provide Medicare services, and agrees to the plans 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%.
