AHIP Final Exam 2027 | Questions and
Correct Answers | Latest Update
Mrs. Andrews is comparing her employer's retiree insurance to Original
Medicare and would like to know which of the following services Original
Medicare will cover if the appropriate criteria are met. What could you tell her?
Original Medicare covers ambulance services.
What impact, if any, have recent regulatory changes had on Medigap plans?
The Part B deductible is no longer covered for individuals newly eligible for Medicare
starting January 1, 2020.
Joan and Loretta are both enrolled in Medicare. Joan pays a premium for Part A
coverage. Loretta does not. Which of the following statements best explains
this difference?
Joan worked only a short time and did not accumulate sufficient work credits. Loretta
worked for well over 10 years accumulating credit for more than 40 quarters of
contributions to the Medicare program.
Larry Miller is an Original Medicare beneficiary with Parts A and B coverage.
Larry is admitted to Good Care Hospital in January with pneumonia and stays
for three days before being discharged. Six months later in July, Larry takes a
bad fall and is admitted to Good Care Hospital with a broken leg. After
emergency surgery to repair his broken leg, Larry is hospitalized for a week
before being discharged home. In December, Larry is admitted to Mount
Wellness Hospital once again with a serious case of the flu. For how many Part
A deductibles will Larry be responsible for?
Larry will be responsible for three Part A deductibles. A benefit period begins the day
a patient is admitted as an inpatient and ends when the patient has not received any
inpatient hospital care for 60 consecutive days in a row. Since Larry's three
,hospitalizations were separated by more than 60 days each, they each represent a
new benefit period, requiring a separate deductible.
What is the purpose of Medicare Part A?
Medicare Part A covers inpatient hospital stays, skilled nursing facility care, hospice
care, and some home health care.
What is the purpose of Medicare Part B?
Medicare Part B covers medically necessary services and preventive services.
How does Medicare Part C (Medicare Advantage) work?
Medicare Part C is an alternative to Original Medicare where private insurers provide
benefits.
What is the coverage gap in Medicare Part D?
The coverage gap (donut hole) is a temporary limit on what the drug plan will cover.
What is a Medigap plan?
Medigap is private health insurance that supplements Original Medicare.
What is the Initial Enrollment Period (IEP) for Medicare?
The IEP is a 7-month period that begins 3 months before the month you turn 65.
What is the General Enrollment Period (GEP)?
The General Enrollment Period is January 1 to March 31 each year.
What is the Annual Election Period (AEP) for Medicare Advantage and Part D?
The Annual Election Period is October 15 to December 7 each year.
What is the Medicare Advantage Open Enrollment Period?
The Medicare Advantage Open Enrollment Period is January 1 to March 31 each year.
,What is a Special Enrollment Period (SEP)?
A Special Enrollment Period is a time outside the standard enrollment periods when
you can sign up for Medicare.
What is the standard Medicare Part B premium for 2024?
The standard Medicare Part B premium is $174.70 per month.
What is the Medicare Part D late enrollment penalty?
A penalty added to your Part D premium if you go 63 or more days without
creditable prescription drug coverage.
What is creditable coverage?
Prescription drug coverage that is expected to pay, on average, at least as much as
Medicare's standard prescription drug coverage.
What is a Medicare Advantage plan?
A type of Medicare health plan offered by a private company that contracts with
Medicare.
What is a Health Maintenance Organization (HMO) plan?
A type of Medicare Advantage plan that usually limits coverage to care from doctors
who work for or contract with the HMO.
What is a Preferred Provider Organization (PPO) plan?
A type of Medicare Advantage plan that allows you to use doctors, hospitals, and
providers outside of the network for an additional cost.
What is a Private Fee-for-Service (PFFS) plan?
A type of Medicare Advantage plan where you can go to any doctor or hospital that
accepts the plan's terms and conditions.
What is a Special Needs Plan (SNP)?
, A type of Medicare Advantage plan that provides more focused and specialized
health care for specific groups of people.
What is the Medicare Part D catastrophic coverage?
Once you reach the catastrophic coverage phase, you pay a small coinsurance or
copayment for covered drugs for the rest of the year.
What is the Medicaid program?
A joint federal and state program that helps with medical costs for some people with
limited income and resources.
What is the Children's Health Insurance Program (CHIP)?
A program that provides health coverage to children in families with incomes too
high to qualify for Medicaid.
What is the Affordable Care Act (ACA)?
A comprehensive health care reform law enacted in March 2010.
What is the Health Insurance Marketplace?
A service that helps people shop for and enroll in health insurance.
What is a pre-existing condition?
A health problem you had before the date that new health coverage starts.
What is guaranteed issue?
A requirement that health insurance companies must sell you a policy regardless of
your health status.
What is community rating?
A rule that requires health insurance companies to charge the same premium to
everyone in a given geographic area, regardless of age or health status.
