AHIP2024 MODULE 2 QUESTIONS WITH
COMPLETE SOLUTION
n 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? - 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.
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? - Juan 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? - He 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? - B. 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? - In 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? - Mrs. Chi may enroll in
a MA MSA plan and remain in her current standalone Part D prescription drug plan.
Mr. Wells is trying to understand the difference between Original Medicare and Medicare Advantage.
What would be a correct description? - Medicare Advantage is a way of covering all the Original
Medicare benefits through private health insurance companies.
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? - SNPs have special programs for enrollees w chronic conditions like
mr.sinclair and they provide script drug coverage that could be very helpful as well
COMPLETE SOLUTION
n 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? - 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.
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? - Juan 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? - He 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? - B. 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? - In 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? - Mrs. Chi may enroll in
a MA MSA plan and remain in her current standalone Part D prescription drug plan.
Mr. Wells is trying to understand the difference between Original Medicare and Medicare Advantage.
What would be a correct description? - Medicare Advantage is a way of covering all the Original
Medicare benefits through private health insurance companies.
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? - SNPs have special programs for enrollees w chronic conditions like
mr.sinclair and they provide script drug coverage that could be very helpful as well
