AHIP MCQ 2 — Questions and Answers
Question 1: Under the ACA, what is the maximum out-of-pocket limit for an individual on a marketplace plan in 2024?
- $5,000
- $7,000
- $9,450 (Correct answer)
- $11,200
Correct answer: $9,450
The ACA sets annual out-of-pocket maximums; for 2024 the individual limit is $9,450 for in-network services.
Question 2: Which Medicare Advantage plan type requires members to choose a primary care physician and get referrals to see specialists?
- PPO
- HMO (Correct answer)
- PFFS
- MSA
Correct answer: HMO
HMO plans require members to designate a PCP and obtain referrals for specialist care within the network.
Question 3: 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?
- 50% manufacturer discount
- 70% manufacturer discount
- 75% manufacturer discount (Correct answer)
- 100% manufacturer discount
Correct 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.
Question 4: Which of the following is NOT considered a Medicare Special Enrollment Period (SEP) trigger?
- Moving out of a plan's service area
- Losing employer-sponsored coverage
- Turning 65 (Correct answer)
- Qualifying for Extra Help (LIS)
Correct answer: Turning 65
Turning 65 triggers the Initial Enrollment Period (IEP), not a Special Enrollment Period.
Question 5: A Medigap Plan G covers which of the following that Plan N does NOT?
- Part A coinsurance
- Part B deductible
- Part B excess charges (Correct answer)
- Foreign travel emergency care
Correct 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.
Question 6: Under HIPAA, how long does an employer-sponsored group health plan have to provide a Certificate of Creditable Coverage to a departing employee?
- 30 days after coverage ends
- Up to 24 months after coverage ends if requested (Correct answer)
- 60 days before coverage ends
- Only upon written request within 6 months
Correct 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.
Question 7: Which star rating category under CMS's Medicare Advantage 5-Star Rating System carries the most weight in the overall composite score?
- Member experience measures (Correct answer)
- Access and complaints measures
- Chronic condition management measures
- Drug plan measures
Correct answer: Member experience measures
Member experience measures, including CAHPS survey results, carry the highest weight in the overall MA star rating calculation.
AHIP MCQ 2
Under the ACA, what is the maximum out-of-pocket limit for an individual on a marketplace plan in 2024?