AHIP 2024 FINAL EXAM NEWEST VERSION 2024-
2025 QUESTIONS AND DETAILED ANSWERS
UPDATED GRADED A+
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
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.
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 answer✔✔You
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.
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 answer✔✔Medicare
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. 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.
Mr. Barker enjoys a comfortable retirement income. He recently
had surgery and expected that he would have certain services
and items covered by the plan with minimal out-of-pocket costs
because his MA-PD coverage has been very good. However,
when he received the bill, he was surprised to see large charges
in excess of his maximum out-of-pocket limit that included some
services and items he thought would be fully covered. He called
you to ask what he could do? What could you tell him? - correct
answer✔✔You can offer to review the plans appeal process to
help him ask the plan to review the coverage decision.
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 answer✔✔Mrs. Chi may enroll in a MA
MSA plan and remain in her current standalone Part D
prescription drug plan.
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 a part of the PPO network.
Mr. Wells is trying to understand the difference between Original
Medicare and Medicare Advantage. What would be a correct
2025 QUESTIONS AND DETAILED ANSWERS
UPDATED GRADED A+
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
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.
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 answer✔✔You
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.
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 answer✔✔Medicare
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. 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.
Mr. Barker enjoys a comfortable retirement income. He recently
had surgery and expected that he would have certain services
and items covered by the plan with minimal out-of-pocket costs
because his MA-PD coverage has been very good. However,
when he received the bill, he was surprised to see large charges
in excess of his maximum out-of-pocket limit that included some
services and items he thought would be fully covered. He called
you to ask what he could do? What could you tell him? - correct
answer✔✔You can offer to review the plans appeal process to
help him ask the plan to review the coverage decision.
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 answer✔✔Mrs. Chi may enroll in a MA
MSA plan and remain in her current standalone Part D
prescription drug plan.
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 a part of the PPO network.
Mr. Wells is trying to understand the difference between Original
Medicare and Medicare Advantage. What would be a correct
