AHIP Module 2 2024 Verified Solutions

AHIP Module 2 2024 Verified Solutions Question 1: Ms. Gibson wants to enroll in a PPO that doesn't 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. Correct answer: a. She can enroll in the PPO, but she will not be able to purchase a stand-alone Medicare Part D prescription drug plan. Question 2: Mrs. Willard wants to know how the benefits under Original Medicare might compare to the benefits package of a Medicare Advantage Plan. What could you tell her? a. Medicare Advantage Plans may offer extra benefits that Original Medicare does not offer, such as vision, hearing, and dental services, and must include a maximum out-of-pocket limit on Part A and Part B services. Correct answer: a. Medicare Advantage Plans may offer extra benefits that Original Medicare does not offer, such as vision, hearing, and dental services, and must include a maximum out-of-pocket limit on Part A and Part B services. Question 3: Mrs. Walters is enrolled in her state's Medicaid program in addition to Medicare. What should she be aware of when considering enrollment in a Medicare Advantage (MA) plan? a. She cannot enroll in an MA Medical Savings Account (MSA) plan. Correct answer: a. She cannot enroll in an MA Medical Savings Account (MSA) plan. Juan Perez, who is turning age 65 next month, intends to work for several more years at Smallcap, Incorporated. Smallcap has a workforce of 15 employees and offers employer-sponsored healthcare coverage. Juan is a naturalized citizen and has contributed to the Medicare system for over 20 years. Juan asks you if he will be entitled to Medicare and if he enrolls how that will impact his employer sponsored healthcare coverage. How would you respond? ️Juan is likely to be eligible for Medicare once he turns age 65 and if he enrolls Medicare would become the primary payor of his healthcare claims and Smallcap does not have to continue to offer him coverage comparable to those under age 65 under its employer-sponsored group health plan. Mr. Romero is 64, retiring soon, and considering enrollment in his employer-sponsored retiree group health plan that includes drug coverage with nominal copays. He heard about a neighbor's MA-PD plan that you represent and because he takes numerous prescription drugs, he is considering signing up for it. What should you tell him? ️He should compare the benefits in his employer-sponsored retiree group health plan with the benefits in his neighbor's MA-PD plan to determine which one will provide sufficient coverage for his prescription needs 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. ️I, II, and IV only 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? ️She could enroll in a PFFS plan and a stand-alone Medicare prescription drug plan 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? ️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. 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.