AHIP 2024: All Segment Exams ||
Complete Questions & Answers (Rated A+)
One of your clients, Lauren Nichols, has heard about a Medicare concept from one of
her neighbors called TrOOP. She asks you to explain it. What do you say? - ANSWER -
TrOOP stands for true out-of-pocket expenses that count toward the Medicare Part D
catastrophic limit and include not onlyexpenses paid by a benefi ciary but also in some
instances drug manufacturer discounts.
Mrs. Chou likes a Private Fee-for-Service (PFFS) plan available in her area that does
not include drug coverage. She wants to enroll in theplan and enroll in a stand-alone
prescription drug plan. What should you tell her? - ANSWER - She could enroll in a
PFFS plan and a stand-alone Medicare prescription drug plan
Mr. Hutchinson has drug coverage through his former employer's retiree plan. He is
concerned about the Part D premium penalty if he does notenroll in a Medicare
prescription drug plan, but does not want to purchase extra coverage that he will not
need. What should you tell him? - ANSWER - If the drug coverage he has is not
expected to pay, on average, at least as much as Medicare's standard Part D
coverageexpects to pay, then he will need to enroll in Medicare Part D during his initial
eligibility period to avoid the late enrollmentpenalty.
Mr.
Robinson was quite ill recently and forgot to pay his
monthly premium for his MA-PD plan. He
is worried that he will lose his coverage nowwhen he needs it the most. He is certain his
plan will disenroll him
because that is what happened to a friend of his in a similar type of
plan. What can you tell Mr. Robinson about
his situation? - ANSWER - Plan sponsors have the option to do nothing
when a plan member does not pay their premiums or disenroll the member after a
graceperiod and notice
- ANSWER - Mr. Alonso receives some help paying for his two generic prescription
drugs from his employer's retiree coverage, but he wants tocompare it to a Part D
prescription drug plan. He asks you what costs he would generally expect to encounter
when enrolling into astandard Medicare Part D prescription drug plan. What should you
tell him?
Types of Medicare Advantage Plans - ANSWER - PPO, HMO, MSA, Cost Plan, PFFS
Medicare-Medicaid plans - ANSWER - Serve both Medicare and Medicaid individuals.
Include Part D coverage. Individuals sometimes referred to as dual eligibles
, Medicare Cost Plan - ANSWER - 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 - ANSWER - Individuals with ESRD
may sign up at anytime. Date on which coverage begins is the fourth month after
dialysis begins.
Medicare Enrollment Period - ANSWER - 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 - ANSWER - 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 - ANSWER - 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 - ANSWER - 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 - ANSWER - 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 - ANSWER - Entiled to benefits under Part A AND
enrolled in Part B.
Part D Prescription Drug benefits - ANSWER - 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 - ANSWER - 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 - ANSWER - $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.
Complete Questions & Answers (Rated A+)
One of your clients, Lauren Nichols, has heard about a Medicare concept from one of
her neighbors called TrOOP. She asks you to explain it. What do you say? - ANSWER -
TrOOP stands for true out-of-pocket expenses that count toward the Medicare Part D
catastrophic limit and include not onlyexpenses paid by a benefi ciary but also in some
instances drug manufacturer discounts.
Mrs. Chou likes a Private Fee-for-Service (PFFS) plan available in her area that does
not include drug coverage. She wants to enroll in theplan and enroll in a stand-alone
prescription drug plan. What should you tell her? - ANSWER - She could enroll in a
PFFS plan and a stand-alone Medicare prescription drug plan
Mr. Hutchinson has drug coverage through his former employer's retiree plan. He is
concerned about the Part D premium penalty if he does notenroll in a Medicare
prescription drug plan, but does not want to purchase extra coverage that he will not
need. What should you tell him? - ANSWER - If the drug coverage he has is not
expected to pay, on average, at least as much as Medicare's standard Part D
coverageexpects to pay, then he will need to enroll in Medicare Part D during his initial
eligibility period to avoid the late enrollmentpenalty.
Mr.
Robinson was quite ill recently and forgot to pay his
monthly premium for his MA-PD plan. He
is worried that he will lose his coverage nowwhen he needs it the most. He is certain his
plan will disenroll him
because that is what happened to a friend of his in a similar type of
plan. What can you tell Mr. Robinson about
his situation? - ANSWER - Plan sponsors have the option to do nothing
when a plan member does not pay their premiums or disenroll the member after a
graceperiod and notice
- ANSWER - Mr. Alonso receives some help paying for his two generic prescription
drugs from his employer's retiree coverage, but he wants tocompare it to a Part D
prescription drug plan. He asks you what costs he would generally expect to encounter
when enrolling into astandard Medicare Part D prescription drug plan. What should you
tell him?
Types of Medicare Advantage Plans - ANSWER - PPO, HMO, MSA, Cost Plan, PFFS
Medicare-Medicaid plans - ANSWER - Serve both Medicare and Medicaid individuals.
Include Part D coverage. Individuals sometimes referred to as dual eligibles
, Medicare Cost Plan - ANSWER - 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 - ANSWER - Individuals with ESRD
may sign up at anytime. Date on which coverage begins is the fourth month after
dialysis begins.
Medicare Enrollment Period - ANSWER - 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 - ANSWER - 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 - ANSWER - 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 - ANSWER - 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 - ANSWER - 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 - ANSWER - Entiled to benefits under Part A AND
enrolled in Part B.
Part D Prescription Drug benefits - ANSWER - 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 - ANSWER - 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 - ANSWER - $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.
