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
Medicare Advantage (Part C) plans are required to cover at minimum:
Answer: All benefits covered under Original Medicare (Parts A and B)
Medicare Advantage plans must cover all services covered under Original Medicare Parts A and B.
Which type of Medicare Advantage plan typically requires members to use a specific network of providers and get referrals?
Answer: HMO
HMO (Health Maintenance Organization) plans generally require members to use network providers and obtain referrals for specialist care.
What is the maximum out-of-pocket (MOOP) limit for Medicare Advantage plans?
Answer: CMS sets an annual limit that plans cannot exceed
CMS establishes an annual MOOP limit for Medicare Advantage plans; individual plans may set lower limits but cannot exceed the CMS cap.
Medicare Advantage plans receive payment from CMS in the form of:
Answer: A fixed monthly capitation payment per enrolled member
CMS pays MA plans a risk-adjusted monthly capitation (per-member per-month) payment.
Which Medicare Advantage plan type serves specific populations such as people with chronic conditions or dual-eligible individuals?
Answer: SNP (Special Needs Plan)
Special Needs Plans (SNPs) are tailored for specific populations including dual-eligible beneficiaries, institutionalized individuals, or those with certain chronic conditions.
A Medicare Advantage PPO plan differs from an HMO primarily because:
Answer: PPOs allow members to see out-of-network providers, usually at a higher cost
PPO plans offer more flexibility by allowing out-of-network care, typically with higher cost-sharing than in-network visits.