Medicare Advantage (Part C) Flashcards
6 cards from real AHIP practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 6 Medicare Advantage (Part C) flashcards as text
To enroll in a Medicare Advantage plan, a beneficiary must:
Answer: Have both Part A and Part B and live in the plan's service area
Beneficiaries must be enrolled in both Medicare Part A and Part B and reside in the plan's service area to join a Medicare Advantage plan.
What is the Medicare Advantage Open Enrollment Period (MA OEP)?
Answer: January 1 – March 31
The MA OEP runs January 1–March 31, allowing current MA enrollees to switch plans or return to Original Medicare once.
Risk adjustment in Medicare Advantage is used to:
Answer: Adjust payments based on enrollees' health status and diagnoses
Risk adjustment ensures MA plans receive higher payments for sicker enrollees, compensating for higher expected costs.
Which star rating system does CMS use to evaluate Medicare Advantage plan quality?
Answer: 1–5 star scale
CMS rates MA plans on a 1 to 5 star scale, where 5 stars represents the highest quality.
What happens to a beneficiary's Original Medicare coverage when they enroll in a Medicare Advantage plan?
Answer: It is suspended but retained; the MA plan provides benefits instead
Enrollees keep their Medicare Parts A and B entitlement, but the MA plan provides and administers their benefits instead of Original Medicare.
A Medicare Advantage PFFS (Private Fee-for-Service) plan is characterized by:
Answer: Setting its own payment rates; any provider who accepts the terms can treat the member
PFFS plans set their own reimbursement rates and terms; any Medicare-participating provider who accepts those terms may provide care.