AHIP Practice Questions and Answers 100% Pass

AHIP Practice Questions and Answers 100% Pass Different ways to get Medicare - Correct Answer ️️ -- Medicare Cost Plans (some also include Part D) - PACE Plans (includes Part D) - Medicare-medicaid plans (includes D) Medicare COST PLANS - Correct Answer ️️ -- NOT an MA (part C) plan - only available in certain areas of the country - can enroll w/ B but not A - if you have A&B, and go out of network, services will be charged as A&B standards - can join anytime plan is accepting new members - can leave anytime and return to A&B original - RX coverage from plan or D PACE Plans - Correct Answer ️️ -- programs for ALL INCLUSIVE CARE for the ELDERLY - Medicare & Medicaid program offered in many states that allows people who otherwise need a nursing home level of care to remain in the community. PACE Qualifications - Correct Answer ️️ -Age 55+ Live in the service area of a PACE organization Certified by state as needing a nursing home level of care @ time of joining, able to live safely in community w/ help of PACE services Dual Eligible - Correct Answer ️️ -- for medicare-medicaid individuals - includes D Part D - Correct Answer ️️ -stand alone or w/ Medicare Health plan Medigap - Correct Answer ️️ -- by private insurance companies - intended to "fill gaps" of A & B (original) - works only with Original - doesn't cover medicare benefits but works in tandem w/ A&B coverage - ex: extra days of coverage or foreign travel emergency care Part A Entitlement - Correct Answer ️️ -- me or spouse paid taxes and worked for 40 quarters (10 years) = Free Part A - if worked less than 10 years, will have to pay a premium for Part A TITLE XVIII - Correct Answer ️️ -A - Hospital B - Medical C - Medicare health plans w/ benefits of A&B D - Prescriptions E - Medigap, miscellaneous provisions Part C - Correct Answer ️️ -- HMOs, PPOs, PFFs, SNPs (Special Needs Plans), MSAs (Medical Savings Account Plans), Employer or Union Group Plans Requirements for MA Plans - Correct Answer ️️ -- entitled to Part A and enrolled in Part B - beneficiary must live in MA plan's service area - must still pay for Part B premium - might be an MA premium - regardless of health status - end-state renal disease beneficiaries have special eligibility requirements Special Needs Plans (SNPs) - Correct Answer ️️ -- must meet specified plan eligibility criteria (dual eligible, specific chronic conditions, institutions or community living, and require an institutional level of care). - 3 types: chronic, dual eligible, institutional Chronic Condition SNPs (C-SNPs) - Correct Answer ️️ -restrict enrollment to special needs individuals w/ specific severe or disabling conditions Dual eligible SNPs (D-SNPs) - Correct Answer ️️ -enroll beneficiaries who are entitled to both Medicare and medial assistance from Medicaid Institutional SNPs (I-SNPs) - Correct Answer ️️ -restrict enrollment to MA eligible individuals who, for 90 days or longer, have had or are expected to need the level of services in an LTC, SNF, LTC nursing facility, SNF/NF, etc. Employer Group Waiver Plans (EGWPs) or Employer Union plans - Correct Answer ️️ -- may only enroll people who are members of an employer/union-sponsored group health plan - has to be "employment-based" group health plan coverage (can't necessarily just be through a group association) Part D - Correct Answer ️️ -- only through private - no "FFS" benefit - Medicare pays a share of the program cost