AHIP Final Exam Questions And Complete Answers

MA Plan Types - Coordinated Care Plans - HMO's - correct answer--Some HMO's offer Point Of Service option. Allows enrollees to go to no plan doctors/hospitals without prior approval for sertain services. HMO-POS may limit services out of network or put cap on out of network coverage. Cost sharing is generally higher than from network providers MA Plan Types - Coordinated Care Plans - PPO's - correct answer--Do not need referral for out of network providers. May pay higher cost sharing amount. MA Plan Types - Medical Savings Account - MSA plan - correct answer--High deductible plan. Medicare makes contribution to beneficiaries savings account. Max deductible in 2019 is $12,650.00. In 2020, $13,400.00. Do not cover Part D prescription drug benefits. Must enroll in stand alone Part D PDP. MA Plan Types - Medical Savings Account - MSA plan - correct answer--May not have network. May have partial or full network. No network providers must accept amount Medicare pays them as payment in full. MA Plan Types - Private Fee For Service plans - PFFS - correct answer--Have option of providing prescription drug coverage, but not required to do so. MA Plan Types - Private Fee For Service plans - PFFS - correct answer--Individuals in PFFS plan may receive covered services from any provider who is eligible to provide Medicare services, and agrees to the plans terms and conditions of payment. Enrollees must inform provider they are a PFFS member, so the provider can decide whether to accept terms and conditions. Not permitted to charge more than cost sharing specified in plan. Cost sharing may include balance billing up to 15%. Medicare Advantage & Prescription Drugs - correct answer--If a beneficiary enrolls in an HMO or PPO plan that does not include prescription drug coverage, CAN NOT join a stand alone PDP. Medicare Advantage & Prescription Drugs - correct answer--Individual enrolled in an MA PFFS plan that does not include a Part D benefit, may enroll in a stand alone PDP. An individual enrolled in an MA MSA plan must join a stand alone PDP plan if they want drug benefits. If enrolled in a Cost Plan, can join a stand alone PDP if the Cost Plan does not offer prescription drug benefits. Medicare Advantage Eligibility - correct answer--Not eligible if have ESRD unless: MA Plan is a SNP plan for people with ESRD, OR person developed ESRD after enrolling in MA plan.