Module 2 AHIP
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? - ANSC-SNP
Mrs. Davenport enrolled in the ABC Medicare Advantage (MA) plan several years ago. In
mid-February of 2021, her doctor confirms a diagnosis of end-stage renal disease (ESRD).
What options will Mrs. Davenport have regarding her MA plan during the next open enrollment
season? - ANSShe may remain in her ABC MA plan, enroll in another MA plan in her service
area, or enroll in a Special Needs Plan (SNP) for individuals suffering from ESRD if one is
available in her area.
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. Kumar is considering a Medicare Advantage HMO and has questions about his ability to
access providers. What should you tell him? - ANSIn most Medicare Advantage HMOs, Mr.
Kumar must generally obtain his services only from providers within the plan's network (except
in an emergency or where care is unavailable within the network).
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? - ANSSNPs have special programs for
enrollees with chronic conditions, like Mr. Sinclair, and they provide prescription drug coverage
that could be very helpful as well.
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.
Mr. Lombardi is interested in a Medicare Advantage (MA) PPO plan that you represent. It is one
of three plans operated by the same organization in Mr. Lombardi's area. The MA PPO plan
does not include drug coverage, but the other two plans do. Mr. Lombardi likes the PPO plan
that does not include drug coverage and intends to obtain his drug coverage through a
stand-alone Medicare prescription drug plan. What should you tell him about this situation? -
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? - ANSC-SNP
Mrs. Davenport enrolled in the ABC Medicare Advantage (MA) plan several years ago. In
mid-February of 2021, her doctor confirms a diagnosis of end-stage renal disease (ESRD).
What options will Mrs. Davenport have regarding her MA plan during the next open enrollment
season? - ANSShe may remain in her ABC MA plan, enroll in another MA plan in her service
area, or enroll in a Special Needs Plan (SNP) for individuals suffering from ESRD if one is
available in her area.
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. Kumar is considering a Medicare Advantage HMO and has questions about his ability to
access providers. What should you tell him? - ANSIn most Medicare Advantage HMOs, Mr.
Kumar must generally obtain his services only from providers within the plan's network (except
in an emergency or where care is unavailable within the network).
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? - ANSSNPs have special programs for
enrollees with chronic conditions, like Mr. Sinclair, and they provide prescription drug coverage
that could be very helpful as well.
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.
Mr. Lombardi is interested in a Medicare Advantage (MA) PPO plan that you represent. It is one
of three plans operated by the same organization in Mr. Lombardi's area. The MA PPO plan
does not include drug coverage, but the other two plans do. Mr. Lombardi likes the PPO plan
that does not include drug coverage and intends to obtain his drug coverage through a
stand-alone Medicare prescription drug plan. What should you tell him about this situation? -
