AHIP Final Exam Questions and Answers 100% Accurate
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Course
AHIP 2023
Institution
AHIP 2023
Types of Medicare Advantage Plans - ANSWERPPO, HMO, MSA, Cost Plan, PFFS
Medicare-Medicaid plans - ANSWERServe both Medicare and Medicaid individuals. Include Part D coverage. Individuals sometimes referred to as dual eligibles
Medicare Cost Plan - ANSWERType of Medicare health plan. Have Par...
Medicare-Medicaid plans - ANSWERServe both Medicare and Medicaid individuals.
Include Part D coverage. Individuals sometimes referred to as dual eligibles
Medicare Cost Plan - ANSWERType 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 - ANSWERIndividuals with ESRD
may sign up at anytime. Date on which coverage begins is the fourth month after
dialysis begins.
Medicare Enrollment Period - ANSWERIndividuals 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 - ANSWERIndividuals 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 - ANSWERFree 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 - ANSWERDon'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 - ANSWERIn 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 - ANSWEREntiled to benefits under Part A AND
enrolled in Part B.
Part D Prescription Drug benefits - ANSWEREntitled 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 - ANSWERDo 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.
Part A Benefits - ANSWERBlood, hospice, home health care, skilled nursing and
rehabilitative care only after a 3 day hospital stay up to 100 days in a benefit period. In
2019, will pay $170.50 coinsurance for days 21 - 100 each benefit period. In patient
psychiatric care is 190 lifetime days. Does not cover custodial or long term care.
Part D Prescription Drug Coverage - ANSWERLate enrollment penalty of 1% of national
standard premium for every month that beneficiary could have had Part D but didn't
enroll. No penalty for beneficiaries with low income assistance or who join a Part D
within 63 days of losing creditable coverage.
Medigap Prescription Drug Coverage - ANSWERIf coverage is not creditable, individual
dropping coverage and enrolling in Part D coverage will pay a late enrollment penalty,
unless they qualify for "ExtraHelp" or enroll in Part D during Special Enrollment Period
for loss of creditable coverage. If informed non Medicare is no longer creditable, will
have an SEP to enroll without penalty.
Medicare Advantage Eligibility - ANSWERNot 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 - ANSWERThree 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 - ANSWERSome 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 - ANSWERDo not need referral for
out of network providers. May pay higher cost sharing amount.
MA Plan Types - Private Fee For Service plans - PFFS - ANSWERIndividuals 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%.
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