MY AHIP 2027 ACTUAL EXAM
QUESTIONS AND CORRECT ANSWERS
Mr.Gomez notes that a Private Fee for Service (PFFS) plan avaliable in his area ha
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s an attractive preminum. He wants to know if he must use doctors in a network as
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xhis current HMO plan requires him to do. What should you tell him? - ANSWERS-
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He may receive health care services from any doctor allowed to bill Medicare as lo
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ng as he shows the doctor the plan's identification card and the doctor agrees to ac
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cept the PFFS plan's payment terms and conditions, which could include balance bi
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lling.
Mrs. Lee is discussing with you the possibility of enrolling in a Private Fee-
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for Service (PFFS) plan. As part of that discussion, what should you be sure to tell
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her? - ANSWERS-
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PFFS plans may choose to offer Part D benefits but are not required to do so.
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Mrs. Ramos is considering a Medicare Advantage PPO and has questions about w
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hich providers she can go to for her health care. What should you tell her? -
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ANSWERS-
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Mrs. Ramos can obtain care from any provider who participates in Original Medicar
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e but generally will have a higher cost-
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sharing amount if she sees a provider who/that is not apart of the PPO network.
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Mr. McTaggert notes that a Private Fee for-
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Service (PFFS) plan avaliable in his area has an attractive premium. He wants to k
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now what makes them different from an HMO or a PPO. What should you tell him?
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x- ANSWERS-
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Enrollees in a PFFS plan can obtain care from any provider in the US who accepts
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xOriginal Medicare, as long as the provider has a reasonable opportunity to access
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the plan's terms and conditions and agrees to accept them.
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Mr. Castillo, a naturalized citizen, previously enrolled in Medicare Part B but has re
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cently stopped paying his Part B premium. Mr. Castillo is still covered by Part A. H
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e would like to enroll in a Medicare Advantage (MA) plan and is still covered by Par
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t A. What should you tell him? - ANSWERS-
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He is not eligible to enroll in a Medicare Advantage plan until he re-
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enrolls in Medicare Part B. vx vx vx vx
Mr. Sinclar has diabetes and heart trouble and is generally satisified with the care h
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e has just received under Original Medicare, but he would like to know more about
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Medicare Advantage Special Needs Plans (SNPs). What could you tell him? -
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ANSWERS-
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SNPs have special programs from enrollees with chronic conditions, like Mr. Sinclai
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r and they provide prescription drug coverage that could be very helpful as well.
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Mrs.Davenport enrolled in the ABC Medicare Advantage (MA) plan several years a vx vx vx vx vx vx vx vx vx vx vx
go. Her doctor recently confirmed a diagnosis of end-
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,stage renal disease (ESRD). What options does Mrs.Davenport have regarding her
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MA plan during the next open enrollment season? - ANSWERS-
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She may remain in her ABC MA plan or enroll in a Special Needs Plan (SNP) for in
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dividuals sufferinf from ESRD if one is available in her area.
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Daniel is a middle- vx vx vx
income Medicare beneficiary. He has chronic bronchitis putting him at severe risk f
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or pneumonia. Otherwise, he has no problems functioning. Which type of SNP is lik
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ely to be most appropriate for him? - ANSWERS-C-SNP
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Mr. Gomez notes that a Private Fee-
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for Service (PFFS) plan available in his area has an attractive premium. He wants t
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o know if he must use doctors in a network as his curreny HMO plan requires him t
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o do. What should you tell him? - ANSWERS-
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He may receive health care services from any doctor allowed to bill Medicare as lo
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ng as he shows the doctor the plan's identification card and the doctor agrees to ac
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cept the PFFS plan's payment terms and conditions, which could include balance bi
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lling.
Mrs. Ramos is considering a Medicare Advantage PPO and has questions about w
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hich providers she can go to for her health care. What should you tell her? -
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ANSWERS-
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Mrs. Ramos can obtain care from any provider who participates in Original Medicar
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e but generally will have a higher cost-
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sharing amount if she sees a provider who/that is not a part of the PPO network.
