AHIP Final Exam Questions COMPLETE SOLUTION

AHIP Final Exam Questions COMPLETE SOLUTION 1. Types of Medicare Advantage Plans: PPO, HMO, MSA, Cost Plan, PFFS 2. Medicare-Medicaid plans: Serve both Medicare and Medicaid individuals. In- clude Part D coverage. Individuals sometimes referred to as dual eligibles 3. 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. 4. 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. 5. 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. 6. 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. 7. 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. 8. 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. 9. 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 10. Part C Medicare Advantage plans: Entiled to benefits under Part A AND enrolled in Part B. 11. 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. 12. 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. 13. Part A Benefits: $1364.00 deductible for each benefit period. Days 1 - 60: $0 coinsurance. Days 61 - 90: $341.00 coinsurance per day. days 91 and beyond: $682.00 coinsurance per each "lifetime reserve day" after day 90 for each benefit period (up to 60 days over a beneficiarys lifetime. Beyond lifetime reserve days, all costs. 14. Part A Benefits: Blood, hospice, home health care, skilled nursing and reha- bilitative care only after a 3 day hospital stay up to 100 days in a benefit period. In 2019