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

Medicare Advantage plans must cover all services covered under Original Medicare Parts A and B.

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

HMO (Health Maintenance Organization) plans generally require members to use network providers and obtain referrals for specialist care.

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

CMS establishes an annual MOOP limit for Medicare Advantage plans; individual plans may set lower limits but cannot exceed the CMS cap.

Question 4

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

Accepted Answer

A fixed monthly capitation payment per enrolled member

Answer

CMS pays MA plans a risk-adjusted monthly capitation (per-member per-month) payment.

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

Special Needs Plans (SNPs) are tailored for specific populations including dual-eligible beneficiaries, institutionalized individuals, or those with certain chronic conditions.

AHIP - America's Health Insurance Plans Practice Test

AHIP - America's Health Insurance Plans Practice Test

AHIP Medicare Advantage (Part C)