AHIP Final Exam Questions & Answers VERSION 2 ().

Types of Medicare Advantage Plans - THE CORRECT ASNWER IS PPO, HMO, MSA,Cost Plan, PFFS Medicare-Medicaid plans - THE CORRECT ASNWER IS Serve both Medicare andMedicaid individuals. Include Part D coverage. Individuals sometimes referred to asdual eligibles Medicare Cost Plan - THE CORRECT ASNWER IS Type of Medicare health plan. HavePart 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 - THE CORRECT ASNWER IS Individuals with ESRD may sign up at anytime. Date on which coverage begins is thefourth month after dialysis begins. Medicare Enrollment Period - THE CORRECT ASNWER IS Individuals who do not enroll in Part B when first eligible can enroll during a General Enrollment Period, Jan 1stto Mar 31st each year. Coverage begins July 1st of that year. Medicare Enrollment Period - Group Health Coverage - THE CORRECT ASNWER ISIndividuals 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 - THE CORRECT ASNWER IS Free if worked 40 quarters ofyour 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 - THE CORRECT ASNWER IS Don't enroll in Part A when fisteligible, will pay a late penalty of up to 10% unless enroll during a Special Enrollment Period. Medicare Part B Premium - THE CORRECT ASNWER IS In 2019, the standard monthlypremium 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 - THE CORRECT ASNWER IS Entiled to benefitsunder Part A AND enrolled in Part B. Part D Prescription Drug benefits - THE CORRECT ASNWER IS Entitled to benefits under Part A but not enrolled in Part B. Must be entitled to Part A AND/OR enrolled inPart B. Part D Low Income Subsidy - THE CORRECT ASNWER IS Do not qualify for Part DLow Income Subsidy, but are of limited means, may qualify for help in Part D costs through State Pharmaceutical Assistance Program. Part A Benefits - THE CORRECT ASNWER IS $1364.00 deductible for each benefit period. Days 1 - 60: $0 coinsurance. Days 61 - 90: $341.00 coinsurance per day. days91 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 reservedays, all costs. Part A Benefits - THE CORRECT ASNWER IS Blood, hospice, home health care, skilled nursing and rehabilitative care only after a 3 day hospital stay up to 100 days in abenefit period. In 2019, will pay $170.50 coinsurance for days 21 - 100 each benefit period. In patient psychiatric care is 190 lifetime days.