AHIP 2024 Questions and Correct
Answers
Mrs. Andrews asked how a Private Fee-for-Service (PFFS) plan might affect her access to services since
she receives some assistance for her health care costs from the State. What should you tell her? - correct
answers:Medicaid may provide additional benefits, but Medicaid will coordinate benefits only with
Medicaid participating providers.
Mr. Sanchez has just turned 65 and is entitled to Part A but has not enrolled in Part B because he has
coverage through an employer plan. If he wants to enroll in a Medicare Advantage plan, what will he
have to do? - correct answers:He will have to enroll in Part B.
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 answers:They are
Medicare health plans such as HMOs, PPOs, PFFS, and MSAs.
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 answers:When possible, it is always the best option to have both the
employer's plan and the MA-PD, so he would have no out-of-pocket expenses.
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 answers: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%of the
Medicare rate
Mrs. Willard 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 answers:Medicare Advantage Plans may offer extra benefits that Original Medicare
does not offer such as vision, hearing, and dental services and must include a maximum out-of-pocket
limit on Part A and Part B services.
, Mrs. Kelly, age 65, is entitled to Part A but has not yet enrolled in Part B. She is considering enrollment in
a Medicare Advantage plan (Part C). What should you advise her to do before she will be able to enroll in
a Medicare Advantage plan? - correct answers:To join a Medicare Advantage plan, she also must enroll in
Part B.
Which of the following statement(s) is/are correct about a Medicare Savings Account (MSA) Plans?I.
MSAs may have either a partial network, full network, or no network of providers.II. MSA plans cover
Part A and Part B benefits but not Part D prescription drug benefits.III. An individual who is enrolled in an
MSA plan is responsible for a minimal deductible of $500 indexed for inflation.IV. Non-network providers
must accept the same amount that Original Medicare would pay them as payment in full. - correct
answers:I, II, and IV
Mrs. Lyons is in good health, uses a single prescription, and lives independently in her own home. She is
attracted by the idea of maintaining control over a Medical Savings Account (MSA) but is not sure if the
plan associated with the account will fit her needs. What specific piece of information about a Medicare
MSA plan would it be important for her to know, prior to enrolling in such a plan? - correct answers:All
MSAs cover Part A and Part B benefits, but not Part D prescription drug benefits, which could be
obtained by also enrolling in a separate prescription drug plan.
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? - correct answers:She
cannot enroll in an MA Medical Savings Account (MSA) plan
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 answers:She can enroll in the PPO, but she will not be able to purchase a stand-alone Medicare
Part D prescription drug plan.
Mrs. Chou likes a Private Fee-for-Service (PFFS) plan available in her area that does not include drug
coverage. She wants to enroll in the plan and enroll in a stand-alone prescription drug plan. What should
you tell her? - correct answers:If she wants drug coverage and a PFFS plan, she could only enroll in a PFFS
plan that includes Medicare prescription drug coverage
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
Answers
Mrs. Andrews asked how a Private Fee-for-Service (PFFS) plan might affect her access to services since
she receives some assistance for her health care costs from the State. What should you tell her? - correct
answers:Medicaid may provide additional benefits, but Medicaid will coordinate benefits only with
Medicaid participating providers.
Mr. Sanchez has just turned 65 and is entitled to Part A but has not enrolled in Part B because he has
coverage through an employer plan. If he wants to enroll in a Medicare Advantage plan, what will he
have to do? - correct answers:He will have to enroll in Part B.
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 answers:They are
Medicare health plans such as HMOs, PPOs, PFFS, and MSAs.
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 answers:When possible, it is always the best option to have both the
employer's plan and the MA-PD, so he would have no out-of-pocket expenses.
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 answers: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%of the
Medicare rate
Mrs. Willard 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 answers:Medicare Advantage Plans may offer extra benefits that Original Medicare
does not offer such as vision, hearing, and dental services and must include a maximum out-of-pocket
limit on Part A and Part B services.
, Mrs. Kelly, age 65, is entitled to Part A but has not yet enrolled in Part B. She is considering enrollment in
a Medicare Advantage plan (Part C). What should you advise her to do before she will be able to enroll in
a Medicare Advantage plan? - correct answers:To join a Medicare Advantage plan, she also must enroll in
Part B.
Which of the following statement(s) is/are correct about a Medicare Savings Account (MSA) Plans?I.
MSAs may have either a partial network, full network, or no network of providers.II. MSA plans cover
Part A and Part B benefits but not Part D prescription drug benefits.III. An individual who is enrolled in an
MSA plan is responsible for a minimal deductible of $500 indexed for inflation.IV. Non-network providers
must accept the same amount that Original Medicare would pay them as payment in full. - correct
answers:I, II, and IV
Mrs. Lyons is in good health, uses a single prescription, and lives independently in her own home. She is
attracted by the idea of maintaining control over a Medical Savings Account (MSA) but is not sure if the
plan associated with the account will fit her needs. What specific piece of information about a Medicare
MSA plan would it be important for her to know, prior to enrolling in such a plan? - correct answers:All
MSAs cover Part A and Part B benefits, but not Part D prescription drug benefits, which could be
obtained by also enrolling in a separate prescription drug plan.
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? - correct answers:She
cannot enroll in an MA Medical Savings Account (MSA) plan
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 answers:She can enroll in the PPO, but she will not be able to purchase a stand-alone Medicare
Part D prescription drug plan.
Mrs. Chou likes a Private Fee-for-Service (PFFS) plan available in her area that does not include drug
coverage. She wants to enroll in the plan and enroll in a stand-alone prescription drug plan. What should
you tell her? - correct answers:If she wants drug coverage and a PFFS plan, she could only enroll in a PFFS
plan that includes Medicare prescription drug coverage
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
