Ahip 2025 Module 2
1. Dr. Elizabeth Brennan does now not agreement with the ABC PFFS plan however
accepts the plan's phrases and situations for charge. Mary Rodgers sees Dr. Brennan
for remedy. How an awful lot may also Dr. Brennan rate? - ANS-Dr. Brennan can price
Mary Rogers no more than the price sharing detailed in the PFFS plan's terms and
circumstance of charge which can also include balance billing up to 15%of the Medicare
fee.
2. Hank's Fish Store, Inc. Is a small company with just 15 employees placed in Florida.
Hank, the store proprietor, has furnished brilliant fitness blessings to the store's team of
workers. William, one in every of the store's long-time employees, will soon be achieving
age 65 and eligible for Medicare. William is in properly fitness. He intends to remain an
active complete-time worker, working several years after turning into eligible for
Medicare. What kind(s) of retiree fitness benefit will Hank's Fish Store be able to provide
William? - ANS-Hank's can keep to provide William the same worker fitness gain plan,
or, if William enrolls in Medicare Part B, it could enroll him in a Medicare Advantage plan
that is presented to the general public.
3. Mr. Barker enjoys a secure retirement earnings. He currently had surgical operation and
anticipated that he might have certain offerings and objects included by means of the
plan with minimum out-of-pocket fees due to the fact his MA-PD insurance has been
excellent. However, whilst he received the invoice, he become amazed to peer huge
costs in excess of his most out-of-pocket restriction that blanketed some services and
gadgets he thought would be fully covered. He known as you to invite what he could do?
What may want to you tell him? - ANS-You can provide to check the plans appeal
procedure to assist him ask the plan to review the coverage choice.
4. Mr. Kelly wants to understand whether he's eligible to enroll in a non-public
charge-for-service (PFFS) plan. What questions could you want to invite to decide his
eligibility? - ANS-You might want to ask Mr. Kelly if he's enrolled in Part A and Part B and
if his doctor will take delivery of the phrases and situations of charge of the PFFS plan.
5. Mr. Lombardi is interested in a Medicare Advantage (MA) PPO plan that you represent. It
is one in all three plans operated by using the equal enterprise in Mr. Lombardi's
location. The MA PPO plan does now not encompass drug coverage, however the other
two plans do. Mr. Lombardi likes the PPO plan that doesn't consist of drug insurance and
intends to acquire his drug insurance via a stand-alone Medicare prescription drug plan.
What should you inform him approximately this example? - ANS-He ought to join either
in one of the MA plans that encompass prescription drug insurance or Original Medicare
with a Medigap plan and standalone Part D prescription drug coverage, however he
can't sign up inside the MA-most effective PPO plan and a stand-by myself prescription
drug plan.
6. Mr. Lopez has heard that he can sign up for a product referred to as "Medicare
Advantage" however is not certain about what form of plan designs are available through
1. Dr. Elizabeth Brennan does now not agreement with the ABC PFFS plan however
accepts the plan's phrases and situations for charge. Mary Rodgers sees Dr. Brennan
for remedy. How an awful lot may also Dr. Brennan rate? - ANS-Dr. Brennan can price
Mary Rogers no more than the price sharing detailed in the PFFS plan's terms and
circumstance of charge which can also include balance billing up to 15%of the Medicare
fee.
2. Hank's Fish Store, Inc. Is a small company with just 15 employees placed in Florida.
Hank, the store proprietor, has furnished brilliant fitness blessings to the store's team of
workers. William, one in every of the store's long-time employees, will soon be achieving
age 65 and eligible for Medicare. William is in properly fitness. He intends to remain an
active complete-time worker, working several years after turning into eligible for
Medicare. What kind(s) of retiree fitness benefit will Hank's Fish Store be able to provide
William? - ANS-Hank's can keep to provide William the same worker fitness gain plan,
or, if William enrolls in Medicare Part B, it could enroll him in a Medicare Advantage plan
that is presented to the general public.
3. Mr. Barker enjoys a secure retirement earnings. He currently had surgical operation and
anticipated that he might have certain offerings and objects included by means of the
plan with minimum out-of-pocket fees due to the fact his MA-PD insurance has been
excellent. However, whilst he received the invoice, he become amazed to peer huge
costs in excess of his most out-of-pocket restriction that blanketed some services and
gadgets he thought would be fully covered. He known as you to invite what he could do?
What may want to you tell him? - ANS-You can provide to check the plans appeal
procedure to assist him ask the plan to review the coverage choice.
4. Mr. Kelly wants to understand whether he's eligible to enroll in a non-public
charge-for-service (PFFS) plan. What questions could you want to invite to decide his
eligibility? - ANS-You might want to ask Mr. Kelly if he's enrolled in Part A and Part B and
if his doctor will take delivery of the phrases and situations of charge of the PFFS plan.
5. Mr. Lombardi is interested in a Medicare Advantage (MA) PPO plan that you represent. It
is one in all three plans operated by using the equal enterprise in Mr. Lombardi's
location. The MA PPO plan does now not encompass drug coverage, however the other
two plans do. Mr. Lombardi likes the PPO plan that doesn't consist of drug insurance and
intends to acquire his drug insurance via a stand-alone Medicare prescription drug plan.
What should you inform him approximately this example? - ANS-He ought to join either
in one of the MA plans that encompass prescription drug insurance or Original Medicare
with a Medigap plan and standalone Part D prescription drug coverage, however he
can't sign up inside the MA-most effective PPO plan and a stand-by myself prescription
drug plan.
6. Mr. Lopez has heard that he can sign up for a product referred to as "Medicare
Advantage" however is not certain about what form of plan designs are available through
