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  • AHIP Medicare Exam Prep 17, MA Benefits Networks Prior Authorization and Cost Sharing

    AHIP Medicare Exam Prep 17, MA Benefits Networks Prior Authorization and Cost Sharing
    2026/09/02
    This podcast is made by Ran Chen, who holds an EA license, Insurance and Securities licenses (Series 6, 63, 65), and the CFP® designation. He is passionate about opening access to high-quality exam preparation resources and helping learners prepare more effectively for professional certification exams. In this episode you will learn: - How network rules differ across HMO, HMO-POS, PPO, and PFFS Medicare Advantage plan models. - Why prior authorization can never be required for emergency or urgently needed services. - The distinction between HMO PCP referral requirements and PPO direct specialist access. - How mandatory Maximum Out-of-Pocket limits function for in-network and combined care. - Why supplemental benefits vary by plan and carry strict caps rather than standardized unlimited coverage. For more free exam prep tools, practice questions, and AI-powered explanations, visit https://open-exam-prep.com/ or YouTube Channel: https://www.youtube.com/@Open-exam-prep
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    4 分
  • AHIP Medicare Exam Prep 16, D-SNPs and Medicaid Benefit Coordination

    AHIP Medicare Exam Prep 16, D-SNPs and Medicaid Benefit Coordination
    2026/09/01
    This podcast is made by Ran Chen, who holds an EA license, Insurance and Securities licenses (Series 6, 63, 65), and the CFP® designation. He is passionate about opening access to high-quality exam preparation resources and helping learners prepare more effectively for professional certification exams. In this episode you will learn: - How Medicare operates as the primary payer while Medicaid acts as the secondary payer of last resort in D-SNP benefit coordination. - The distinction between Full Benefit Dual Eligibles (FBDE) and Partial Duals (QMB, SLMB, QI) to avoid assuming full Medicaid benefits. - How integrated plan designs like FIDE SNPs and HIDE SNPs streamline Medicare and Medicaid coverage and administration. - The mechanics of the Dual/LIS Special Enrollment Period, including quarterly usage rules and state-level contract variations. - Why verifying a beneficiary's specific Medicaid eligibility tier is crucial for avoiding common AHIP exam traps. For more free exam prep tools, practice questions, and AI-powered explanations, visit https://open-exam-prep.com/ or YouTube Channel: https://www.youtube.com/@Open-exam-prep
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    4 分
  • AHIP Medicare Exam Prep 15, Special Needs Plans D-SNP C-SNP and I-SNP

    AHIP Medicare Exam Prep 15, Special Needs Plans D-SNP C-SNP and I-SNP
    2026/08/31
    This podcast is made by Ran Chen, who holds an EA license, Insurance and Securities licenses (Series 6, 63, 65), and the CFP® designation. He is passionate about opening access to high-quality exam preparation resources and helping learners prepare more effectively for professional certification exams. In this episode you will learn: - Key differences in target populations and eligibility for D-SNP, C-SNP, and I-SNP. - Why qualification for one SNP type never automatically establishes eligibility for another. - Strict C-SNP physician verification rules and disenrolling unverified enrollees. - Residence and level of care requirements specific to I-SNP enrollment. - How Health Risk Assessments and Interdisciplinary Care Teams structure SNP care coordination. For more free exam prep tools, practice questions, and AI-powered explanations, visit https://open-exam-prep.com/ or YouTube Channel: https://www.youtube.com/@Open-exam-prep
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    4 分
  • AHIP Medicare Exam Prep 14, PFFS and Medicare Savings Account Plans

    AHIP Medicare Exam Prep 14, PFFS and Medicare Savings Account Plans
    2026/08/30
    This podcast is made by Ran Chen, who holds an EA license, Insurance and Securities licenses (Series 6, 63, 65), and the CFP® designation. He is passionate about opening access to high-quality exam preparation resources and helping learners prepare more effectively for professional certification exams. In this episode you will learn: - How Private Fee-for-Service (PFFS) provider terms and conditions work on a visit-by-visit basis - Network variations in PFFS plans including full, partial, and non-network structures - The unique standalone Part D enrollment rules for PFFS and MSA plans - How the high deductible and CMS deposit structure operates in Medicare Medical Savings Accounts - Key exam traps surrounding MSA drug coverage limitations and out-of-pocket gaps For more free exam prep tools, practice questions, and AI-powered explanations, visit https://open-exam-prep.com/ or YouTube Channel: https://www.youtube.com/@Open-exam-prep
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    4 分
  • AHIP Medicare Exam Prep 13, Medicare Advantage PPO Rules

