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AHIP Final Exam Questions
C C
Types o𝑓 Medicare Advantage Plans PPO, HMO, MSA, Cost Plan, PFFS
Medicare-Medicaid plans Serve both Medicare and Medicaid individuals. Include Part D coverage.
Individuals sometimes re𝑓erred to as dual eligibles
Medicare Cost Plan 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.
Medicare Entitlement/Enrollment - Part A & Part B Individuals with ESRD may sign up at anytime. Date on which coverage begins is
the 𝑓ourth month a𝑓ter dialysis begins.
Medicare Enrollment Period Individuals 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 Individuals 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 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 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 In 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 Entiled to bene𝑓its under Part A AND enrolled in Part B.
Part D Prescription Drug bene𝑓its Entitled 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 Do 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.
AHIP Final Exam Questions
C C
Types o𝑓 Medicare Advantage Plans PPO, HMO, MSA, Cost Plan, PFFS
Medicare-Medicaid plans Serve both Medicare and Medicaid individuals. Include Part D coverage.
Individuals sometimes re𝑓erred to as dual eligibles
Medicare Cost Plan 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.
Medicare Entitlement/Enrollment - Part A & Part B Individuals with ESRD may sign up at anytime. Date on which coverage begins is
the 𝑓ourth month a𝑓ter dialysis begins.
Medicare Enrollment Period Individuals 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 Individuals 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 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 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 In 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 Entiled to bene𝑓its under Part A AND enrolled in Part B.
Part D Prescription Drug bene𝑓its Entitled 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 Do 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.
