MCQ Flashcards
7 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 7 MCQ flashcards as text
Under the ACA, what is the maximum out-of-pocket limit for an individual on a marketplace plan in 2024?
Answer: $9,450
The ACA sets annual out-of-pocket maximums; for 2024 the individual limit is $9,450 for in-network services.
Which Medicare Advantage plan type requires members to choose a primary care physician and get referrals to see specialists?
Answer: HMO
HMO plans require members to designate a PCP and obtain referrals for specialist care within the network.
A beneficiary enrolled in a Medicare Part D plan purchases a brand-name drug during the coverage gap. Under current law, what discount applies to the drug's cost?
Answer: 75% manufacturer discount
The Inflation Reduction Act eliminated the coverage gap donut hole, but prior law provided a 75% manufacturer discount on brand-name drugs in the gap.
Which of the following is NOT considered a Medicare Special Enrollment Period (SEP) trigger?
Answer: Turning 65
Turning 65 triggers the Initial Enrollment Period (IEP), not a Special Enrollment Period.
A Medigap Plan G covers which of the following that Plan N does NOT?
Answer: Part B excess charges
Plan G covers Part B excess charges, while Plan N does not cover excess charges billed above Medicare's approved amount.
Under HIPAA, how long does an employer-sponsored group health plan have to provide a Certificate of Creditable Coverage to a departing employee?
Answer: Up to 24 months after coverage ends if requested
Employers must provide the certificate automatically upon request and for up to 24 months after coverage ends.
Which star rating category under CMS's Medicare Advantage 5-Star Rating System carries the most weight in the overall composite score?
Answer: Member experience measures
Member experience measures, including CAHPS survey results, carry the highest weight in the overall MA star rating calculation.