Module 2 Final Review Complete Solutions

Module 2 Final Review Complete Solutions Question 1: What options does Mrs. Davenport have regarding her Medicare Advantage (MA) plan after being diagnosed with end-stage renal disease (ESRD)? a. Enroll in another MA plan in her service area b. Enroll in a Special Needs Plan (SNP) for individuals suffering from ESRD if one is available c. Remain in her current ABC MA plan d. All of the above Correct answer: d. All of the above Question 2: How does a Private Fee-for-Service (PFFS) plan differ from an HMO or PPO? a. Enrollees in a PFFS plan must use a specific network of providers b. Enrollees in a PFFS plan can obtain care from any provider in the U.S. who accepts Original Medicare c. Enrollees in a PFFS plan can only see doctors who participate in the plan's network d. None of the above Correct answer: b. Enrollees in a PFFS plan can obtain care from any provider in the U.S. who accepts Original Medicare Question 3: What are the benefits of Medicare Advantage Plans compared to Original Medicare? a. Medicare Advantage Plans offer extra benefits that Original Medicare does not, such as vision, hearing, and dental services b. Medicare Advantage Plans do not offer extra benefits that Original Medicare does not c. Medicare Advantage Plans are more expensive than Original Medicare d. None of the above Correct answer: a. Medicare Advantage Plans offer extra benefits that Original Medicare does not, such as vision, hearing, and dental services 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? ️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. Mrs. Chou likes a Private Fee-for-Service (PFFS) plan available in her area that does not include drug coverage. She wants to enroll in the plan and enroll in a stand-alone prescription drug plan. What should you tell her? ️She could enroll in a PFFS plan and a stand-alone Medicare 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? ️In most Medicare Advantage HMOs, Mr. Kumar must generally obtain his services only from providers who have a contractual relationship with the plan (except in an emergency or where care is unavailable within the network). Mr. Barker enjoys a comfortable retirement income. He recently had surgery and expected that he would have certain services and items covered by the plan with minimal out-of-pocket costs because his MA-PD coverage has been very good. However, when he received the bill, he was surprised to see large charges in excess of his maximum out-of-pocket limit that included a number of services and items he thought would be fully covered. He called you to ask what he could do? What could you tell him? ️You can offer to review the plans appeal process to help him ask the plan to review the coverage decision. Mr. Greco is in excellent health, lives in his own home, and has a sizeable income from his investments. He has a friend enrolled in a Medicare Advantage Special Needs Plan (SNP). His friend has mentioned that the SNP charges very low cost-sharing amounts and Mr. Greco would like to join that plan. What should you tell him? ️SNPs limit enrollment to certain subpopulations of beneficiaries. Given his current situation, he is unlikely to qualify and would not be able to enroll in the SNP. Mrs. Radford asks whether there are any special eligibility requirements for Medicare Advantage. What should you tell her? ️Mrs. Radford must be entitled to Part A and enrolled in Part B to enroll in Medicare Advantage.