AHIP Final Exam newest (2025/2026) | Questions and
100% Correct Answers with Rationales | A+ Graded||
chronic condition SNP (C-SNP) - ANSWER-restrict
enrollment to individuals with certain or disabling chronic
conditions such as diabetes, heart failure, cancer, etc.
-each one will specify the condition
dual eligible snp (D-SNP) - ANSWER-enroll beneficiaries
who are entitled to both medicare and medical assistance
from a state plan under medicaid
fully integrated dual eligible snp (FIDE) - ANSWER-subset
snp that provides dial eligible enrollees access to
,medicare and medicaid benefits under a single managed
care organization
institutional SNPs (I-SNP) - ANSWER-restrict enrollment
to MA eligible individuals who, for 90 days or longer, have
had or are expected to need the level of services provided
in long term care skilled nurses facility, an intermediate
care facility, or for individuals with intellectual and
developmental disabilites, a long term care hospital or
psychiatric facility
IE SNP - ANSWER-enroll Ma eligible individuals who live
in the comminuty but require an institutional level of care -
may be limited to assisted living facilities
, private fee for service plans (PFFS) - ANSWER-may
receive covered services from any provider in the US who
is eligible to provide medicare services and agrees to
accept the plants terms and conditions of payment
not to accept - ANSWER-non-network providers that
accept original medicare may choose ___ PFFS plan
enrollees
15% - ANSWER-PFFS - cost sharing may include balance
billing up to ___ of the medicare rate only if allowed in the
plans terms and conditions
Qualified Medicare beneficiary program (QMBP) -
ANSWER-helps pay premiums, deductibles, coinsurance,
and copayments for part a and b or both
100% Correct Answers with Rationales | A+ Graded||
chronic condition SNP (C-SNP) - ANSWER-restrict
enrollment to individuals with certain or disabling chronic
conditions such as diabetes, heart failure, cancer, etc.
-each one will specify the condition
dual eligible snp (D-SNP) - ANSWER-enroll beneficiaries
who are entitled to both medicare and medical assistance
from a state plan under medicaid
fully integrated dual eligible snp (FIDE) - ANSWER-subset
snp that provides dial eligible enrollees access to
,medicare and medicaid benefits under a single managed
care organization
institutional SNPs (I-SNP) - ANSWER-restrict enrollment
to MA eligible individuals who, for 90 days or longer, have
had or are expected to need the level of services provided
in long term care skilled nurses facility, an intermediate
care facility, or for individuals with intellectual and
developmental disabilites, a long term care hospital or
psychiatric facility
IE SNP - ANSWER-enroll Ma eligible individuals who live
in the comminuty but require an institutional level of care -
may be limited to assisted living facilities
, private fee for service plans (PFFS) - ANSWER-may
receive covered services from any provider in the US who
is eligible to provide medicare services and agrees to
accept the plants terms and conditions of payment
not to accept - ANSWER-non-network providers that
accept original medicare may choose ___ PFFS plan
enrollees
15% - ANSWER-PFFS - cost sharing may include balance
billing up to ___ of the medicare rate only if allowed in the
plans terms and conditions
Qualified Medicare beneficiary program (QMBP) -
ANSWER-helps pay premiums, deductibles, coinsurance,
and copayments for part a and b or both
