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