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Mr. Kumar is considering a Medicare Advantage HMO and has questions about his
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xability to access providers. What should you tell him? - ANSWERS-
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In most Medicare Advantage HMOs, Mr. Kumar must generally obtain his services
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only from providers who have a contractual relationship with the plan (except in em
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ergency or where care is unavailable within the network)
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Mr.Greco is in excellent health, lives in his own home, and has aa sizeable income
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from his investments. He has a friend enrolled in a Medicare Advantage Special Ne
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eds Plan (SNP). His friend has mentioned that the SNP charges very low costs sha
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ring amounts and Mr. Greco would like to join that plan. What should you tell him?
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- ANSWERS-
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SNPs limit enrollment to certain subpopulations of beneficiaries. Given his current s
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ituation, he is unlikelt to qualify and would not be able to enroll in the SNP.
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Dr. Elizabeth Brennan does not contract with the PFFS plan but she accepts the pl
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an's terms and conditions for payment. Mary Rodgers sees Dr. Brennan for treatme
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nt. How much may Dr. Brennan charge? - ANSWERS-
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Dr. Brennan can charge Mary Rodgers no more than the cost sharing specified in t
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he PFFS plan's terms and condition of payment which may include balance billing
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up to 15 percent of the Medicare rate.
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Mrs.Lyons is in good health, uses a single prescription, and lives independently in
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her own home. She is attracted by the idea of maintaining control over a Medical S
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avings Account (MSA) but is not sure if the plan associated with the account will fit
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, her needs. What specific piece of information about a Medicare MSA plan would it
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be important for her to know, prior to enrolling in such a plan? - ANSWERS-
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All MSAs cover Part A and Part B benefits, but not Part D prescription drug benefit
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s, which could be obtained by also enrolling in a separate prescription drug plan.
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Mrs.Lee is discussing with you the possibility of enrolling in a Private Fee-for-
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Service (PFFS) plan. As part of that discussion, what should you be sure to tell her
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? - ANSWERS-
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PFFS plans may choose to offer Part D benefits but are not required to do so.
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Which of the following statements is correct about Medicare Savings Account (MSA
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) Plans?
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I. MSAs may have either a partial network, full network, or no network of providers
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II. MSA plans cover Part A and Part B benefits but not Part D prescription drug ben
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efits.
III. An individual who is enrolled in an MSA plan is responsible for a minimal deduct
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ible of $500 indexed for inflation
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IV. Non- vx
network providers must accept the same amount that Original Medicare would pay
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them as payment in full. - ANSWERS-I, II. and IV only.
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Mr. Davies is turning 65 next month. He would like to enroll in a Medicare health pl
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an but does not want to be limited in terms of where he obtains his care. What sho
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uld you tell him about how a Medicare Cost Plan might fit his needs? - ANSWERS-
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Cost plan enrollees can choose to receive Medicare covered services under the pla
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n's benefits by going to plan network providers and paying plan cost-
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sharing or may receive services from non-network providers and pay cost-
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sharing due under Original Medicare.
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Mr. Chen is enrolled in his employer's group health plan and will be retiring soon. H
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e would like to know his options since he has decided to drop his retiree coverage
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and is eligible for Medicare. What should you tell him? - ANSWERS-
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Mr. Chen can disenroll from his employer-
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sponsored coverage to elect a Medicare Advantage or Part D plan, but he should r
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evaluate if he really wants to drop his employer coverage.
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When soliciting referrals from current members of an MA or Part D plan, what may
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you do? - ANSWERS-
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Enrollment period (SEP) for both MA and Part D due to a change of residence?
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I. Edward (enrolled in MA and Part D) moves to a new home within the same neigh
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borhood in his existing plan's service area.
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II. Fiona (enrolled in MA and Part D) moves cross-
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country to an area outside her existing plan's service area.
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III. Gilbert moves into a plan service area where there is now a Part D plan availabl
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e to him from a service area where no Part D plan was available.
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IV. Henry makes a permanent move providing him with new MA and Part D options
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.
Which of the following steps may a Part D sponsor adopt for beneficiaries who are
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at risk of misusing or abusing frequently abused drugs?
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QUESTIONS AND CORRECT ANSWERS
Mr.Gomez notes that a Private Fee for Service (PFFS) plan avaliable in his area ha
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s an attractive preminum. He wants to know if he must use doctors in a network as
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xhis current HMO plan requires him to do. What should you tell him? - ANSWERS-
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He may receive health care services from any doctor allowed to bill Medicare as lo
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ng as he shows the doctor the plan's identification card and the doctor agrees to ac
vx vx vx vx vx vx vx vx vx vx vx vx vx vx vx
cept the PFFS plan's payment terms and conditions, which could include balance bi
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lling.
