AHIP 2027 MODULE 2 EXAM
QUESTIONS AND VERIFIED
SOLUTIONS|VERIFIED & ALREADY
GRADED A+
Most Studied | Updated
WESTERN GOVERNOR’S UNIVERSITY
2027 VERSION
QUESTIONS & ANSWERS
#Bright_minds #stuvia@2026
, QUESTIONS & ANSWERS
QUESTIONS ANSWERS
Gary Summers is enrolled in Ajax All Medicare Advantage (MA) plans
Medicare Advantage plan. Gary has must have a "maximum out-of-pocket"
recently faced a series of health issues limit (known as "MOOP") for Part A
leading to substantial out-of-pocket and Part B benefits. Once the MA plan
expenses. Gary understands that in member pays a specified amount of cost-
Original Medicare (Parts A and B) there is sharing that health plan pays 100
no annual out-of-pocket maximum. He asks percent of the medical services covered.
you if the same is true of his Medicare
Advantage plan? How do you respond?
Stefan Merritt is turning 65 next month. Stefan is eligible to enroll in Medicare
Stefan legally entered the United States Advantage if he is entitled to Part A and
over twenty years ago, holds a green card, enrolled in Part B. Stefan should go to
but is not a citizen. Since he entered the the Social Security website to enroll in
country, Stefan has worked at Smallcap Medicare Part A and B if he has not
Incorporated and contributed to the done so already. Once he is enrolled, he
Medicare system. Stefan suffers from can choose a Medicare Advantage plan.
diabetes. He will soon retire and asks you if
he can enroll in a Medicare Advantage plan
that you represent. How would you
respond?
Conrad is 64, retiring soon, and He should compare the benefits in his
considering enrollment in his employer- employer-sponsored retiree group
sponsored MA retiree group health plan health plan with the benefits in his
that includes drug coverage with nominal neighbor's MA-PD plan to determine
copays. He heard about a neighbor's MA- which one will provide sufficient
PD plan that you represent and because he coverage for his prescription needs.
takes numerous prescription drugs, he is
considering signing up for it. What should
you tell him?
Mr. Church notes that a Private Fee-for- He may receive health care services
Service (PFFS) plan available in his area from any doctor allowed to bill
has an attractive premium. He wants to Medicare, if he shows the doctor the
know if he must use doctors in a network as plan's identification card and the doctor
his current HMO plan requires him to do. agrees to accept the PFFS plan's
What should you tell him? payment terms and conditions, which
could include balance billing.
Mr. Maddox is considering a Medicare In most Medicare Advantage HMOs,
Advantage HMO and has questions about Mr. Maddox must generally obtain his
services only from providers within the
QUESTIONS AND VERIFIED
SOLUTIONS|VERIFIED & ALREADY
GRADED A+
Most Studied | Updated
WESTERN GOVERNOR’S UNIVERSITY
2027 VERSION
QUESTIONS & ANSWERS
#Bright_minds #stuvia@2026
, QUESTIONS & ANSWERS
QUESTIONS ANSWERS
Gary Summers is enrolled in Ajax All Medicare Advantage (MA) plans
Medicare Advantage plan. Gary has must have a "maximum out-of-pocket"
recently faced a series of health issues limit (known as "MOOP") for Part A
leading to substantial out-of-pocket and Part B benefits. Once the MA plan
expenses. Gary understands that in member pays a specified amount of cost-
Original Medicare (Parts A and B) there is sharing that health plan pays 100
no annual out-of-pocket maximum. He asks percent of the medical services covered.
you if the same is true of his Medicare
Advantage plan? How do you respond?
Stefan Merritt is turning 65 next month. Stefan is eligible to enroll in Medicare
Stefan legally entered the United States Advantage if he is entitled to Part A and
over twenty years ago, holds a green card, enrolled in Part B. Stefan should go to
but is not a citizen. Since he entered the the Social Security website to enroll in
country, Stefan has worked at Smallcap Medicare Part A and B if he has not
Incorporated and contributed to the done so already. Once he is enrolled, he
Medicare system. Stefan suffers from can choose a Medicare Advantage plan.
diabetes. He will soon retire and asks you if
he can enroll in a Medicare Advantage plan
that you represent. How would you
respond?
Conrad is 64, retiring soon, and He should compare the benefits in his
considering enrollment in his employer- employer-sponsored retiree group
sponsored MA retiree group health plan health plan with the benefits in his
that includes drug coverage with nominal neighbor's MA-PD plan to determine
copays. He heard about a neighbor's MA- which one will provide sufficient
PD plan that you represent and because he coverage for his prescription needs.
takes numerous prescription drugs, he is
considering signing up for it. What should
you tell him?
Mr. Church notes that a Private Fee-for- He may receive health care services
Service (PFFS) plan available in his area from any doctor allowed to bill
has an attractive premium. He wants to Medicare, if he shows the doctor the
know if he must use doctors in a network as plan's identification card and the doctor
his current HMO plan requires him to do. agrees to accept the PFFS plan's
What should you tell him? payment terms and conditions, which
could include balance billing.
Mr. Maddox is considering a Medicare In most Medicare Advantage HMOs,
Advantage HMO and has questions about Mr. Maddox must generally obtain his
services only from providers within the
