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2025 AHIP Medicare Health Plans New Full Questions and Answers ( Included ) 100% Correct
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2025 AHIP Medicare Health Plans New Full Questions and Answers ( Included ) 100% Correct
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AHIP Medicare Health PlansBy ExamNavigator
, AHIP Medicare Health Plans
1. Part C: Medicare Advantage Plans, aka MA.
Answer:
• Health plans that cover allMedicare Part A and Part B benefits and are offered by private
companies.
• Some plans may also cover Part D, prescription drug benefits. These plans areknown as
MAPD.
• All MA plans have a maximum out-of-pocket limit (MOOP) for basic benefits.
• Many MA plans also offer additional benefits that Medicare does not cover, knownas
supplemental benefits.
2. Types of Medicare Advantage (MA) plans.
Answer:
• Coordinated Care Plans.
• Private Fee-for- Service (PFFS) Plans.
• Medical Savings Account (MSA) Plans.
3. Coordinated Care Plans: These plans have a network of preferred providers andincl
Answer:
• Health Maintenance Organizations (HMOs).
• Preferred Provider Organizations (PPOs), which may be local or regional.
4. HMOs
Answer: Generally, only cover services furnished by doctors and hospitals withinthe plan's
network, known as participating providers.
However, some offer a Point of Service (POS) option that allows enrollees to go to out-of-
network doctors and hospitals without receiving prior approval for certainservices.
5. How do HMOs work?
Answer: • May need to select a primary care doctor and may needa referral for specialty care to
be covered.
6. How do HMO-POS plans work?
Answer:
• Same as HMOs, but these plans allow themto go to out-of-network doctors and hospitals for
certain services, without prior approval.
• It may limit the services available out-of-network or may put a dollar cap on theamount of
out-of-network coverage.
• Cost-sharing is generally higher for services furnished by out-of-network providersthan for
services obtained from participating providers.
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