Insurance Exam Prep

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 evaluate Part D plans based on total estimated annual cost rather than monthly premium alone - A step-by-step comparison process for verifying drug dosages, formulary status, and tier placement - How utilization controls like prior authorization and step therapy impact actual drug coverage - Why pharmacy network status can s...

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 coverage determinations, formulary exceptions, and tiering exceptions function under Medicare Part D. - Why specialty tier medications are strictly excluded from tiering exception requests on the exam. - The critical difference between grievances for service issues and appeals for coverage denials. - Timeframes for standard 72-hour and expedited 24-hour review r...

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: - A continuous gap of 63 days or longer without creditable drug coverage triggers the Medicare Part D late enrollment penalty. - Penalty calculations count only full calendar months without creditable coverage, ignoring partial months. - The monthly penalty equals one percent of the current national base beneficiary premium multiplied by full uncovered m...

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 the Medicare Prescription Payment Plan spreads out-of-pocket Part D costs across remaining calendar months - Why the program changes payment timing without altering drug prices, copays, or total out-of-pocket costs - How monthly payment amounts are calculated based on when in the calendar year costs are incurred - Voluntary election r...

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: - What Part D Extra Help is and how it reduces premiums, deductibles, copayments, and waives late enrollment penalties - How automatic deeming works for Dual eligibles, SSI recipients, and Medicare Savings Program enrollees - How CMS plan reassignment protects LIS beneficiaries when standalone plan premiums exceed benchmarks - Why agents must v...

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: - The current CMS standard Medicare Part D structure features three benefit phases (deductible, initial coverage, catastrophic coverage), completely eliminating the legacy coverage gap or donut hole. - Maximum standard deductible caps are set by CMS at $590 in 2025 and $615 in 2026, after which beneficiaries pay 25% cost-sharing under defined standard benefit design. - Beneficiary o...

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 determine whether a drug falls under Medicare Part A, Part B, or Part D - The specific categories of drugs statutorily excluded from basic Part D coverage - Key vaccine coverage rules separating Part B preventive shots from Part D vaccines - How enhanced Part D plans differ from b...

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 Part D plans structure formularies into drug tiers from Tier 1 generics to Tier 5 specialty drugs - Why cross-referencing both specific medications and preferred network pharmacies is essential for accurate cost estimates - The mechanics of utilization management tools including prior authorization, step therapy, and quantity limits - Rules surrounding m...

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 Original Medicare and Medigap beneficiaries pair with stand-alone PDPs for compliant Part D coverage. - Why enrolling in a stand-alone PDP while in a standard HMO or PPO causes automatic disenrollment from Medicare Advantage. - The two major plan exceptions—MSA plans and non-drug PFFS plans—that allow stand-alone PDP enrol...

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 eligibility requirements for stand-alone PDPs versus MA-PD plans - The concept of creditable drug coverage and how it prevents late enrollment penalties - The critical risk of losing employer or union health benefits when enrolling in Part D - How incompatible plan combinations trigger automatic disenrollment from Medicare A...

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 identify and select the valid Medicare Advantage election period before analyzing plan features. - The differences between ICEP, AEP, and MA OEP rules and timing. - Key triggers for Special Enrollment Periods such as moving, losing creditable coverage, or SNP eligibility. - Common exam traps regarding disenrollment rules and M...

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: - The exact criteria that distinguish an organization determination, an appeal, and a grievance on the AHIP exam. - How to evaluate standard versus expedited pathways based on beneficiary health risks and pre-service versus payment status. - Key differences between coverage/payment disputes and quality-of-care complaints. - Common exam traps involving dual-issue s...

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 CMS Star Ratings evaluate Medicare Advantage and Part D plans on a 1-to-5 star scale across key performance categories. - Why Star Ratings reflect aggregate past performance and can never be represented as a guarantee of individual health outcomes. - The specific eligibility parameters and once-per-calendar-year rule for the 5-Star S...

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 c...

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 H...

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 a...

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 S...

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 o...

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 P...

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 e...

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 t...

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 and Medicaid as the payer of last resort for dual-eligible beneficiaries - The distinction between full-benefit and partial-benefit dual eligibility based on income and asset levels - How Medicare Savings Programs like QMB, SLMB, and QI assist with Part A and Part B costs, i...

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 and secondary payer rules based on employer size and active employment status. - Key differences between active employer health plans, retiree coverage, and COBRA. - Why COBRA does not trigger a Medicare Part B Special Enrollment Period and the risk of penalties. - Requirements for creditable drug coverage and the 63...

