AHIP Final Exam Questions
Types of Medicare Advantage Plans - ANSPPO, HMO, MSA, Cost Plan, PFFS
Medicare-Medicaid plans - ANSServe both Medicare and Medicaid individuals. Include Part
D coverage. Individuals sometimes referred to as dual eligibles
Medicare Cost Plan - ANSType 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 - ANSIndividuals with ESRD may sign up
at anytime. Date on which coverage begins is the fourth month after dialysis begins.
Medicare Enrollment Period - ANSIndividuals 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 - ANSIndividuals 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 - ANSFree 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 - ANSDon'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 - ANSIn 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 - ANSEntiled to benefits under Part A AND enrolled in
Part B.
Part D Prescription Drug benefits - ANSEntitled 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 - ANSDo 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.
Types of Medicare Advantage Plans - ANSPPO, HMO, MSA, Cost Plan, PFFS
Medicare-Medicaid plans - ANSServe both Medicare and Medicaid individuals. Include Part
D coverage. Individuals sometimes referred to as dual eligibles
Medicare Cost Plan - ANSType 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 - ANSIndividuals with ESRD may sign up
at anytime. Date on which coverage begins is the fourth month after dialysis begins.
Medicare Enrollment Period - ANSIndividuals 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 - ANSIndividuals 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 - ANSFree 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 - ANSDon'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 - ANSIn 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 - ANSEntiled to benefits under Part A AND enrolled in
Part B.
Part D Prescription Drug benefits - ANSEntitled 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 - ANSDo 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.
