COMPREHENSIVE QUESTIONS AND VERIFIED
ANSWERS COMPLETE STUDE GUIDE GRADE A+ GET
IT 100% RIGHT
Mr. Lopez has heard that he can sign up for a product called "Medicare
Advantage" but is not sure about what type of plan designs are
available through this program. What should you tell him about the
types of health plans that are available through the Medicare
Advantage program? - (correct answer) a. They are Medicare health
plans such as HMOs, PPOs, PFFS, and MSAs. Correct
Mr. Wells is trying to understand the difference between Original
Medicare and Medicare Advantage. What would be a correct
description? - (correct answer) b. Medicare Advantage is a way of
covering all the Original Medicare benefits through private health
insurance companies. Correct
Mrs. Radford asks whether there are any special eligibility requirements
for Medicare Advantage. What should you tell her? - (correct answer)
d. Mrs. Radford must be entitled to Part A and enrolled in Part B to
enroll in Medicare Advantage. Correct
,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 enroll in a Medicare Advantage
(MA) plan and is still covered by Part A. What should you tell him? -
(correct answer) a. He is not eligible to enroll in a Medicare
Advantage plan until he re-enrolls in Medicare Part B. Correct
Mrs. Billings enrolled in the ABC Medicare Advantage (MA) plan several
years ago. Her doctor recently confirmed a diagnosis of end-stage renal
disease (ESRD). What options does Mrs. Billings have in regard to her
MA plan during the next open enrollment season? - (correct answer)
d. She may remain in her ABC MA plan or enroll in a Special Needs Plan
(SNP) for individuals suffering from ESRD if one is available in her area.
Correct
Daniel is a middle-income Medicare beneficiary. He has chronic
bronchitis, putting him at severe risk for pneumonia. Otherwise, he has
no problems functioning. Which type of SNP is likely to be most
appropriate for him? - (correct answer) b. C-SNP Correct
Mr. Kumar is considering a Medicare Advantage HMO and has
questions about his ability to access providers. What should you tell
him? - (correct answer) a. In most Medicare Advantage HMOs, Mr.
Kumar must obtain his services only from providers who have a
contractual relationship with the plan (except in an emergency).
Correct
,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? - (correct answer) d. 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. Sinclair has diabetes and heart trouble and is generally satisfied
with the care he has received under Original Medicare, but he would
like to know more about Medicare Advantage Special Needs Plans
(SNPs). What could you tell him? - (correct answer) b. SNPs have
special programs for enrollees with chronic conditions, like Mr. Sinclair,
and they provide prescription drug coverage that could be very helpful
as well. Correct
Mr. Greco is in excellent health, lives in his own home, and has a
sizeable income from his investments. He has a friend enrolled in a
Medicare Advantage Special Needs Plan (SNP). His friend has
mentioned that the SNP charges very low cost-sharing amounts and
Mr. Greco would like to join that plan. What should you tell him? -
(correct answer) c. SNPs limit enrollment to certain sub-populations
of beneficiaries. Given his current situation, he is unlikely to qualify and
would not be able to enroll in the SNP. Correct
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 like his current HMO plan requires him to do.
What should you tell him? - (correct answer) a. 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. Correct
Mrs. Lee is discussing with you the possibility of enrolling in a Private
Fee-for-Service (PFFS) plan. As part of that discussion, what should you
be sure to tell her? - (correct answer) b. PFFS plans may choose to
offer Part D benefits but are not required to do so. Correct
Mr. McTaggert notes that a Private Fee-for-Service (PFFS) plan available
in his area has an attractive premium. He wants to know what makes
them different from an HMO or a PPO. What should you tell him? -
(correct answer) d. Enrollees in a PFFS plan can obtain care from any
provider in the U.S. who accepts Original Medicare, as long as the
provider has a reasonable opportunity to access the plan's terms and
conditions and agrees to accept them. Correct
Dr. Elizabeth Brennan does not contract with the PFFS plan but accepts
the plan's terms and conditions for payment. Mary Rodgers sees Dr.
Brennan for treatment. How much may Dr. Brennan charge? - (correct
answer) b. Dr. Brennan can charge Mary Rogers no more than the
cost sharing specified in the PFFS plan's terms and condition of
payment which may include balance billing up to 15 percent of the
Medicare rate. Correct
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