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AHIP Final Exam questions and answers 2015/2016
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AHIP Final Exam Questions1. MA Plan Types - Coordinated Care Plans - HMO's >ANS>Some 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
2. MA Plan Types - Coordinated Care Plans - PPO's >ANS>Do not need referral for out of
network providers. May pay higher cost sharing amount.
3. MA Plan Types - Medical Savings Account - MSA plan >ANS>High deductible plan.
Medicare makes contribution to beneficiaries savings account. Max deductible in 2019 is
$12,650.00. In 2020, $13,400.00. Do not cover Part D prescription drug benefits. Must
enroll in stand alone Part D PDP.
4. MA Plan Types - Medical Savings Account - MSA plan >ANS>May not have network.
May have partial or full network. No network providers must accept amount Medicare
pays them as payment in full.
5. MA Plan Types - Private Fee For Service plans - PFFS >ANS>Have option of providing
prescription drug coverage, but not required to do so.
6. MA Plan Types - Private Fee For Service plans - PFFS >ANS>Individuals 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%.
7. Medicare Advantage & Prescription Drugs >ANS>If a beneficiary enrolls in an HMO or
PPO plan that does not include prescription drug coverage, CAN NOT join a stand alone
PDP.
8. Medicare Advantage & Prescription Drugs >ANS>Individual enrolled in an MA PFFS
plan that does not include a Part D benefit, may enroll in a stand alone PDP. An
individual enrolled in an MA MSA plan must join a stand alone PDP plan if they want
drug benefits. If enrolled in a Cost Plan, can join a stand alone PDP if the Cost Plan
does not offer prescription drug benefits.
9. Medicare Advantage Eligibility >ANS>Not eligible if have ESRD unless: MA Plan is a
SNP plan for people with ESRD, OR person developed ESRD after enrolling in MA plan.
10. Medicare Advantage Special Needs Plans >ANS>Three 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.
11. Medicare Cost Plan >ANS>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 apply. Can get
Part D Rx coverage if available, or apply for a separate PDP.
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