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AHIP2024 MODULE 2 QUESTIONS AND ANSWER | LATEST UPDATE

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, which could include balance billing. Juan Hernandez is turning 65 next month, Juan legally entered the United States over twenty years ago but is not a citizen. Since his entry into the country, Juan has worked at Smallcap Incorporated and contributed to the Medicare system. Juan suffers fro...

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  • September 17, 2024
  • 7
  • 2024/2025
  • Exam (elaborations)
  • Questions & answers
  • AHIP
  • AHIP
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2024 /2025 | © copyright | This work may not be copied for profit gain | Excel!




AHIP2024 MODULE 2 QUESTIONS AND
ANSWER | LATEST UPDATE
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?


✓ -:- He may receive health care services from any doctor allowed to bill

Medicare, as long as he shows the doc tor the plan's identification card

and the doctor agrees to accept the PFFS plan's payment terms and

conditions, which could include balance billing.




Juan Hernandez is turning 65 next month, Juan legally entered the United States over twenty

years ago but is not a citizen. Since his entry into the country, Juan has worked at Smallcap

Incorporated and contributed to the Medicare system. Juan suffers from diabetes. He will

soon retire and asks you if he can enroll in a Medicare Advantage plan that you represent.

How would you respond?


✓ -:- Juan is eligible to enroll in a Medicare Advantage as long as he is

entitled to Part A and enrolled in Part B. Juan should go to the Social

Security website to enroll in Medicare Part A and B if he has not done so

already. Once he is enrolled, he can choose a Medicare Advantage plan.




Mr. Castillo, a naturalized citizen, previously enrolled in Medicare Part B but has recently

stopped paying his Part B premium. Mr. Castillo is still covered by Part A. He would like to


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, 2024 /2025 | © copyright | This work may not be copied for profit gain | Excel!


enroll in a Medicare Advantage (MA) plan and is still covered by Part A. What should you

tell him?


✓ -:- He is not eligible to enroll in a Medicare Advantage plan until he re -

enrolls in Medicare Part B.




Mrs. Ramos is considering a Medicare Advantage PPO and has questions about which

providers she can go to for her health care. What should you tell her?


✓ -:- B. Mrs. Ramos can obtain care from any provider who participates in

Original Medicare, but generally will have a higher cost -sharing amount if

she sees a provider who/that is not part of the PPO network. Correct




Mr. Kumar is considering a Medicare Advantage HMO and has questions about his ability to

access providers. What should you tell him?


✓ -:- In Medicare Advantage HMO plans, services provided by primar y

care physicians are covered at 100%, but those of specialists are covered

at 80% ?




Mrs. Chi is age 75 and enjoys a comfortable but not extremely high-income level. She wishes

to enroll in a MA MSA plan that she heard about from her neighbor. She also wants to have

prescription drug coverage since her doctor recently prescribed several expensive




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