AHIP2024 MODULE 2
Mr. Gomez notes that a Private Fee-for-Service (PFFS) plan available in his area has an
attractive premium. He wants to know if he must use doctors in a network as his current HMO
plan requires him to do. What should you tell him? - ANSHe may receive health care services
from any doctor allowed to bill Medicare, as long as he shows the doctor the plan's identification
card and the doctor agrees to accept the PFFS plan's payment terms and conditions, which
could include balance billing.
Juan Hernandez is turning 65 next month, Juan legally entered the United States over twenty
years ago but is not a citizen. Since his entry into the country, Juan has worked at Smallcap
Incorporated and contributed to the Medicare system. Juan suffers from diabetes. He will soon
retire and asks you if he can enroll in a Medicare Advantage plan that you represent. How would
you respond? - ANSJuan is eligible to enroll in a Medicare Advantage as long as he is entitled
to Part A and enrolled in Part B. Juan should go to the Social Security website to enroll in
Medicare Part A and B if he has not done so already. Once he is enrolled, he can choose a
Medicare Advantage plan.
Mr. Castillo, a naturalized citizen, previously enrolled in Medicare Part B but has recently
stopped paying his Part B premium. Mr. Castillo is still covered by Part A. He would like to enroll
in a Medicare Advantage (MA) plan and is still covered by Part A. What should you tell him? -
ANSHe is not eligible to enroll in a Medicare Advantage plan until he re-enrolls in Medicare Part
B.
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? - ANSB. 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 part of the PPO network.
Correct
Mr. Kumar is considering a Medicare Advantage HMO and has questions about his ability to
access providers. What should you tell him? - ANSIn Medicare Advantage HMO plans, services
provided by primary care physicians are covered at 100%, but those of specialists are covered
at 80% ?
Mrs. Chi is age 75 and enjoys a comfortable but not extremely high-income level. She wishes to
enroll in a MA MSA plan that she heard about from her neighbor. She also wants to have
prescription drug coverage since her doctor recently prescribed several expensive medications.
Currently, she is enrolled in Original Medicare and a standalone Part D plan. How would you
advise Mrs. Chi? - ANSMrs. Chi may enroll in a MA MSA plan and remain in her current
standalone Part D prescription drug plan.
Mr. Gomez notes that a Private Fee-for-Service (PFFS) plan available in his area has an
attractive premium. He wants to know if he must use doctors in a network as his current HMO
plan requires him to do. What should you tell him? - ANSHe may receive health care services
from any doctor allowed to bill Medicare, as long as he shows the doctor the plan's identification
card and the doctor agrees to accept the PFFS plan's payment terms and conditions, which
could include balance billing.
Juan Hernandez is turning 65 next month, Juan legally entered the United States over twenty
years ago but is not a citizen. Since his entry into the country, Juan has worked at Smallcap
Incorporated and contributed to the Medicare system. Juan suffers from diabetes. He will soon
retire and asks you if he can enroll in a Medicare Advantage plan that you represent. How would
you respond? - ANSJuan is eligible to enroll in a Medicare Advantage as long as he is entitled
to Part A and enrolled in Part B. Juan should go to the Social Security website to enroll in
Medicare Part A and B if he has not done so already. Once he is enrolled, he can choose a
Medicare Advantage plan.
Mr. Castillo, a naturalized citizen, previously enrolled in Medicare Part B but has recently
stopped paying his Part B premium. Mr. Castillo is still covered by Part A. He would like to enroll
in a Medicare Advantage (MA) plan and is still covered by Part A. What should you tell him? -
ANSHe is not eligible to enroll in a Medicare Advantage plan until he re-enrolls in Medicare Part
B.
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? - ANSB. 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 part of the PPO network.
Correct
Mr. Kumar is considering a Medicare Advantage HMO and has questions about his ability to
access providers. What should you tell him? - ANSIn Medicare Advantage HMO plans, services
provided by primary care physicians are covered at 100%, but those of specialists are covered
at 80% ?
Mrs. Chi is age 75 and enjoys a comfortable but not extremely high-income level. She wishes to
enroll in a MA MSA plan that she heard about from her neighbor. She also wants to have
prescription drug coverage since her doctor recently prescribed several expensive medications.
Currently, she is enrolled in Original Medicare and a standalone Part D plan. How would you
advise Mrs. Chi? - ANSMrs. Chi may enroll in a MA MSA plan and remain in her current
standalone Part D prescription drug plan.
