AHIP Certification Test Bank | Comprehensive Questions &
Answers Guide A+ Exam 2027 Prep
Question 1.
Medicare ID Cards .
Answer: -every Medicare beneficiary gets a ID card
-in 2019, they stopped using SS numbers for ID
-protects beneficiaries from identity theft
-need to bring card when you get care
-destroy old cards
-keep part D cards, Advantage cards or Medicap cards
Question 2.
Medicare Law .
Answer: -Title XVIII of the SS Act
-health insurance for the Aged and disabled
Subsections
Part A: Hospital Insurance Benefits like skilled nursing facilities, rehab,
hospice
Part B: Supplementary insurance like outpatient services such as physician
care
Part C: Medicare Advantage plans which must cover Part A and B benefits
Part D: Prescription drug coverage
Part E: Misc. Provisions like Medigap coverage and Medicare cost plans
• Different Ways to Get Medicare . Answer: -Original Medicare(Part A and B)
-Medicare Advantage plans(Part C with or w/o part D)
-Medicare cost plans
-PACE plans
-Medicare-Medicaid plans
-Medicare PDP(Part D)
-Original Medicare with Medigap
Question 3.
Medigap .
Answer: a private insurance policy that pays the difference between the
medical charge and the amount that Medicare pays
Question 4.
Medicaid .
Answer: A federal and state assistance program that pays for health care
services for people who cannot afford them.
,Question 5.
Examples of Ways to Get Medicare .
Answer: 1. Mr. Jones: has Medigap plan to cover Medicare cost sharing and
stand along PDP to cover his drugs
2. Mrs. Hernandez: purchased Medicare advantage plan that includes Part D
to cover Medicare, drug and cost sharing benefits
-Mr. Watanabe recieves both Medicare and Medicaid benefits
-Ms. Krauss has purchased a Medicare advantage plan without Part D because
she gets a generous drug plan from a former employer
• Original Medicare . Answer: -has two parts: A and B
Part A: Hospital, skilled nursing facility, hospice and home health services
Part B: outpatient and professional services like those provided by a doctor or
non-physician professional, clinical lab services, durable medical equipment,
preventive services and other med services
Question 6.
Medicare Advantage Plans .
Answer: -Part C
Includes:
-HMO's, some plans include Part D
-PPO, some include Part D
-Private Fee for Service Plans(PFFS), some may offer part D but are not
obligated
-Special Needs Plans(all include part D)
-Medical Savings account Plans(No Part D)
-Employer or Union Group Plans
Question 7.
All MA plans must: .
Answer: -Cover all A and B benefits
-provide cost sharing equivalent to OG Medicare but may be different for
specific services
-include annual max out of pocket limit on total enrollee cost
sharing(deductibles, coinsurance, copayments) for Part and b services
-OG Medicare does not have max limit
-Cover the following services even when provided by non network providers:
-emergency services, out of area services and out of area renal dialysis
Question 8.
Extra Benefits Medicare Health plans might cover extra benefits like: .
Answer: -vision services
-hearing aids
,-routine dental services and/or dentures
-routine transport to medical appts.
-Chiropractic services
-annual physical exams
-in home safety assessments and fail prevention devices
-worldwide urgently needed and emergency services
-over the counter drugs
-*an annual physical is different from the annual wellness visit covered under
Medicare which doesnt include physical exam
Question 9.
Medicare Cost Plans .
Answer: -not part of Advantage plans, OG Medicare and only available in
certain areas of the country
-must have at least Part B, dont need A
-if enrollees go to non network provider, the services covered under their OG
Medicare benefits, but they pay the higher Part A and/or B coinsurance and
deductibles that apply under the OG rather than their cost plan coinsurance
and deductibles
-individuals can join anytime the plan is accepting new members, different
enrollment/disenrollment periods apply to Medicare cost plans than to
Advantage or OG -enrollees can leave anytime and return to OG
-can get PDP if offered or join a Part D plan, but Part D enrollment period
apply to any benefit changes
Question 10.
Deductible .
Answer: Amount you must pay before you begin receiving any benefits from
your insurance company
Question 11.
