AHIP MODULE 2 2023
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? - Answer- She can enroll in the PPO, but she will not be
able to purchase a stand-alone Medicare Part D prescription drug plan
Mrs. Willard wants to know generally how the benefits under Original Medicare might compare to the benefits package of a Medicare Advantage Plan before she starts looking at specific plans. What could you tell her? - Answer- Medicare Advantage Plans may offer extra benefits that Original Medicare does not offer such as vision, hearing, and dental services and must include a maximum out-of-pocket limit on Part A and Part B services.
Mrs. Walters is enrolled in her state's Medicaid program in addition to Medicare. What should she be aware of when considering enrollment in a Medicare Advantage (MA) plan? - Answer- She cannot enroll in an MA Medical Savings Account (MSA) plan
Mrs. Andrews asked how a Private Fee-for-Service (PFFS) plan might affect her access
to services since she receives some assistance for her health care costs from the State.
What should you tell her? - Answer- Medicaid may provide additional benefits, but Medicaid will only pay for these services if they are furnished by Medicaid participating providers.
Mrs. Kelly, age 65, is entitled to Part A but has not yet enrolled in Part B. She is considering enrollment in a Medicare Advantage plan (Part C). What should you advise her to do before she will be able to enroll in a Medicare Advantage plan? - Answer- To join a Medicare Advantage plan, she also must enroll in Part B.
Mr. Lopez has heard that he can sign up for a product called "Medicare Advantage" but is not sure about what type of plan designs are available through this program. What should you tell him about the types of health plans that are available through the Medicare Advantage program? - Answer- They are Medicare health plans such as HMOs, PPOs, PFFS, and MSAs.
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? - 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.
Daniel is a middle-income Medicare beneficiary. He has chronic bronchitis, putting him at severe risk for pneumonia. Otherwise, he has no problems functioning. Which type of
SNP is likely to be most appropriate for him? - Answer- C-SNP
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? - Answer- She can enroll in the PPO, but she will not be
able to purchase a stand-alone Medicare Part D prescription drug plan
Mrs. Willard wants to know generally how the benefits under Original Medicare might compare to the benefits package of a Medicare Advantage Plan before she starts looking at specific plans. What could you tell her? - Answer- Medicare Advantage Plans may offer extra benefits that Original Medicare does not offer such as vision, hearing, and dental services and must include a maximum out-of-pocket limit on Part A and Part B services.
Mrs. Walters is enrolled in her state's Medicaid program in addition to Medicare. What should she be aware of when considering enrollment in a Medicare Advantage (MA) plan? - Answer- She cannot enroll in an MA Medical Savings Account (MSA) plan
Mrs. Andrews asked how a Private Fee-for-Service (PFFS) plan might affect her access
to services since she receives some assistance for her health care costs from the State.
What should you tell her? - Answer- Medicaid may provide additional benefits, but Medicaid will only pay for these services if they are furnished by Medicaid participating providers.
Mrs. Kelly, age 65, is entitled to Part A but has not yet enrolled in Part B. She is considering enrollment in a Medicare Advantage plan (Part C). What should you advise her to do before she will be able to enroll in a Medicare Advantage plan? - Answer- To join a Medicare Advantage plan, she also must enroll in Part B.
Mr. Lopez has heard that he can sign up for a product called "Medicare Advantage" but is not sure about what type of plan designs are available through this program. What should you tell him about the types of health plans that are available through the Medicare Advantage program? - Answer- They are Medicare health plans such as HMOs, PPOs, PFFS, and MSAs.
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? - 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.
Daniel is a middle-income Medicare beneficiary. He has chronic bronchitis, putting him at severe risk for pneumonia. Otherwise, he has no problems functioning. Which type of
SNP is likely to be most appropriate for him? - Answer- C-SNP
