AHIP Module 2 All Answers Correct

AHIP Module 2 All Answers Correct Question 1: Which type of Special Needs Plan (SNP) would be most suitable for Daniel, a middle-income Medicare beneficiary with chronic bronchitis? a. D-SNP b. C-SNP c. Institutional SNP d. All of the above Correct answer: b. C-SNP Question 2: What types of health plans are available through the Medicare Advantage program? a. HMOs and PPOs only b. HMOs, PPOs, PFFS, MSAs, and SNPs c. Only HMOs and SNPs d. None of the above Correct answer: b. HMOs, PPOs, PFFS, MSAs, and SNPs Question 3: How does a Private Fee-for-Service (PFFS) plan differ from an HMO or PPO? a. Enrollees in a PFFS plan can obtain care from any provider in the U.S. who accepts Original Medicare. b. Enrollees in a PFFS plan must use a specific network of providers. c. Enrollees in a PFFS plan can only see doctors who participate in the plan's network. d. All of the above Correct answer: a. Enrollees in a PFFS plan can obtain care from any provider in the U.S. who accepts Original Medicare. Mr. Sinclair has diabetes and heart trouble and is generally satisfied with the care he has received under Original Medicare, but he would like to know more about Medicare Advantage Special Needs Plans (SNPs). What could you tell him? SNPs have special programs for enrollees with chronic conditions, like Mr. Sinclair, and they provide prescription drug coverage that could be very helpful as well. Correct: Chronic condition SNPs (C-SNPs) restrict enrollment and tailor services to individuals with chronic conditions, such as Mr. Sinclair. All SNPs include prescription drug coverage. 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? 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. Correct: Because Dr. Brennan accepts the plan's terms and conditions for payment, she is permitted to charge this amount. 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. Correct: Enrollees or their representatives may file a grievance if they experience problems with their health care services, such as timeliness, appropriateness, access to, and/or setting of a provided health service, procedure, or item. Mrs. Ramos is considering a Medicare Advantage PPO and has questions about which providers she can go to for her health care. What should you tell her? Mrs. Ramos can obtain care from any provider who participates in Original Medicare, but generally will have a higher cost-sharing amount if she sees a provider who/that is not a part of the PPO network. Correct: MA-PPO enrollees may seek care from any provider who accepts Medicare. However, enrollees are typically responsible for higher cost-sharing payments if their provider is out-of-network.