Correct Answers | Latest Update
Mrs. Andrews is comparing her employer's retiree insurance to Original
Medicare and would like to know which of the following services Original
Medicare will cover if the appropriate criteria are met. What could you tell her?
Original Medicare covers ambulance services.
What impact, if any, have recent regulatory changes had on Medigap plans?
The Part B deductible is no longer covered for individuals newly eligible for Medicare
starting January 1, 2020.
Joan and Loretta are both enrolled in Medicare. Joan pays a premium for Part A
coverage. Loretta does not. Which of the following statements best explains
this difference?
Joan worked only a short time and did not accumulate sufficient work credits. Loretta
worked for well over 10 years accumulating credit for more than 40 quarters of
contributions to the Medicare program.
Larry Miller is an Original Medicare beneficiary with Parts A and B coverage.
Larry is admitted to Good Care Hospital in January with pneumonia and stays
for three days before being discharged. Six months later in July, Larry takes a
bad fall and is admitted to Good Care Hospital with a broken leg. After
emergency surgery to repair his broken leg, Larry is hospitalized for a week
before being discharged home. In December, Larry is admitted to Mount
Wellness Hospital once again with a serious case of the flu. For how many Part
A deductibles will Larry be responsible for?
Larry will be responsible for three Part A deductibles. A benefit period begins the day
a patient is admitted as an inpatient and ends when the patient has not received any
inpatient hospital care for 60 consecutive days in a row. Since Larry's three
,hospitalizations were separated by more than 60 days each, they each represent a
new benefit period, requiring a separate deductible.
What is the purpose of Medicare Part A?
Medicare Part A covers inpatient hospital stays, skilled nursing facility care, hospice
care, and some home health care.
What is the purpose of Medicare Part B?
Medicare Part B covers medically necessary services and preventive services.
How does Medicare Part C (Medicare Advantage) work?
Medicare Part C is an alternative to Original Medicare where private insurers provide
benefits.
What is the coverage gap in Medicare Part D?
The coverage gap (donut hole) is a temporary limit on what the drug plan will cover.
What is a Medigap plan?
Medigap is private health insurance that supplements Original Medicare.
What is the Initial Enrollment Period (IEP) for Medicare?
The IEP is a 7-month period that begins 3 months before the month you turn 65.
What is the General Enrollment Period (GEP)?
The General Enrollment Period is January 1 to March 31 each year.
What is the Annual Election Period (AEP) for Medicare Advantage and Part D?
The Annual Election Period is October 15 to December 7 each year.
What is the Medicare Advantage Open Enrollment Period?
The Medicare Advantage Open Enrollment Period is January 1 to March 31 each year.
,What is a Special Enrollment Period (SEP)?
A Special Enrollment Period is a time outside the standard enrollment periods when
you can sign up for Medicare.
What is the standard Medicare Part B premium for 2024?
The standard Medicare Part B premium is $174.70 per month.
What is the Medicare Part D late enrollment penalty?
A penalty added to your Part D premium if you go 63 or more days without
creditable prescription drug coverage.
What is creditable coverage?
Prescription drug coverage that is expected to pay, on average, at least as much as
Medicare's standard prescription drug coverage.
What is a Medicare Advantage plan?
A type of Medicare health plan offered by a private company that contracts with
Medicare.
What is a Health Maintenance Organization (HMO) plan?
A type of Medicare Advantage plan that usually limits coverage to care from doctors
who work for or contract with the HMO.
What is a Preferred Provider Organization (PPO) plan?
A type of Medicare Advantage plan that allows you to use doctors, hospitals, and
providers outside of the network for an additional cost.
What is a Private Fee-for-Service (PFFS) plan?
A type of Medicare Advantage plan where you can go to any doctor or hospital that
accepts the plan's terms and conditions.
What is a Special Needs Plan (SNP)?
, A type of Medicare Advantage plan that provides more focused and specialized
health care for specific groups of people.
What is the Medicare Part D catastrophic coverage?
Once you reach the catastrophic coverage phase, you pay a small coinsurance or
copayment for covered drugs for the rest of the year.
What is the Medicaid program?
A joint federal and state program that helps with medical costs for some people with
limited income and resources.
What is the Children's Health Insurance Program (CHIP)?
A program that provides health coverage to children in families with incomes too
high to qualify for Medicaid.
What is the Affordable Care Act (ACA)?
A comprehensive health care reform law enacted in March 2010.
What is the Health Insurance Marketplace?
A service that helps people shop for and enroll in health insurance.
What is a pre-existing condition?
A health problem you had before the date that new health coverage starts.
What is guaranteed issue?
A requirement that health insurance companies must sell you a policy regardless of
your health status.
What is community rating?
A rule that requires health insurance companies to charge the same premium to
everyone in a given geographic area, regardless of age or health status.
