Ahip 2025 Module 2
Mrs. Radford asks whether there are any special eligibility requirements for Medicare
Advantage. What should you tell her?
Mrs. Radford must be entitled to Part A and enrolled in Part B to enroll in Medicare Advantage.
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.
Question 2Answer
I, II, and IV only
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?
She could file a grievance with her plan to complain about the lack of timeliness in getting an
appointment.
Mr. Lombardi is interested in a Medicare Advantage (MA) PPO plan that you represent. It is one
of three plans 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 prescription drug plan. What should you tell him about this situation?
He could enroll either in one of the MA plans that include prescription drug coverage or Original
Medicare with a Medigap plan and standalone Part D prescription drug coverage, but he cannot
enroll in the MA-only PPO plan and a stand-alone prescription drug 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?
She can enroll in the PPO, but she will not be able to purchase a stand-alone Medicare Part D
prescription drug plan.
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?
You would need to ask Mr. Kelly if he is enrolled in Part A and Part B and if his doctor will accept
the terms and conditions of payment of the PFFS plan.
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?
There are Medicare health plans such as HMOs, PPOs, PFFS, and MSAs.
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?
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. Wells is trying to understand the difference between Original Medicare and Medicare
Advantage. What would be the correct description?
Medicare Advantage is a way of covering all the Original Medicare benefits through private
health insurance companies.
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
can enroll in a Medicare Advantage plan?
To join a Medicare Advantage plan, she also must enroll in Part B.
Mrs. Radford asks whether there are any special eligibility requirements for Medicare
Advantage. What should you tell her?
Mrs. Radford must be entitled to Part A and enrolled in Part B to enroll in Medicare Advantage.
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.
Question 2Answer
I, II, and IV only
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?
She could file a grievance with her plan to complain about the lack of timeliness in getting an
appointment.
Mr. Lombardi is interested in a Medicare Advantage (MA) PPO plan that you represent. It is one
of three plans 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 prescription drug plan. What should you tell him about this situation?
He could enroll either in one of the MA plans that include prescription drug coverage or Original
Medicare with a Medigap plan and standalone Part D prescription drug coverage, but he cannot
enroll in the MA-only PPO plan and a stand-alone prescription drug 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?
She can enroll in the PPO, but she will not be able to purchase a stand-alone Medicare Part D
prescription drug plan.
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?
You would need to ask Mr. Kelly if he is enrolled in Part A and Part B and if his doctor will accept
the terms and conditions of payment of the PFFS plan.
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?
There are Medicare health plans such as HMOs, PPOs, PFFS, and MSAs.
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?
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. Wells is trying to understand the difference between Original Medicare and Medicare
Advantage. What would be the correct description?
Medicare Advantage is a way of covering all the Original Medicare benefits through private
health insurance companies.
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
can enroll in a Medicare Advantage plan?
To join a Medicare Advantage plan, she also must enroll in Part B.
