2024 AHIP Module 2 Exam Study Guide Review
with Correct Definitions.
Mrs. Radford asks whether there are any special eligibility requirements for
Medicare Advantage. What should you tell her? - Exact Answer Mrs. Radford must
be entitled to Part A and enrolled in Part B to enroll in Medicare Advantage.
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? - Exact Answer 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.
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? - Exact
Answer 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
Mrs. Lyons is in good health, uses a single prescription, and lives independently in
her own home. She is attracted by the idea of maintaining control over a Medical
Savings Account (MSA) but is not sure if the plan associated with the account will
, 2024 AHIP Module 2 Exam Study Guide Review
with Correct Definitions.
fit her needs. What specific piece of information about a Medicare MSA plan
would it be important for her to know, prior to enrolling in such a plan? - Exact
Answer All MSAs cover Part A and Part B benefits, but not Part D prescription drug
benefits, which could be obtained by also enrolling in a separate prescription drug
plan.
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? - Exact Answer 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.
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? -
Exact Answer 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.
Ms. Gibson recently lost her employer group health and drug coverage and now
she wants to enroll in a PPO that does not include drug coverage. What should
you tell her about obtaining drug coverage? - Exact Answer She can enroll in the
with Correct Definitions.
Mrs. Radford asks whether there are any special eligibility requirements for
Medicare Advantage. What should you tell her? - Exact Answer Mrs. Radford must
be entitled to Part A and enrolled in Part B to enroll in Medicare Advantage.
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? - Exact Answer 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.
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? - Exact
Answer 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
Mrs. Lyons is in good health, uses a single prescription, and lives independently in
her own home. She is attracted by the idea of maintaining control over a Medical
Savings Account (MSA) but is not sure if the plan associated with the account will
, 2024 AHIP Module 2 Exam Study Guide Review
with Correct Definitions.
fit her needs. What specific piece of information about a Medicare MSA plan
would it be important for her to know, prior to enrolling in such a plan? - Exact
Answer All MSAs cover Part A and Part B benefits, but not Part D prescription drug
benefits, which could be obtained by also enrolling in a separate prescription drug
plan.
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? - Exact Answer 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.
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? -
Exact Answer 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.
Ms. Gibson recently lost her employer group health and drug coverage and now
she wants to enroll in a PPO that does not include drug coverage. What should
you tell her about obtaining drug coverage? - Exact Answer She can enroll in the
