AHIP Medicare Advantage (Part C)

Question 1

Medicare Advantage (Part C) plans are required to cover at minimum:

Accepted Answer

All benefits covered under Original Medicare (Parts A and B)

Answer

Part A benefits only

Answer

Part B benefits only

Answer

Part A, B, and D benefits combined

Question 2

Which type of Medicare Advantage plan typically requires members to use a specific network of providers and get referrals?

Accepted Answer

HMO

Answer

PPO

Answer

PFFS

Answer

SNP

Question 3

What is the maximum out-of-pocket (MOOP) limit for Medicare Advantage plans?

Accepted Answer

CMS sets an annual limit that plans cannot exceed

Answer

There is no federal limit

Answer

Plans may set any limit approved by their state insurance commissioner

Answer

The MOOP matches the Original Medicare deductible

Question 4

Medicare Advantage plans receive payment from CMS in the form of:

Accepted Answer

A fixed monthly capitation payment per enrolled member

Answer

Fee-for-service reimbursement per claim

Answer

Annual lump-sum grants

Answer

State Medicaid matching funds

Question 5

Which Medicare Advantage plan type serves specific populations such as people with chronic conditions or dual-eligible individuals?

Accepted Answer

SNP (Special Needs Plan)

Answer

PPO

Answer

PFFS

Answer

MSA

Question 6

A Medicare Advantage PPO plan differs from an HMO primarily because:

Accepted Answer

PPOs allow members to see out-of-network providers, usually at a higher cost

Answer

PPOs do not cover Part B services

Answer

PPOs require referrals for all specialist visits

Answer

PPOs only operate in rural areas