AHIP 2025 Module 2 QUIZ Questions with Correct Answers

Hank's Fish Store, Inc. is a small company with just 15 employees located in Florida. Hank, the store owner, has provided excellent health benefits to the store's workforce. William, one of the store's long-time employees, will soon be reaching age 65 and eligible for Medicare. William is in good health. He intends to remain an active full-time employee, working several years after becoming eligible for Medicare. What type(s) of retiree health benefit will Hank's Fish Store be able to offer William? a.Hank's can only offer the same plan it provides to its employees who are not Medicare eligible. b.A MSA plan that includes prescription drug coverage. c.A PACE plan. d.Hank's can continue to offer William the same employee health benefit plan, or, if William enrolls in Medicare Part B, it can enroll him in a Medicare Advantage plan that is offered to the public. - ANSWERSd.Hank's can continue to offer William the same employee health benefit plan, or, if William enrolls in Medicare Part B, it can enroll him in a Medicare Advantage plan that is offered to the public. 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? a.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. b.Dr. Brennan can charge the beneficiary the same cost-sharing as Original Medicare as long as she sends the claim to Medicare and not the plan. c.Dr. Brennan can charge Mary Rodgers more than the cost sharing specified in the PFFS plan's terms and conditions as long as she treats all beneficiaries the same. d.Dr. Brennan can charge Mary Rodgers no more than the cost sharing specified in the PFFS plan's terms and conditions of payment which may include balance billing up to 25% of the Medicare rate. - ANSWERSa.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. 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? a.MA 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. b.All MA Plans offer cost-sharing that is lower than Original Medicare for all Part A and Part B covered services, but the maximum out-of-pocket limit is higher than in Original Medicare. d.MA Plans are not permitted to offer any benefits beyond those available under the Original Medicare program and must have the same maximum out-of-pocket limit on Part A and Part B services as Original FFS Medicare. - ANSWERSa.MA 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. 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? a.She can enroll in the PPO, but she will not be able to purchase a stand-alone Medicare Part D prescription drug plan. b.She can enroll in the PPO and if she decides that she wants drug coverage, she will be able to drop her PPO at any time in favor of a Medicare Advantage plan that includes such drug coverage c.She can enroll in the PPO and purchase drug coverage through a stand-alone Medicare Part D prescription drug plan. d.She can enroll in the PPO and purchase drug coverage through a Medigap plan. - ANSWERSa.She can enroll in the PPO, but she will not be able to purchase a stand-alone Medicare Part D prescription drug plan. Mr. Lombardi is interested in a (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. a.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. b.He could enroll in the MA-only PPO plan and a stand-alone Medicare prescription drug plan. d.He cannot enroll in a stand-alone prescription drug plan because you do not represent such a plan. - ANSWERSa.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. 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? a.If she wants drug coverage and a PFFS plan, she could only enroll in a PFFS plan that includes Medicare prescription drug coverage b.She could enroll in the PFFS plan and a Medigap plan that offers drug coverage, but not in a stand-alone Medicare prescription drug plan. c.She could enroll in a PFFS plan and a stand-alone Medicare prescription drug plan. d.She could enroll in a PFFS plan, but not in a stand-alone drug plan. - ANSWERSc.She could enroll in a PFFS plan and a stand-alone Medicare prescription drug plan.