AHIP Final Exam Questions With Correct Answers 2024/2025

AHIP Final Exam Questions With Correct
Answers 2024/2025
Types of Medicare Advantage Plans - correct answer-PPO, HMO, MSA, Cost Plan, PFFS



Medicare-Medicaid plans - correct answer-
Serve both Medicare and Medicaid individuals. Include Part D coverage. Individuals sometimes refer
red to as dual eligibles



Medicare Cost Plan - correct answer-
Type of Medicare health plan. Have Part B to enroll. Can join anytime plan is accepting new memb
ers. A non network provider will can charge higher coinsurances and deuctibles. Different enrollme
nt/disenrollment periods apply. Can get Part D Rx coverage if available, or apply for a separate PDP
.



Medicare Entitlement/Enrollment - Part A & Part B - correct answer-
Individuals with ESRD may sign up at anytime. Date on which coverage begins is the fourth month
after dialysis begins.



Medicare Enrollment Period - correct answer-
Individuals who do not enroll in Part B when first eligible can enroll during a General Enrollment P
eriod, Jan 1st to Mar 31st each year. Coverage begins July 1st of that year.



Medicare Enrollment Period - Group Health Coverage - correct answer-
Individuals who have group health coveage through employer may enroll in Part A and/or Part B a
nytime while on group coverage during a Special Enrollment Period. Occurs during the 8 month pe
riod following last month of group coverage.



Medicare Part A Premium - correct answer-
Free 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 - correct answer-
Don'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 - correct answer- U 3 U 3 U 3 U 3 U 3 U 3



In 2019, the standard monthly premium is $135.50 or higher depending on income. Deducted
U 3 U 3 U 3 U 3 U 3 U 3 U 3 U 3 U 3 U 3 U 3 U 3 U 3



from
U 3



S.S. check or Railroad Retirement check. Do not enroll when first eligible, premium is
U 3 U3 U 3 U 3 U 3 U 3 U 3 U 3 U 3 U3 U 3 U 3 U 3



increased 10
U 3 U 3



% for each 12 month period not enrolled. Deductible for 2019 is $185.00
U 3 U 3 U 3 U 3 U 3 U 3 U 3 U 3 U 3 U 3 U 3 U 3




Part C Medicare Advantage plans - correct answer-
U 3 U 3 U 3 U 3 U 3 U 3 U 3



Entiled to benefits under Part A AND enrolled in Part B.
U 3 U 3 U 3 U 3 U 3 U 3 U 3 U 3 U 3 U 3




Part D Prescription Drug benefits - correct answer-
U 3 U 3 U 3 U 3 U 3 U 3 U 3



Entitled to benefits under Part A but not enrolled in Part B. Must be entitled to Part A
U 3 U 3 U 3 U 3 U 3 U 3 U 3 U 3 U 3 U 3 U 3 U 3 U 3 U 3 U 3 U 3 U 3



AND/OR en rolled in Part B.
U 3 U 3 U3 U 3 U 3 U 3




Part D Low Income Subsidy - correct answer-
U 3 U 3 U 3 U 3 U 3 U 3 U 3



Do not qualify for Part D Low Income Subsidy, but are of limited means, may qualify
U 3 U 3 U 3 U 3 U 3 U 3 U 3 U 3 U 3 U 3 U 3 U 3 U 3 U 3 U 3



for help in Pa rt D costs through State Pharmaceutical Assistance Program.
U 3 U 3 U 3 U 3 U3 U 3 U 3 U 3 U 3 U 3 U 3 U 3




Part A Benefits - correct answer-$1364.00 deductible for each benefit period.
U 3 U 3 U 3 U 3 U 3 U 3 U 3 U 3 U 3 U 3



Days 1 - 60: $0 coinsurance. Days 61 -
U 3 U 3 U 3 U3 U 3 U 3 U 3 U 3 U 3



90: $341.00 coinsurance per day. days 91 and beyond: $682.00 coinsurance per each
U 3 U 3 U 3 U 3 U 3 U 3 U 3 U 3 U 3 U 3 U 3 U 3



"lifetime res erve day" after day 90 for each benefit period (up to 60 days over a
U 3 U 3 U3 U 3 U 3 U 3 U 3 U 3 U 3 U 3 U 3 U 3 U 3 U 3 U 3 U 3 U 3



beneficiarys lifetime. Beyond l ifetime reserve days, all costs.
U 3 U 3 U 3 U 3 U3 U 3 U 3 U 3 U 3




Part A Benefits - correct answer-
U 3 U 3 U 3 U 3 U 3



Blood, hospice, home health care, skilled nursing and rehabilitative care only after a 3
U 3 U 3 U 3 U 3 U 3 U 3 U 3 U 3 U 3 U 3 U 3 U 3 U 3



day hospital stay up to 100 days in a benefit period. In 2019, will pay $170.50
U 3 U 3 U3 U 3 U 3 U 3 U 3 U 3 U 3 U 3 U 3 U 3 U 3 U 3 U 3 U 3



coinsurance for days 21 -
U 3 U 3 U 3 U 3 U 3



100 each benefit period. In patient psychiatric care is 190 lifetime days. Does not cover
U 3 U 3 U 3 U 3 U 3 U 3 U 3 U 3 U 3 U 3 U 3 U 3 U 3 U 3



custodial or long term care.
U 3 U3 U 3 U 3 U 3




Part D Prescription DrugU 3 U 3 U 3 U 3 Coverage - correct answer- U 3 U3 U 3



Late enrollment penalty U 3 U 3 of 1% of national standard premium for every month that
U 3 U 3 U 3 U 3 U 3 U 3 U 3 U 3 U 3 U 3



beneficiary coul d have
U 3 U 3 U3 U 3 U 3 had Part D but didn't enroll. No penalty for beneficiaries with
U 3 U 3 U 3 U 3 U 3 U 3 U 3 U 3 U 3 U 3



low income assistance
U 3 U 3 U 3 U 3 or wh o join a Part D within 63 days of losing creditable
U 3 U3 U 3 U 3 U 3 U 3 U 3 U 3 U 3 U 3 U 3 U 3



coverage.
U 3




Medigap Prescription Drug Coverage - correct answer-
U3 U3 U 3 U3 U 3 U 3



If coverage is not creditable, individual dropping coverage and enrolling in Part D coverage
U 3 U3 U 3 U 3 U 3 U 3 U 3 U 3 U 3 U 3 U3 U 3 U 3