AHIP TRAINING MODULE 2 VERIFIED SOLUTIONS
Question 1: Lopez is trying to understand the different types of Medicare Advantage plans available.
What should you tell him?
a. They are Medicare health plans such as HMO, PPO, PFFS, SNP, and MSA.
Correct answer: a. They are Medicare health plans such as HMO, PPO, PFFS, SNP, and MSA.
Question 2: Whalen is trying to understand the difference between Original Medicare and Medicare
Advantage. What should you tell him?
a. MA is a way of covering all of the Original Medicare benefits through private health insurance
companies.
Correct answer: a. MA is a way of covering all of the Original Medicare benefits through private health
insurance companies.
LYONS is in good health, uses a single Rx, and lives independently in her own home. She is attracted by
the idea of maintaining control over a MSA, but is not sure if the plan associated with the acct. will fit
her needs.
(MA MSA) ✔️ALL MSA's cover Part A and Part B benefits, but NOT Part D Rx benefits, which could be
obtained by also enrolling in a separate Rx plan.
DAVIES is turning 65 next month. he would like to enroll in a Medicare health plan, but does not want to
be limited in terms of where he obtains his care. What should you tell him about how a Medicare cost
plan might fit his needs.
(MA costs) ✔️Cost plan enrollees can choose to receive Medicare covered services under the plan's
benefits by going to plan network providers and paying plan cost sharing, or may receive services from
Non-network providers and pay cost-sharing due under Original Medicare.
ROMERO is 64, retiring soon, and considering enrollment in his employer-sponsored retiree group
health plan that includes Rx coverage with nominal copays. He heard about a neighbor's MA-PD plan
that you represent and because he takes numerous Rx's, he is considering signing up for it.
, (MA-PD_ ✔️It is ALWAYS the best option to talk with his benefits administrator to see whether he
needs both an employer sponsored plan and a private MA-PD and what might happen if he were to sign
up for both.
WALTER'S is enrolled in her state's Medicaid program in addition to Medicare. What should she be
aware of when considering enrollment in a Medicare Health plan?
(Medicaid) ✔️Medicaid will coordinate benefits ONLY with Medicaid participating providers.
ANDREWS asked how a 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?
(PFFS and Medicaid) ✔️Medicaid may provide additional benefits, but Medicaid will coordinate
benefits ONLY with Medicaid participating providers.
LOMBARDI is interested in a MA PPO plan that you represent. It is one of three plan operated by the
same organization in Mr. Lombardi's area. The MA-PPO plan does NOT include drug coverage, but the
other two plans do. Mr. Lombardi likes the PPO plan that does not include drug coverage and intends to
obtain his drug coverage through a stand-alone Medicare Rx plan.
(MA PPO) ✔️He could enroll in one of the MA plans that include Rx coverage or a Medigap plan and a
stand-alone Rx plan, but he CAN'T enroll in the MA-only PPO plan and a stand-alone Rx plan.
CHOU likes a PFFS plan available in her area that does not offer drug coverage. She wants to enroll in the
plan and enroll in a stand-alone Rx plan. What should you tell her?
(MA-PFFS) ✔️She COULD enroll in a PFFS plan and a stand-alone Medicare Rx plan.
Medicare Advantage plans ✔️Private companies offer health plan that cover all Medicare Part A and B
benefits.
--Many also cover Part D Rx benefits MA-PD plans
--ALL MA plans offer a max out of pocket limit.
--Many MA plans offer extra benefits that Medicare DOESN'T cover
--Certain plans can restrict enrollment eligibility to:
SNP; employees and/or retirees waiver plans
Other types of Medicare plans such as:
Question 1: Lopez is trying to understand the different types of Medicare Advantage plans available.
What should you tell him?
a. They are Medicare health plans such as HMO, PPO, PFFS, SNP, and MSA.
Correct answer: a. They are Medicare health plans such as HMO, PPO, PFFS, SNP, and MSA.
Question 2: Whalen is trying to understand the difference between Original Medicare and Medicare
Advantage. What should you tell him?
a. MA is a way of covering all of the Original Medicare benefits through private health insurance
companies.
Correct answer: a. MA is a way of covering all of the Original Medicare benefits through private health
insurance companies.
LYONS is in good health, uses a single Rx, and lives independently in her own home. She is attracted by
the idea of maintaining control over a MSA, but is not sure if the plan associated with the acct. will fit
her needs.
(MA MSA) ✔️ALL MSA's cover Part A and Part B benefits, but NOT Part D Rx benefits, which could be
obtained by also enrolling in a separate Rx plan.
DAVIES is turning 65 next month. he would like to enroll in a Medicare health plan, but does not want to
be limited in terms of where he obtains his care. What should you tell him about how a Medicare cost
plan might fit his needs.
(MA costs) ✔️Cost plan enrollees can choose to receive Medicare covered services under the plan's
benefits by going to plan network providers and paying plan cost sharing, or may receive services from
Non-network providers and pay cost-sharing due under Original Medicare.
ROMERO is 64, retiring soon, and considering enrollment in his employer-sponsored retiree group
health plan that includes Rx coverage with nominal copays. He heard about a neighbor's MA-PD plan
that you represent and because he takes numerous Rx's, he is considering signing up for it.
, (MA-PD_ ✔️It is ALWAYS the best option to talk with his benefits administrator to see whether he
needs both an employer sponsored plan and a private MA-PD and what might happen if he were to sign
up for both.
WALTER'S is enrolled in her state's Medicaid program in addition to Medicare. What should she be
aware of when considering enrollment in a Medicare Health plan?
(Medicaid) ✔️Medicaid will coordinate benefits ONLY with Medicaid participating providers.
ANDREWS asked how a 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?
(PFFS and Medicaid) ✔️Medicaid may provide additional benefits, but Medicaid will coordinate
benefits ONLY with Medicaid participating providers.
LOMBARDI is interested in a MA PPO plan that you represent. It is one of three plan operated by the
same organization in Mr. Lombardi's area. The MA-PPO plan does NOT include drug coverage, but the
other two plans do. Mr. Lombardi likes the PPO plan that does not include drug coverage and intends to
obtain his drug coverage through a stand-alone Medicare Rx plan.
(MA PPO) ✔️He could enroll in one of the MA plans that include Rx coverage or a Medigap plan and a
stand-alone Rx plan, but he CAN'T enroll in the MA-only PPO plan and a stand-alone Rx plan.
CHOU likes a PFFS plan available in her area that does not offer drug coverage. She wants to enroll in the
plan and enroll in a stand-alone Rx plan. What should you tell her?
(MA-PFFS) ✔️She COULD enroll in a PFFS plan and a stand-alone Medicare Rx plan.
Medicare Advantage plans ✔️Private companies offer health plan that cover all Medicare Part A and B
benefits.
--Many also cover Part D Rx benefits MA-PD plans
--ALL MA plans offer a max out of pocket limit.
--Many MA plans offer extra benefits that Medicare DOESN'T cover
--Certain plans can restrict enrollment eligibility to:
SNP; employees and/or retirees waiver plans
Other types of Medicare plans such as:
