AHIP FINAL EXAM WITH ACTUAL CORRECT
QUESTIONS AND VERIFIED DETAILED
ANSWERS| CURRENTLY TESTING VERSION |
ALREADY GRADED A+|EXPERT VERIFIED
FOR GUARANTEED PASS 2026-2027
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
1|Page
,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.
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
2|Page
, "lifetime reserve day" after day 90 for each benefit period (up to 60 days over a
beneficiarys lifetime. Beyond lifetime reserve days, all costs.
Part A Benefits
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.
Part D Prescription Drug Coverage
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.
Medigap Prescription Drug Coverage
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.
Medicare Advantage Eligibility
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.
Medicare Advantage Special Needs Plans
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.
MA Plan Types - Coordinated Care Plans - HMO's
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
3|Page
QUESTIONS AND VERIFIED DETAILED
ANSWERS| CURRENTLY TESTING VERSION |
ALREADY GRADED A+|EXPERT VERIFIED
FOR GUARANTEED PASS 2026-2027
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
1|Page
,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.
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
2|Page
, "lifetime reserve day" after day 90 for each benefit period (up to 60 days over a
beneficiarys lifetime. Beyond lifetime reserve days, all costs.
Part A Benefits
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.
Part D Prescription Drug Coverage
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.
Medigap Prescription Drug Coverage
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.
Medicare Advantage Eligibility
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.
Medicare Advantage Special Needs Plans
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.
MA Plan Types - Coordinated Care Plans - HMO's
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
3|Page
