AHIP2024 MODULE 2 questions and 100% correct answers
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AHIP2024 MODULE 2 questions and 100% correct answers
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 answ...
AHIP2024 MODULE 2 questions and
100% correct answers
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 answersHe 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.
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? - correct
answersJuan 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 enroll in a Medicare Advantage
(MA) plan and is still covered by Part A. What should you tell him? - correct answersHe 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? - correct answersB. 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? - correct answersIn Medicare Advantage HMO plans, services
provided by primary 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 medications. Currently, she is enrolled in
Original Medicare and a standalone Part D plan. How would you advise Mrs. Chi? - correct answersMrs.
Chi may enroll in a MA MSA plan and remain in her current standalone Part D prescription drug plan.
Mr. Wells is trying to understand the difference between Original Medicare and Medicare Advantage.
What would be a correct description? - correct answersMedicare Advantage is a way of covering all the
Original Medicare benefits through private health insurance companies.
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 answersSNPs have special programs for enrollees w chronic
conditions like mr.sinclair and they provide script drug coverage that could be very helpful as well
Mr. Romero is 64, retiring soon, and considering enrollment in his employer-sponsored retiree group
health plan that includes drug coverage with nominal copays. He heard about a neighbor's MA-PD plan
that you represent and because he takes numerous prescription drugs, he is considering signing up for it.
What should you tell him? - correct answersHe should compare the benefits in his employer-sponsored
retiree group health plan with the benefits in his neighbor's MA-PD plan to determine which one will
provide sufficient coverage for his prescription needs.
Mrs. Wang wants to know generally how the benefits under Original Medicare might compare to the
benefits package of a Medicare Advantage Plan before she starts looking at specific plans. What could
you tell her? - correct answersMedicare Advantage Plans may offer extra benefits that Original Medicare
does not offer such as vision, hearing, and dental services. It must include a maximum out-of-pocket
limit on Part A and Part B services.
Mr. Kelly wants to know whether he is eligible to sign up for a Private fee-for-service (PFFS) plan. What
questions would you need to ask to determine his eligibility? - correct answersYou would need to ask Mr.
Kelly if he is enrolled in Part A and Part B and if he lives in the PFFS plan's service area.
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 answersSNPs 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.
Which of the following statement(s) is/are correct about a Medicare Savings Account (MSA) Plans? -
correct answers
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 answersShe can enroll in the PPO, but she will not be able to purchase a stand-alone Medicare
Part D prescription drug plan.
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 answersC-SNP
Dr. Elizabeth Brennan does not contract with the ABC 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 answersDr. 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%of the
Medicare rate.
Mrs. Burton is a retiree with substantial income. She is enrolled in an MA-PD plan and was disappointed
with the service she received from her primary care physician because she was told she would have to
wait five weeks to get an appointment when she was feeling ill. She called you to ask what she could do
so she would not have to put up with such poor access to care. What could you tell her? - correct
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