AHIP Final Exam
Questions
1. Types of Medicare Advantage Plans: PPO, HMO, MSA, Cost Plan, PFFS
2. Medicare-Medicaid plans: Serve both Medicare and Medicaid individuals.
In- clude Part D coverage. Individuals sometimes referred to as dual eligibles
3. 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 ap- ply. Can get Part D Rx coverage if available, or apply for a separate
PDP.
4. 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.
5. 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.
6. Medicare Enrollment Period - Group Health Coverage: 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.
7. 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.
8. 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.
9. 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
10. Part C Medicare Advantage plans: Entiled to benefits under Part A
AND enrolled in Part B.
11. 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.
12. 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
Pharma- ceutical Assistance Program.
13. 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 "lifetime reserve day" after day 90 for each benefit
period
This study(up todownloaded
source was 60 days over a from
by 100000899511392 beneficiarys lifetime.
CourseHero.com on 06-08-2025 15:33:51Beyond
GMT -05:00 lifetime reserve days,
1/
4
https://www.coursehero.com/file/250042554/AHIP-Final-Exam-Questionsdocx/
Questions
1. Types of Medicare Advantage Plans: PPO, HMO, MSA, Cost Plan, PFFS
2. Medicare-Medicaid plans: Serve both Medicare and Medicaid individuals.
In- clude Part D coverage. Individuals sometimes referred to as dual eligibles
3. 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 ap- ply. Can get Part D Rx coverage if available, or apply for a separate
PDP.
4. 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.
5. 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.
6. Medicare Enrollment Period - Group Health Coverage: 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.
7. 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.
8. 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.
9. 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
10. Part C Medicare Advantage plans: Entiled to benefits under Part A
AND enrolled in Part B.
11. 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.
12. 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
Pharma- ceutical Assistance Program.
13. 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 "lifetime reserve day" after day 90 for each benefit
period
This study(up todownloaded
source was 60 days over a from
by 100000899511392 beneficiarys lifetime.
CourseHero.com on 06-08-2025 15:33:51Beyond
GMT -05:00 lifetime reserve days,
1/
4
https://www.coursehero.com/file/250042554/AHIP-Final-Exam-Questionsdocx/
