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AHIP TRAINING MODULE #2 questions and answers rated A+ 2025/2026
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AHIP TRAINING MODULE #2 questions and answers rated A+ 2025/2026
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AHIP TRAINING MODULE #2LOPEZ has heard that he can sign on for a product called MA, however is not certain
approximately what sort of plan designs are available via this software
(MA plan, sorts) - ANSThey are Medicare fitness plans together with HMO, PPO, PFFS,
SNP AND MSA
WHALEN is making an attempt to recognize the difference between Original Medicare and
MA.
(MA vs Original Medicare) - ANSMA is a way of masking ALL of the Original Medicare
advantages thru non-public health insurance agencies.
During a income presentation in Ms. Sully's domestic, she tells you that she has hearing
about a kind of Medicare plan called PFFS. She desires to know if this would be to be had to
her.
(MA-PFFS) - ANSA PFFS plan is one of numerous sorts of MA plans presented by way of
personal entities and she or he may additionally sign up in a single if it's far to be had in her
area.
RADFORD asks whether there are any special eligibility requirement s for MA
(MA requirements/eligibility) - ANSMrs. Radford MUST be entitled to Part A and enrolled in
Part B to sign up for MA.
BASS lives on a constrained fixed profits and is worried about the cost of healthcare. What
should you tell her approximately the kind of assist to be had to low earnings people below
the Medicare application?
(Help for people with confined profits/sources) - ANSAs a Medicare beneficiary with
restrained earnings/sources she may contact her State Medicaid agency to apply for help
buying the Part B top rate and cost sharing and Part D Rx coverage.
KUMAR is thinking about MA HMO and has questions about his capacity to access carriers.
(MA HMO vendors) - ANSIn MOST MA HMO's, Mr. Kumar MUST obtain his offerings
simplest from companies who have a contractual courting with the plan (Except in an
Emergency)
RAMOS is considering a MA PPO and has questions on which companies she will be able to
visit for her health care.
(MA PPO companies) - ANSMrs. Ramos can acquire care from any issuer who participates
in Original Medicare, however normally could be charged a decrease co-price if she goes to
one of the plan's PREFERRED providers.
, SINCLAIR has diabetes and coronary heart hassle and is commonly glad with the care he
has received below Original Medicare, however he would love to realize extra approximately
MA SNP.
(MA SNP eligibility) - ANSSNP's have special programs for enrollees with persistent
situations, like Mr. Sinclair, and that they offer Rx coverage that would be very beneficial as
nicely.
GRECO is in top notch fitness, lives in his personal domestic, and has a large income from
his investments. He has a chum enrolled in a MA SNP. His pal has mentioned that the SNP
costs very low cost sharing amts. And Mr. Greco would really like to enroll in the plan.
(MA SNP eligibility) - ANSSNP LIMIT enrollment to certain sub-populations of beneficiaries.
Given his contemporary state of affairs, he's not likely to qualify and would NOT be able to
sign up in the SNP
GOMEZ notes that a PFFS plan available in his vicinity has an attractive top class. He wants
to recognise if he have to use doctors in a community like his current HMO plan calls for him
to do.
(MA PFFS companies) - ANSHe may additionally receive health care services from ANY
medical doctor allowed to bill Medicare, so long as he suggests the medical doctor the plan's
identity card and the medical doctor concurs to accept the PFFS plan's payment phrases
and conditions, that can include stability billing.
LEE is discussing with you the opportunity of enrolling in a PFFS plan. As part of the
dialogue, what need to you be sure to inform her?
(MA PFFS) - ANSIf she makes use of NON-NETWORK providers, he medical doctors and
sanatorium ought to decide whether to treat her on a VISIT BY VISIT basis.
McTAGGERT notes that a PFFS plan available in his vicinity has an attractive top rate. He
wants to realize what makes them special from an HMO or a PPO.
(MA PFFS vs. HMO or PPO) - ANSEnrollees in a PFFS plan can gain care from ANY
provider in the US, who accepts Original Medicare, as long as the issuer has a reasonable
possibility to get admission to the plan's phrases and situations and is of the same opinion to
simply accept them.
Dr. Elizabeth Brennan does no longer agreement with the PFFS plan, but accepts the plan's
phrases and situations for charge, how will she receives a commission?
(MA PFFS provider price) - ANSGenerally, the PFFS plan pays Dr. Brennan directly the
equal amt. Original Medicare could pay her.
LYONS is in top health, makes use of a unmarried Rx, and lives independently in her very
own domestic. She is attracted with the aid of the concept of maintaining manage over a
MSA, however is not sure if the plan associated with the acct. Will in shape her desires.
(MA MSA) - ANSALL MSA's cowl Part A and Part B benefits, however NOT Part D Rx
benefits, which may be obtained by also enrolling in a separate Rx plan.
DAVIES is popping sixty five subsequent month. He would like to sign up for a Medicare
fitness plan, but does no longer want to be confined in terms of in which he obtains his care.
What need to you inform him approximately how a Medicare fee plan might fit his desires.
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