Exam (elaborations)
2025 AHIP Medicare Health Plans New Full Questions and Answers ( Included ) 100% Correct
- Course
- Institution
2025 AHIP Medicare Health Plans New Full Questions and Answers ( Included ) 100% Correct
[Show more]
Content preview
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.
The benefits of buying summaries with Stuvia:
Guaranteed quality through customer reviews
Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.
Quick and easy check-out
You can quickly pay through credit card or Stuvia-credit for the summaries. There is no membership needed.
Focus on what matters
Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!
Frequently asked questions
What do I get when I buy this document?
You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.
Satisfaction guarantee: how does it work?
Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.
Who am I buying these notes from?
Stuvia is a marketplace, so you are not buying this document from us, but from seller ExamNavigator. Stuvia facilitates payment to the seller.
Will I be stuck with a subscription?
No, you only buy these notes for $10.99. You're not tied to anything after your purchase.
Can Stuvia be trusted?
4.6 stars on Google & Trustpilot (+1000 reviews)
73243 documents were sold in the last 30 days
Founded in 2010, the go-to place to buy study notes for 14 years now