AHIP Final Exam Questions Already Graded A+

Types of Medicare Advantage Plans Ans-PPO, HMO, MSA, Cost Plan, PFFS Medicare-Medicaid plans Ans-Serve both Medicare and Medicaid individuals. Include Part D coverage. Individuals sometimes referred to as dual eligibl ...

Types of Medicare Advantage Plans Ans-PPO, HMO, MSA, Cost Plan, PFFS Medicare-Medicaid plans Ans-Serve both Medicare and Medicaid individuals. Include Part D coverage. Individuals sometimes referred to as dual eligibles Medicare Cost Plan Ans-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 - Part A & Part B Ans-Individuals with ESRD may sign up at anytime. Date on which coverage begins is the fourth month after dialysis begins. Medicare Enrollment Period Ans-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 - Group Health Coverage Ans-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. Medicare Part A Premium Ans-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 Ans-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 Ans-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 Ans-Entiled to benefits under Part A AND enrolled in Part B. Part D Prescription Drug benefits Ans-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 Ans-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. Part A Benefits Ans-$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. Part A Benefits Ans-Blood, hospice, home health care, skilled nursing and rehabilitative care only after a 3 day hospital stay up to 100 days in a benefit period. In 2019, will pay $170.50 coinsurance for days 21 - 100 each benefit period. In patient psychiatric care is 190 lifetime days. Does not cover custodial or long term care. Part D Prescription Drug Coverage Ans-Late enrollment penalty of 1% of national standard premium for every month that beneficiary could have had Part D but didn't enroll. No penalty for beneficiaries with low income assistance or who join a Part D within 63 days of losing creditable coverage. Medigap Prescription Drug Coverage Ans-If coverage is not creditable, individual dropping coverage and enrolling in Part D coverage will pay a late enrollment penalty, unless they qualify for "ExtraHelp" or enroll in Part D during Special Enrollment Period for loss of creditable coverage. If informed non Medicare is no longer creditable, will have an SEP to enroll without penalty. Medicare Advantage Eligibility Ans-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. Medicare Advantage Special Needs Plans A