    AHIP Medicare Exam Prep 13, Medicare Advantage PPO Rules
    2026/08/29
    This podcast is made by Ran Chen, who holds an EA license, Insurance and Securities licenses (Series 6, 63, 65), and the CFP® designation. He is passionate about opening access to high-quality exam preparation resources and helping learners prepare more effectively for professional certification exams. In this episode you will learn: - Out-of-network providers are not obligated to treat PPO members for non-emergency or non-urgent care. - PPO plans do not require primary care physician selection or specialist referrals. - Differential cost sharing results in higher out-of-network copayments and coinsurance. - PPO rules require both an in-network MOOP and a combined in-network and out-of-network MOOP. - The FLEX mnemonic for remembering key PPO exam rules and avoiding common test traps. For more free exam prep tools, practice questions, and AI-powered explanations, visit https://open-exam-prep.com/ or YouTube Channel: https://www.youtube.com/@Open-exam-prep
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    4 分
  • AHIP Medicare Exam Prep 12, Medicare Advantage HMO Rules

    AHIP Medicare Exam Prep 12, Medicare Advantage HMO Rules
    2026/08/28
    This podcast is made by Ran Chen, who holds an EA license, Insurance and Securities licenses (Series 6, 63, 65), and the CFP® designation. He is passionate about opening access to high-quality exam preparation resources and helping learners prepare more effectively for professional certification exams. In this episode you will learn: - Primary care physician (PCP) gatekeeping and referral requirements in Medicare Advantage HMOs. - Clear distinctions between non-covered routine out-of-network care and mandatory covered emergency services. - How urgently needed care is defined and covered when beneficiaries travel out of the plan service area. - Key exceptions including out-of-area renal dialysis and Point-of-Service (POS) option riders. - The P-E-R-C mental shortcut to quickly answer HMO network and coverage scenarios on the AHIP exam. For more free exam prep tools, practice questions, and AI-powered explanations, visit https://open-exam-prep.com/ or YouTube Channel: https://www.youtube.com/@Open-exam-prep
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    4 分
  • AHIP Medicare Exam Prep 11, Medicare Advantage Eligibility and Enrollment

    AHIP Medicare Exam Prep 11, Medicare Advantage Eligibility and Enrollment
    2026/08/27
    This podcast is made by Ran Chen, who holds an EA license, Insurance and Securities licenses (Series 6, 63, 65), and the CFP® designation. He is passionate about opening access to high-quality exam preparation resources and helping learners prepare more effectively for professional certification exams. In this episode you will learn: - Enrollees must have active Medicare Part A and Part B and continue paying Part B premiums. - Beneficiaries must maintain a primary residence in the plan's geographic service area. - Permanent relocations or out-of-area stays over 6 months trigger plan disenrollment and a Special Election Period. - Annual Election Period enrollments take effect on January 1st of the following calendar year. - The 'A, B, Stay' mnemonic simplifies key Medicare Advantage eligibility standards. For more free exam prep tools, practice questions, and AI-powered explanations, visit https://open-exam-prep.com/ or YouTube Channel: https://www.youtube.com/@Open-exam-prep
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    4 分
  • AHIP Medicare Exam Prep 10, Solving Medicare Basics Scenarios

    AHIP Medicare Exam Prep 10, Solving Medicare Basics Scenarios
    2026/08/26
    This podcast is made by Ran Chen, who holds an EA license, Insurance and Securities licenses (Series 6, 63, 65), and the CFP® designation. He is passionate about opening access to high-quality exam preparation resources and helping learners prepare more effectively for professional certification exams. In this episode you will learn: - How to apply a five-step framework to solve complex Medicare scenario questions on the AHIP exam. - Primary versus secondary payer rules for active employer coverage based on employee count. - Why COBRA is not active employer coverage and its impact on Part B enrollment penalties. - How Part B enrollment timing determines the six-month Medigap Open Enrollment Period. - Rules governing dual eligibility and Special Enrollment Periods for Special Needs Plans. For more free exam prep tools, practice questions, and AI-powered explanations, visit https://open-exam-prep.com/ or YouTube Channel: https://www.youtube.com/@Open-exam-prep
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    4 分