AHIP - 2 Questions with Correct Solutions

AHIP - 2 Questions with Correct Solutions

Question:
1. Mr. Wells is trying to understand the difference between Original Medicare and Medicare
Advantage. What would be the correct description?

Answer:
Medicare Advantage is a way of covering all the Original Medicare benefits through private
health insurance companies.


Question:
2. 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?

Answer:
They are Medicare health plans such as HMOs, PPOs, PFFS, and MSAs.


Question:
3. Mr. Kumar is considering a Medicare Advantage HMO and has questions about his ability
to access providers. What should you tell him?

Answer:
In most Medicare Advantage HMOs, Mr. Kumar must generally obtain his services only from
providers who have a contractual relationship with the plan (except in an emergency or
where care is unavailable within the network).


Question:
4. 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?

Answer:
He is not eligible to enroll in a Medicare Advantage plan until he re-enrolls in Medicare Part
B.


Question:
5. Mrs. Walters is enrolled in her state's Medicaid program in addition to Medicare. What
should she be aware of when considering enrollment in a Medicare Advantage (MA) plan?

Answer:
She cannot enroll in an MA Medical Savings Account (MSA) plan.

, Question:
6. 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?

Answer:
C-SNP


Question:
7. 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?

Answer:
She could file a grievance with her plan to complain about the lack of timeliness in getting an
appointment.


Question:
8. 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?

Answer:
SNPs limit enrollment to certain subpopulations of beneficiaries. Given his current situation,
he is unlikely to qualify and would not be able to enroll in the SNP.


Question:
9. 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?

Answer:
She can enroll in the PPO, but she will not be able to purchase a stand-alone Medicare Part D
prescription drug plan.


Question:
10. 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?