Mr. Sanchez has just turned 65 and is entitled to Part A but has not enrolled in Part B because he has coverage through an employer plan. If he wants to enroll in a Medicare Advantage plan, what will he have to do? Mrs. Walters is enrolled in her state's Medicaid program in addition to Medicare. Wh...
AHIP 2023 Module 2 | with
100% Correct Answers
Mr. Sanchez has just turned 65 and is entitled to Part A but has not enrolled in Part B because he has
coverage through an employer plan. If he wants to enroll in a Medicare Advantage plan, what will he
have to do? Correct Answer: He will have to enroll in Part B.
Mrs. Walters is enrolled in her state's Medicaid program in addition to Medicare. What should she be
aware of when considering enrollment in a Medicare Advantage (MA) plan? Correct Answer: She cannot
enroll in an MA Medical Savings Account (MSA) plan.
Mr. Gomez notes that a Private Fee-for-Service (PFFS) plan available in his area has an attractive
premium. He wants to know if he must use doctors in a network as his current HMO plan requires him
to do. What should you tell him? Correct Answer: He may receive health care services from any doctor
allowed to bill Medicare, as long as he shows the doctor the plan's identification card and the doctor
agrees to accept the PFFS plan's payment terms and conditions, which could include balance billing.
Ms. Gibson recently lost her employer group health and drug coverage and now she wants to enroll in a
PPO that does not include drug coverage. What should you tell her about obtaining drug coverage?
Correct Answer: She can enroll in the PPO, but she will not be able to purchase a stand-alone Medicare
Part D prescription drug plan.
Mrs. Kelly, age 65, is entitled to Part A but has not yet enrolled in Part B. She is considering enrollment in
a Medicare Advantage plan (Part C). What should you advise her to do before she will be able to enroll
in a Medicare Advantage plan? Correct Answer: To join a Medicare Advantage plan, she also must enroll
in Part B.
Mrs. Andrews asked how a Private Fee-for-Service (PFFS) plan might affect her access to services since
she receives some assistance for her health care costs from the State. What should you tell her? Correct
Answer: Medicaid may provide additional benefits, but Medicaid will only pay for these services if they
are furnished by Medicaid participating providers.
Mr. Kumar is considering a Medicare Advantage HMO and has questions about his ability to access
providers. What should you tell him? Correct Answer: In most Medicare Advantage HMOs, Mr. Kumar
must generally obtain his services only from providers within the plan's network (except in an
emergency or where care is unavailable within the network).
Juan Perez, who is turning age 65 next month, intends to work for several more years at Smallcap,
Incorporated. Smallcap has a workforce of 15 employees and offers employer-sponsored healthcare
coverage. Juan is a naturalized citizen and has contributed to the Medicare system for over 20 years.
Juan asks you if he will be entitled to Medicare and if he enrolls how that will impact his employer-
sponsored healthcare coverage. How would you respond? Correct Answer: Juan is likely to be eligible
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