AHIP Medicare Advantage (Part C) 2

Question 1

To enroll in a Medicare Advantage plan, a beneficiary must:

Accepted Answer

Have both Part A and Part B and live in the plan's service area

Answer

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.

Question 2

What is the Medicare Advantage Open Enrollment Period (MA OEP)?

Accepted Answer

January 1 – March 31

Answer

The MA OEP runs January 1–March 31, allowing current MA enrollees to switch plans or return to Original Medicare once.

Question 3

Risk adjustment in Medicare Advantage is used to:

Accepted Answer

Adjust payments based on enrollees' health status and diagnoses

Answer

Risk adjustment ensures MA plans receive higher payments for sicker enrollees, compensating for higher expected costs.

Question 4

Which star rating system does CMS use to evaluate Medicare Advantage plan quality?

Accepted Answer

1–5 star scale

Answer

CMS rates MA plans on a 1 to 5 star scale, where 5 stars represents the highest quality.

Question 5

What happens to a beneficiary's Original Medicare coverage when they enroll in a Medicare Advantage plan?

Accepted Answer

It is suspended but retained; the MA plan provides benefits instead

Answer

Enrollees keep their Medicare Parts A and B entitlement, but the MA plan provides and administers their benefits instead of Original Medicare.

AHIP - America's Health Insurance Plans Practice Test