AHIP MODULE 2 EXAM QUESTIONS AND ANSWERS 2024 LATEST
SOLUTIONS
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. 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. 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. 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. 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. 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. 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. 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 1 / 2
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. 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. 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. 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. 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. PFFS plans may choose to offer Part D benefits but are not required to do so. Correct
Mr. McTaggart 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. Enrollees in a PFFS plan can obtain care from any provider in the U.S. who accepts
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