AHIP 2027 Certification with Latest Frequently Asked Questions and Verified Answers

AHIP 2027 Certification with Latest Frequently Asked Questions and Verified Answers A Medicare beneficiary wants a plan that generally requires receiving all routine care from a network of contracted providers and selecting a primary care physician (PCP). Which Medicare Advantage plan best fits this preference? A. Preferred Provider Organization (PPO) B. Private Fee-for-Service (PFFS) C. Health Maintenance Organization (HMO) D. Medicare Medical Savings Account (MSA) Correct Answer: C. Health Maintenance Organization (HMO) Rationale: HMO plans generally require members to receive covered services through network providers, except for emergencies, urgent care, or authorized out-of-area services. Most HMOs also require members to select a PCP who coordinates their care. A Medicare Advantage enrollee wants the flexibility to see both in-network and out-of-network providers, although out-of-network services may cost more. Which plan type is most appropriate? A. HMO B. PPO C. SNP D. Cost Plan Correct Answer: B. PPO Rationale: PPO plans offer members the flexibility to use both in-network and out-of-network providers. Members usually pay lower cost-sharing when using in-network providers.