AHIP MCQ 2

Question 1

Under the ACA, what is the maximum out-of-pocket limit for an individual on a marketplace plan in 2024?

Accepted Answer

$9,450

Answer

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?

Accepted Answer

HMO

Answer

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?

Accepted Answer

75% manufacturer discount

Answer

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?

Accepted Answer

Turning 65

Answer

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?

Accepted Answer

Part B excess charges

Answer

Plan G covers Part B excess charges, while Plan N does not cover excess charges billed above Medicare's approved amount.

AHIP - America's Health Insurance Plans Practice Test

AHIP - America's Health Insurance Plans Practice Test

AHIP MCQ 2