Coinsurance .
Answer: a provision under which both the insured and the insurer share the
covered losses
Question 12.
PACE Plans .
Answer: -programs for All Inclusive Care for the Elderly
-allows people who otherwise need nursing home level of care to remain in the
community
Qualifiers:
, -age 55 or older
-live in service area of PACE org
-be certified by the state as needing a nursing home level of care
-at the time the individual joins, he or she can live safely in the community
with the help of PACE services
Question 13.
Medicare/Medicaid (Medi-Medi) Plans .
Answer: -serve individuals eligible for both
-dual eligibles
-include Part D PDP
• Part D . Answer: -stand alone PDP or coverage under Medicare health plan
Question 14.
Medigap Coverage .
Answer: -sold by private insurance companies to fill gaps in coverage
-works only with OG Medicare
-covers all or a portion of Part A and B costsharing for beneficiaries in OG
-does not cover Medicare benefits but works in tandem with OG coverage
-some policies cover benefits not covered by A or B like extra coverage days
for inpatient care or foreign travel emergency care
Question 15.
Medicare Entitlement and Enrollment(Parts A and B) - Automatic Enrollment .
Answer: -individuals already getting SS or Railroad Retirement Board will
automatically get enrolled in A and B the first day of the month they turn 65(if
birthday is on the first day of the month, it will start the first day of the prior
month), these individuals can refuse Part B coverage
-individuals with disabilities who are under age 65 are automatically enrolled
in Parts A and B the month after they have recieved SS or RRB for 24 months,
they are also given ability to refuse B
--Note: disabled individuals in PR automatically get Part A after 24 months but
need to sign up for B if they want it
-individuals with ALS get Part A and B automatically the month their SS
disability benefits begin
• Part A and B Enrollment - Signups . Answer: -individuals who are close to 65
but dont get SS or RRB may sign up during their initial enrollment period that
is 3 months before their 65th birthday, that includes the month they turn 65
and ends 3 months after
-individuals with ESRD may sign up for Medicare at any time, but the date that
their coverage begins is usually on the 4th month after dialysis treatments
begin
Answers Guide A+ Exam 2027 Prep
Question 1.
Medicare ID Cards .
Answer: -every Medicare beneficiary gets a ID card
-in 2019, they stopped using SS numbers for ID
-protects beneficiaries from identity theft
-need to bring card when you get care
-destroy old cards
-keep part D cards, Advantage cards or Medicap cards
Question 2.
Medicare Law .
Answer: -Title XVIII of the SS Act
-health insurance for the Aged and disabled
Subsections
Part A: Hospital Insurance Benefits like skilled nursing facilities, rehab,
hospice
Part B: Supplementary insurance like outpatient services such as physician
care
Part C: Medicare Advantage plans which must cover Part A and B benefits
Part D: Prescription drug coverage
Part E: Misc. Provisions like Medigap coverage and Medicare cost plans
• Different Ways to Get Medicare . Answer: -Original Medicare(Part A and B)
-Medicare Advantage plans(Part C with or w/o part D)
-Medicare cost plans
-PACE plans
-Medicare-Medicaid plans
-Medicare PDP(Part D)
-Original Medicare with Medigap
Question 3.
Medigap .
Answer: a private insurance policy that pays the difference between the
medical charge and the amount that Medicare pays
Question 4.
Medicaid .
Answer: A federal and state assistance program that pays for health care
services for people who cannot afford them.
,Question 5.
Examples of Ways to Get Medicare .
Answer: 1. Mr. Jones: has Medigap plan to cover Medicare cost sharing and
stand along PDP to cover his drugs
2. Mrs. Hernandez: purchased Medicare advantage plan that includes Part D
to cover Medicare, drug and cost sharing benefits
-Mr. Watanabe recieves both Medicare and Medicaid benefits
-Ms. Krauss has purchased a Medicare advantage plan without Part D because
she gets a generous drug plan from a former employer
• Original Medicare . Answer: -has two parts: A and B
Part A: Hospital, skilled nursing facility, hospice and home health services
Part B: outpatient and professional services like those provided by a doctor or
non-physician professional, clinical lab services, durable medical equipment,
preventive services and other med services
Question 6.
