AHIP Module 2 Test Questions with Verified Answers
Mr. Sinclair has diabetes and heart trouble and is which could be obtained by also enrolling in a
generally satisfied with the care he has received separate prescription drug plan.
under Original Medicare, but he would like to know
more about Medicare Advantage Special Needs
Plans (SNPs). What could you tell him? - Mr. Gomez notes that a Private Fee-for-Service
ANSWER -a. SNPs have special programs for (PFFS) plan available in his area has an attractive
enrollees with chronic conditions, like Mr. Sinclair, premium. He wants to know if he must use doctors in
and they provide prescription drug coverage that a network as his current HMO plan requires him to
could be very helpful as well. do. What should you tell him? - ANSWER -c. He
may receive health care services from any doctor
allowed to bill Medicare, as long as he shows the
Ms. Gibson recently lost her employer group health doctor the plan's identification card and the doctor
and drug coverage and now she wants to enroll in a agrees to accept the PFFS plan's payment terms and
PPO that does not include drug coverage. What conditions, which could include balance billing.
should you tell her about obtaining drug coverage? - Correct
ANSWER -b. She can enroll in the PPO, but
she will not be able to purchase a stand-alone
Medicare Part D prescription drug plan. Mrs. Willard wants to know generally how the benefits
under Original Medicare might compare to the
benefits package of a Medicare Advantage Plan
Mrs. Kelly, age 65, is entitled to Part A but has not before she starts looking at specific plans. What
yet enrolled in Part B. She is considering enrollment could you tell her? - ANSWER -a. Medicare
in a Medicare Advantage plan (Part C). What should Advantage Plans may offer extra benefits that
you advise her to do before she will be able to enroll Original Medicare does not offer such as vision,
in a Medicare Advantage plan? - ANSWER -d. hearing, and dental services and must include a
In order to join a Medicare Advantage plan, she also maximum out-of-pocket limit on Part A and Part B
must enroll in Part B. services.
Mr. Lopez has heard that he can sign up for a Mrs. Davenport enrolled in the ABC Medicare
product called "Medicare Advantage" but is not sure Advantage (MA) plan several years ago. In mid-
about what type of plan designs are available February of 2021, her doctor confirms a diagnosis of
through this program. What should you tell him about end-stage renal disease (ESRD). What options will
the types of health plans that are available through Mrs. Davenport have regarding her MA plan during
the Medicare Advantage program? - the next open enrollment season? - ANSWER -
ANSWER -c. They are Medicare health plans a. She may remain in her ABC MA plan, enroll in
such as HMOs, PPOs, PFFS, and MSAs. another MA plan in her service area, or enroll in a
Special Needs Plan (SNP) for individuals suffering
from ESRD if one is available in her area.
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 Mrs. Burton is a retiree with substantial income. She
control over a Medical Savings Account (MSA) but is is enrolled in an MA-PD plan and was disappointed
not sure if the plan associated with the account will fit with the service she received from her primary care
her needs. What specific piece of information about a physician because she was told she would have to
Medicare MSA plan would it be important for her to wait five weeks to get an appointment when she was
know, prior to enrolling in such a plan? - feeling ill. She called you to ask what she could do so
ANSWER -c. All MSAs cover Part A and Part B she would not have to put up with such poor access
benefits, but not Part D prescription drug benefits, to care. What could you tell her? - ANSWER -b.
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Mr. Sinclair has diabetes and heart trouble and is which could be obtained by also enrolling in a
generally satisfied with the care he has received separate prescription drug plan.
under Original Medicare, but he would like to know
more about Medicare Advantage Special Needs
Plans (SNPs). What could you tell him? - Mr. Gomez notes that a Private Fee-for-Service
ANSWER -a. SNPs have special programs for (PFFS) plan available in his area has an attractive
enrollees with chronic conditions, like Mr. Sinclair, premium. He wants to know if he must use doctors in
and they provide prescription drug coverage that a network as his current HMO plan requires him to
could be very helpful as well. do. What should you tell him? - ANSWER -c. He
may receive health care services from any doctor
allowed to bill Medicare, as long as he shows the
Ms. Gibson recently lost her employer group health doctor the plan's identification card and the doctor
and drug coverage and now she wants to enroll in a agrees to accept the PFFS plan's payment terms and
PPO that does not include drug coverage. What conditions, which could include balance billing.
should you tell her about obtaining drug coverage? - Correct
ANSWER -b. She can enroll in the PPO, but
she will not be able to purchase a stand-alone
Medicare Part D prescription drug plan. Mrs. Willard wants to know generally how the benefits
under Original Medicare might compare to the
benefits package of a Medicare Advantage Plan
Mrs. Kelly, age 65, is entitled to Part A but has not before she starts looking at specific plans. What
yet enrolled in Part B. She is considering enrollment could you tell her? - ANSWER -a. Medicare
in a Medicare Advantage plan (Part C). What should Advantage Plans may offer extra benefits that
you advise her to do before she will be able to enroll Original Medicare does not offer such as vision,
in a Medicare Advantage plan? - ANSWER -d. hearing, and dental services and must include a
In order to join a Medicare Advantage plan, she also maximum out-of-pocket limit on Part A and Part B
must enroll in Part B. services.
Mr. Lopez has heard that he can sign up for a Mrs. Davenport enrolled in the ABC Medicare
product called "Medicare Advantage" but is not sure Advantage (MA) plan several years ago. In mid-
about what type of plan designs are available February of 2021, her doctor confirms a diagnosis of
through this program. What should you tell him about end-stage renal disease (ESRD). What options will
the types of health plans that are available through Mrs. Davenport have regarding her MA plan during
the Medicare Advantage program? - the next open enrollment season? - ANSWER -
ANSWER -c. They are Medicare health plans a. She may remain in her ABC MA plan, enroll in
such as HMOs, PPOs, PFFS, and MSAs. another MA plan in her service area, or enroll in a
Special Needs Plan (SNP) for individuals suffering
from ESRD if one is available in her area.
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 Mrs. Burton is a retiree with substantial income. She
control over a Medical Savings Account (MSA) but is is enrolled in an MA-PD plan and was disappointed
not sure if the plan associated with the account will fit with the service she received from her primary care
her needs. What specific piece of information about a physician because she was told she would have to
Medicare MSA plan would it be important for her to wait five weeks to get an appointment when she was
know, prior to enrolling in such a plan? - feeling ill. She called you to ask what she could do so
ANSWER -c. All MSAs cover Part A and Part B she would not have to put up with such poor access
benefits, but not Part D prescription drug benefits, to care. What could you tell her? - ANSWER -b.
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