Mrs. Lee is discussing with you the possibility of enrolling in a Private Fee-
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for Service (PFFS) plan. As part of that discussion, what should you be sure to tell
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her? - ANSWERS-
x vx vx
PFFS plans may choose to offer Part D benefits but are not required to do so.
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Mrs. Ramos is considering a Medicare Advantage PPO and has questions about w
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hich providers she can go to for her health care. What should you tell her? -
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ANSWERS-
vx
Mrs. Ramos can obtain care from any provider who participates in Original Medicar
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e but generally will have a higher cost-
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sharing amount if she sees a provider who/that is not apart of the PPO network.
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Mr. McTaggert notes that a Private Fee for-
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Service (PFFS) plan avaliable in his area has an attractive premium. He wants to k
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now what makes them different from an HMO or a PPO. What should you tell him?
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x- ANSWERS-
vx
Enrollees in a PFFS plan can obtain care from any provider in the US who accepts
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xOriginal Medicare, as long as the provider has a reasonable opportunity to access
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the plan's terms and conditions and agrees to accept them.
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Mr. Castillo, a naturalized citizen, previously enrolled in Medicare Part B but has re
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cently stopped paying his Part B premium. Mr. Castillo is still covered by Part A. H
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e would like to enroll in a Medicare Advantage (MA) plan and is still covered by Par
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t A. What should you tell him? - ANSWERS-
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He is not eligible to enroll in a Medicare Advantage plan until he re-
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enrolls in Medicare Part B. vx vx vx vx
Mr. Sinclar has diabetes and heart trouble and is generally satisified with the care h
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e has just received under Original Medicare, but he would like to know more about
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Medicare Advantage Special Needs Plans (SNPs). What could you tell him? -
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ANSWERS-
vx
SNPs have special programs from enrollees with chronic conditions, like Mr. Sinclai
vx vx vx vx vx vx vx vx vx vx vx
r and they provide prescription drug coverage that could be very helpful as well.
vx vx vx vx vx vx vx vx vx vx vx vx vx
Mrs.Davenport enrolled in the ABC Medicare Advantage (MA) plan several years a vx vx vx vx vx vx vx vx vx vx vx
go. Her doctor recently confirmed a diagnosis of end-
vx vx vx vx vx vx vx vx
,stage renal disease (ESRD). What options does Mrs.Davenport have regarding her
vx vx vx vx vx vx vx vx vx vx v
MA plan during the next open enrollment season? - ANSWERS-
x vx vx vx vx vx vx vx vx vx
She may remain in her ABC MA plan or enroll in a Special Needs Plan (SNP) for in
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dividuals sufferinf from ESRD if one is available in her area.
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Daniel is a middle- vx vx vx
income Medicare beneficiary. He has chronic bronchitis putting him at severe risk f
vx vx vx vx vx vx vx vx vx vx vx vx
or pneumonia. Otherwise, he has no problems functioning. Which type of SNP is lik
vx vx vx vx vx vx vx vx vx vx vx vx vx
ely to be most appropriate for him? - ANSWERS-C-SNP
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Mr. Gomez notes that a Private Fee-
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for Service (PFFS) plan available in his area has an attractive premium. He wants t
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o know if he must use doctors in a network as his curreny HMO plan requires him t
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o do. What should you tell him? - ANSWERS-
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He may receive health care services from any doctor allowed to bill Medicare as lo
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ng as he shows the doctor the plan's identification card and the doctor agrees to ac
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cept the PFFS plan's payment terms and conditions, which could include balance bi
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lling.
Mrs. Ramos is considering a Medicare Advantage PPO and has questions about w
vx vx vx vx vx vx vx vx vx vx vx vx
hich providers she can go to for her health care. What should you tell her? -
vx vx vx vx vx vx vx vx vx vx vx vx vx vx vx
ANSWERS-
vx
Mrs. Ramos can obtain care from any provider who participates in Original Medicar
vx vx vx vx vx vx vx vx vx vx vx vx
e but generally will have a higher cost-
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sharing amount if she sees a provider who/that is not a part of the PPO network.
