MY AHIP Exam | Questions & 100% Correct Answers (Verified) | Latest Update | Grade A+

Mr.Gomez notes that a Private Fee for Service (PFFS) plan avaliable in his area has an attractive preminum. 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? Correct Answer: He 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. Mrs. Lee is discussing with you the possibility of enrolling in a Private Fee- for Service (PFFS) plan. As part of that discussion, what should you be sure to tell her? Correct Answer: PFFS plans may choose to offer Part D benefits but are not required to do so. 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? 2 Correct 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 apart of the PPO network. Mr. McTaggert notes that a Private Fee for-Service (PFFS) plan avaliable in his area has an attractive premium. He wants to know what makes them different from an HMO or a PPO. What should you tell him? Correct Answer: Enrollees in a PFFS plan can obtain care from any provider in the US who accepts Original Medicare, as long as the provider has a reasonable opportunity to access the plan's terms and conditions and agrees to accept them. 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? Correct Answer: He is not eligible to enroll in a Medicare Advantage plan until he reenrolls in Medicare Part B. Mr. Sinclar has diabetes and heart trouble and is generally satisified with the care he has just received under Original Medicare, but he would like to know more about Medicare Advantage Special Needs Plans (SNPs). What could you tell him? 3 Correct Answer: SNPs have special programs from enrollees with chronic conditions, like Mr. Sinclair and they provide prescription drug coverage that could be very helpful as well. Mrs.Davenport enrolled in the ABC Medicare Advantage (MA) plan several years ago. Her doctor recently confirmed a diagnosis of end-stage renal disease (ESRD). What options does Mrs.Davenport have regarding her MA plan during the next open enrollment season? Correct Answer: She may remain in her ABC MA plan or enroll in a Special Needs Plan (SNP) for individuals sufferinf from ESRD if one is available in her area. Daniel is a middle-income Medicare beneficiary. He has chronic bronchitis putting hi