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 administration and networks between Medigap and Medicare Advantage - Why Medigap and Medicare Advantage are strictly mutually exclusive and cannot overlap - How prescription drug coverage is handled under each insurance path - Premium structures and cost-sharing mechanics tested on the AHIP exam - Enrollment protections, medical underwriting r...

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: - The exact dates and permitted plan changes for the Annual Election Period (AEP) from October 15 to December 7. - Why the Medicare Advantage Open Enrollment Period (MA OEP) is restricted solely to existing MA plan enrollees. - The major exam trap regarding Original Medicare enrollees attempting to use MA OEP in the f...

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 the 7-month Initial Enrollment Period operates and how to determine effective dates based on application timing. - Why the General Enrollment Period runs from January 1 to March 31 with coverage beginning the first of the following month. - How the Part B late enrollment penalty is calculated as a 10% premium surcharge p...

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 between Part A benefit period deductibles and Part B annual deductibles - How 20% Part B coinsurance applies after the annual deductible is satisfied - The operational mechanics of Medicare assignment and provider limiting charges - Why non-participating providers can assess a 15% excess charge on Medicare claims - Why Original M...

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: - Part A uses benefit period deductibles rather than calendar-year deductibles, resetting after 60 consecutive days without inpatient care. - Part B requires a monthly premium with 20% coinsurance and no maximum out-of-pocket limit under Original Medicare. - Hospital observation status counts as Part B outpatient care, which fails the three-day inpatient requirement for P...

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 between Medicare eligibility, entitlement, enrollment, and effective dates - Non-age qualifying rules for Social Security Disability Insurance, ALS, and ESRD - The 24-month SSDI waiting period rule and the ALS immediate entitlement exception - Specific entitlement timelines for End-Stage Renal Disease beneficiaries - How to avoid common AHIP trick q...

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 the annual AHIP Medicare training and FWA exam assess CMS compliance for Medicare Advantage and Part D plans - The specific roles and agent categories that require annual AHIP completion prior to marketing - How carrier-specific product training and contracting rules build upon the baseline AHIP score - Why studying c...

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: - The crucial difference in the burden of proof between named peril and open peril policies. - How to calculate Actual Cash Value (ACV) by subtracting depreciation from replacement cost. - To distinguish between liability coverage, which requires fault, and medical payments, which does not. - That property insurance is first-party coverage f...

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: - The formula for Actual Cash Value (ACV) and how it differs from Replacement Cost. - How to correctly apply a deductible to a covered property loss. - The key differences between split liability limits and a combined single limit. - How to calculate a coinsurance penalty using the 'Did Carry vs. S...

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 use a systematic checklist to analyze complex exam scenarios for coverage gaps. - To identify the crucial difference between a named insured and an insured by definition. - How to determine if a specific cause of loss (peril) is covered by the policy in the question. - To spot c...

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: - The key differences between admitted insurers (state-licensed, guaranty fund protection) and nonadmitted insurers (unlicensed, no guaranty fund). - Why a "diligent search" is a strict prerequisite before placing a policy with a surplus lines insurer. - The purpose of residual markets as a last-resort option for obtaining essential insurance coverage. - H...

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: - That State Guaranty Associations exist to pay the claims of insolvent insurers, protecting policyholders. - That these associations are funded through assessments on solvent member insurers, not by taxpayers. - That claim payments are subject to statutory limits, commonly up to $300,000 for P&C claims. - Why it is a strictly p...

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: - A deposit premium is an estimated, upfront payment for auditable policies like Workers' Compensation and General Liability. - Auditable policy premiums are based on variable exposures, such as payroll for Workers' Comp or gross sales for General Liability. - A final audit occurs after the policy period to compare the initial e...

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: - That a Certificate of Insurance (COI) is only evidence of a policy's existence at a specific point in time. - Why a COI does not grant any policy rights or coverage to the certificate holder. - The critical difference between a certificate holder and a true 'additional insured' status, which requires a...

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: - The critical difference between property rights (Mortgagee, Loss Payee) and liability protection (Additional Insured). - Why a Mortgagee has the strongest rights and gets paid even if the insured commits fraud. - The distinction between a standard Loss Payee and a Lender's Loss Payable clause for personal property. - When to u...

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: - The critical steps in the insurance claims process, from First Notice of Loss to Settlement. - The crucial difference between salvage (recovering property) and subrogation (recovering from a third party). - Why producers and adjusters must avoid making unauthorized promises about claim payments. - The purpose and function of a claim r...

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: - The critical difference between a mid-term cancellation and an end-of-term nonrenewal. - Why insurers have broader rights to cancel a policy within the first 60 days. - How premium refunds are calculated as pro-rata or short-rate depending on who cancels. - The universal requirement for insurers to provide advance written notice before t...