AHM-510

The AHIP AHM-510 exam, focusing on Medicare Advantage and Part D, covers a wide range of topics. There isn't a definitive list of "main points" as the exam's weighting can shift, but consistently important areas include:

I. Medicare Basics: While not the focus , a solid understanding of foundational Medicare is crucial. This includes:

• Eligibility: Understanding who qualifies for Medicare (age, disability, etc.).
• Parts A, B, C, and D: Know the coverage specifics of each part, including premiums, deductibles, and cost-sharing.
• Enrollment Periods: Understanding the different enrollment periods (Initial Enrollment Period, Annual Enrollment Period, etc.) is critical.

II. Medicare Advantage (Part C): This is a major portion of the exam. Key areas include:

• Types of MA Plans: HMO, PPO, EPO, Special Needs Plans (SNPs), and their differences.
• Benefits and Coverage: Understanding what is included in MA plans and how it differs from Original Medicare.
• Marketing and Sales Regulations: Knowing the rules and regulations surrounding the sale of MA plans is essential.
• Plan Comparisons: Understanding how to compare different plans based on their benefits, costs, and networks.
• Appeals and Grievances: The process for handling member complaints.

III. Medicare Part D (Prescription Drug Coverage): This is another significant section. Important concepts include:

• Plan Types: Understanding the different types of Part D plans (PDP, stand-alone, and those integrated into MA plans).
• Formulary: Knowing how formularies work and how to find information on drug coverage.
• Cost-Sharing: Understanding premiums, deductibles, and cost-sharing aspects of Part D coverage.
• Enrollment and Changes: The enrollment periods and rules for changing plans.
• Coordination of Benefits: How Part D interacts with other insurance plans.

IV. Sales and Compliance:

• HIPAA Compliance: Understanding and adhering to HIPAA regulations related to patient privacy and security is crucial.
• Ethical Sales Practices: Knowing the ethical and legal considerations in selling Medicare plans.
• State and Federal Regulations: Familiarity with relevant laws and regulations governing the selling of Medicare plans.

In short: The exam heavily emphasizes a deep understanding of Medicare Advantage and Part D plans, their complexities, and the regulations guiding their sales and marketing. While Medicare basics are essential context, the majority of the exam will test your detailed knowledge of Part C and Part D. Always refer to the most current AHIP study materials for the most accurate and up-to-date information.