2026 AHIP Final Exam Answers Updated
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Terms in this set (28)
Types of Medicare Advantage PPO, HMO, MSA, Cost Plan, PFFS
Plans
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 - Individuals with ESRD may sign up at anytime.
Part A & Part B 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 - Individuals who have group health coveage
Group Health Coverage 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.
Questions and Answers (Latest
Update) (Verified Answers by Expert)
Save
Terms in this set (28)
Types of Medicare Advantage PPO, HMO, MSA, Cost Plan, PFFS
Plans
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 - Individuals with ESRD may sign up at anytime.
Part A & Part B 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 - Individuals who have group health coveage
Group Health Coverage 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.