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Mr. Kumar is considering a Medicare Advantage HMO and has questions about his
vx vx vx vx vx vx vx vx vx vx vx vx v
xability to access providers. What should you tell him? - ANSWERS-
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In most Medicare Advantage HMOs, Mr. Kumar must generally obtain his services
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only from providers who have a contractual relationship with the plan (except in em
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ergency or where care is unavailable within the network)
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Mr.Greco is in excellent health, lives in his own home, and has aa sizeable income
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from his investments. He has a friend enrolled in a Medicare Advantage Special Ne
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eds Plan (SNP). His friend has mentioned that the SNP charges very low costs sha
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ring amounts and Mr. Greco would like to join that plan. What should you tell him?
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- ANSWERS-
vx
SNPs limit enrollment to certain subpopulations of beneficiaries. Given his current s
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ituation, he is unlikelt to qualify and would not be able to enroll in the SNP.
vx vx vx vx vx vx vx vx vx vx vx vx vx vx vx
Dr. Elizabeth Brennan does not contract with the PFFS plan but she accepts the pl
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an's terms and conditions for payment. Mary Rodgers sees Dr. Brennan for treatme
vx vx vx vx vx vx vx vx vx vx vx vx
nt. How much may Dr. Brennan charge? - ANSWERS-
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Dr. Brennan can charge Mary Rodgers no more than the cost sharing specified in t
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he PFFS plan's terms and condition of payment which may include balance billing
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up to 15 percent of the Medicare rate.
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Mrs.Lyons is in good health, uses a single prescription, and lives independently in
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her own home. She is attracted by the idea of maintaining control over a Medical S
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avings Account (MSA) but is not sure if the plan associated with the account will fit
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, her needs. What specific piece of information about a Medicare MSA plan would it
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be important for her to know, prior to enrolling in such a plan? - ANSWERS-
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All MSAs cover Part A and Part B benefits, but not Part D prescription drug benefit
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s, which could be obtained by also enrolling in a separate prescription drug plan.
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Mrs.Lee is discussing with you the possibility of enrolling in a Private Fee-for-
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Service (PFFS) plan. As part of that discussion, what should you be sure to tell her
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? - ANSWERS-
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PFFS plans may choose to offer Part D benefits but are not required to do so.
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Which of the following statements is correct about Medicare Savings Account (MSA
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) Plans?
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I. MSAs may have either a partial network, full network, or no network of providers
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II. MSA plans cover Part A and Part B benefits but not Part D prescription drug ben
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efits.
III. An individual who is enrolled in an MSA plan is responsible for a minimal deduct
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ible of $500 indexed for inflation
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IV. Non- vx
network providers must accept the same amount that Original Medicare would pay
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them as payment in full. - ANSWERS-I, II. and IV only.
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Mr. Davies is turning 65 next month. He would like to enroll in a Medicare health pl
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an but does not want to be limited in terms of where he obtains his care. What sho
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uld you tell him about how a Medicare Cost Plan might fit his needs? - ANSWERS-
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Cost plan enrollees can choose to receive Medicare covered services under the pla
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n's benefits by going to plan network providers and paying plan cost-
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sharing or may receive services from non-network providers and pay cost-
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sharing due under Original Medicare.
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Mr. Chen is enrolled in his employer's group health plan and will be retiring soon. H
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e would like to know his options since he has decided to drop his retiree coverage
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and is eligible for Medicare. What should you tell him? - ANSWERS-
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Mr. Chen can disenroll from his employer-
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sponsored coverage to elect a Medicare Advantage or Part D plan, but he should r
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evaluate if he really wants to drop his employer coverage.
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When soliciting referrals from current members of an MA or Part D plan, what may
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you do? - ANSWERS-
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Enrollment period (SEP) for both MA and Part D due to a change of residence?
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I. Edward (enrolled in MA and Part D) moves to a new home within the same neigh
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borhood in his existing plan's service area.
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II. Fiona (enrolled in MA and Part D) moves cross-
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country to an area outside her existing plan's service area.
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III. Gilbert moves into a plan service area where there is now a Part D plan availabl
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e to him from a service area where no Part D plan was available.
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IV. Henry makes a permanent move providing him with new MA and Part D options
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.
Which of the following steps may a Part D sponsor adopt for beneficiaries who are
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at risk of misusing or abusing frequently abused drugs?
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