Exam (elaborations)
2024 AHIP FINAL EXAM QUESTIONS WITH CORRECT ANSWERS
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2024 AHIP FINAL EXAM QUESTIONS WITH CORRECT ANSWERS
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2024 AHIP FINAL EXAMQUESTIONS WITH CORRECT
ANSWERS
Types of Medicare Advantage Plans - CORRECT-ANSWERSPPO, HMO, MSA,
Cost Plan, PFFS
Medicare Advantage Eligibility - CORRECT-ANSWERSNot eligible if have ESRD
unless: MA Plan is a SNP plan for people with ESRD, OR person developed
ESRD after enrolling in MA plan.
Medicare Advantage Special Needs Plans - CORRECT-ANSWERSThree types.
Chronic Condition (CSNP) for specific severe or disabling conditions. Dual
Eligible (DSNP) for entitlement to both Medicare and Medicaid.
Institutionalized (ISNP) for individuals who need services in skilled nursing
facility for 90 days or longer. All SNP plans include prescription drug
coverage.
MA Plan Types - Coordinated Care Plans - HMO's - CORRECT-ANSWERSSome
HMO's offer Point Of Service option. Allows enrollees to go to no plan
doctors/hospitals without prior approval for sertain services. HMO-POS may
limit services out of network or put cap on out of network coverage. Cost
sharing is generally higher than from network providers
MA Plan Types - Coordinated Care Plans - PPO's - CORRECT-ANSWERSDo not
need referral for out of network providers. May pay higher cost sharing
amount.
MA Plan Types - Private Fee For Service plans - PFFS - CORRECT-
ANSWERSIndividuals in PFFS plan may receive covered services from any
provider who is eligible to provide Medicare services, and agrees to the plans
terms and conditions of payment. Enrollees must inform provider they are a
PFFS member, so the provider can decide whether to accept terms and
conditions. Not permitted to charge more than cost sharing specified in plan.
Cost sharing may include balance billing up to 15%.
MA Plan Types - Medical Savings Account - MSA plan - CORRECT-
ANSWERSHigh deductible plan. Medicare makes contribution to beneficiaries
savings account. Max deductible in 2019 is $12,650.00. In 2020, $13,400.00.
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