Medicare Advantage Plans .
Answer: -Part C
Includes:
-HMO's, some plans include Part D
-PPO, some include Part D
-Private Fee for Service Plans(PFFS), some may offer part D but are not
obligated
-Special Needs Plans(all include part D)
-Medical Savings account Plans(No Part D)
-Employer or Union Group Plans
Question 7.
All MA plans must: .
Answer: -Cover all A and B benefits
-provide cost sharing equivalent to OG Medicare but may be different for
specific services
-include annual max out of pocket limit on total enrollee cost
sharing(deductibles, coinsurance, copayments) for Part and b services
-OG Medicare does not have max limit
-Cover the following services even when provided by non network providers:
-emergency services, out of area services and out of area renal dialysis
Question 8.
Extra Benefits Medicare Health plans might cover extra benefits like: .
Answer: -vision services
-hearing aids
,-routine dental services and/or dentures
-routine transport to medical appts.
-Chiropractic services
-annual physical exams
-in home safety assessments and fail prevention devices
-worldwide urgently needed and emergency services
-over the counter drugs
-*an annual physical is different from the annual wellness visit covered under
Medicare which doesnt include physical exam
Question 9.
Medicare Cost Plans .
Answer: -not part of Advantage plans, OG Medicare and only available in
certain areas of the country
-must have at least Part B, dont need A
-if enrollees go to non network provider, the services covered under their OG
Medicare benefits, but they pay the higher Part A and/or B coinsurance and
deductibles that apply under the OG rather than their cost plan coinsurance
and deductibles
-individuals can join anytime the plan is accepting new members, different
enrollment/disenrollment periods apply to Medicare cost plans than to
Advantage or OG -enrollees can leave anytime and return to OG
-can get PDP if offered or join a Part D plan, but Part D enrollment period
apply to any benefit changes
Question 10.
Deductible .
Answer: Amount you must pay before you begin receiving any benefits from
your insurance company
Question 11.
Coinsurance .
Answer: a provision under which both the insured and the insurer share the
covered losses
Question 12.
PACE Plans .
Answer: -programs for All Inclusive Care for the Elderly
-allows people who otherwise need nursing home level of care to remain in the
community
Qualifiers:
, -age 55 or older
-live in service area of PACE org
-be certified by the state as needing a nursing home level of care
-at the time the individual joins, he or she can live safely in the community
with the help of PACE services
Question 13.
Medicare/Medicaid (Medi-Medi) Plans .
Answer: -serve individuals eligible for both
-dual eligibles
-include Part D PDP
• Part D . Answer: -stand alone PDP or coverage under Medicare health plan
Question 14.
Medigap Coverage .
Answer: -sold by private insurance companies to fill gaps in coverage
-works only with OG Medicare
-covers all or a portion of Part A and B costsharing for beneficiaries in OG
-does not cover Medicare benefits but works in tandem with OG coverage
-some policies cover benefits not covered by A or B like extra coverage days
for inpatient care or foreign travel emergency care
Question 15.
Medicare Entitlement and Enrollment(Parts A and B) - Automatic Enrollment .
Answer: -individuals already getting SS or Railroad Retirement Board will
automatically get enrolled in A and B the first day of the month they turn 65(if
birthday is on the first day of the month, it will start the first day of the prior
month), these individuals can refuse Part B coverage
-individuals with disabilities who are under age 65 are automatically enrolled
in Parts A and B the month after they have recieved SS or RRB for 24 months,
they are also given ability to refuse B
--Note: disabled individuals in PR automatically get Part A after 24 months but
need to sign up for B if they want it
-individuals with ALS get Part A and B automatically the month their SS
disability benefits begin
• Part A and B Enrollment - Signups . Answer: -individuals who are close to 65
but dont get SS or RRB may sign up during their initial enrollment period that
is 3 months before their 65th birthday, that includes the month they turn 65
and ends 3 months after
-individuals with ESRD may sign up for Medicare at any time, but the date that
their coverage begins is usually on the 4th month after dialysis treatments
begin
