Entertaining AHIP 2025
1. A beneficiary lately lost her enterprise group fitness and drug insurance and now she
desires to join in a PPO that does not consist of drug insurance. What should you inform
her about obtaining drug insurance? - ANS-She can enroll in a PPO with out drug
coverage. However, If a beneficiary enrolls in a MA plan that is an HMO or PPO plan that
doesn't consist of Part D coverage, the beneficiary cannot be a part of a standalone
Prescription Drug Plan (PDP).
2. A purchaser enjoys a cozy retirement income. He currently had surgical procedure and
anticipated that he would have sure services and items blanketed via the plan with
minimal out-of-pocket prices due to the fact his MA-PD coverage has been excellent.
However, while he acquired the invoice, he become surprised to peer huge prices in
extra of his maximum out-of-pocket restrict that blanketed a few offerings and gadgets
he thought might be completely covered. He known as you to invite what he could do?
What ought to you inform him? - ANS-Medicare Advantage (MA) plan enrollees have a
right to gain a evaluation (enchantment) to positive selections about fitness care price,
coverage of services, or prescription drug insurance. Medicare fitness plans must offer
enrollees with a written description of the appeals process.
3. A purchaser is enrolled in her kingdom's Medicaid program further to Medicare. What
should she be aware of whilst considering enrollment in a Medicare Advantage (MA)
plan? - ANS-The consumer is a twin-eligible. Dual-eligible beneficiaries might also enroll
in any sort of MA plan except a MA Medical Savings Account (MSA) plan.
4. A capacity consumer calls and asks whether there are any special eligibility necessities
for Medicare Advantage. What have to you tell her? - ANS-To be eligible to enroll in
Medicare Advantage, an individual need to be entitled (no longer enrolled) to Part A and
enrolled in Part B.
5. A potential customer has heard that he can join up for a product referred to as "Medicare
Advantage" but is not certain approximately what sort of plan designs are to be had via
this program. What must you inform him approximately the sorts of fitness plans which
can be available through the Medicare Advantage application? - ANS-There are
coordinated care Medicare Advantage plans that include HMOs and PPOs. There are
also Private-Fee-for-Service (PFFS), Medicare Savings Account (MSA), and Special
Needs Plans (SNPs)
6. Benefits of Medicare Prescription Payment Plan - ANS-Expanding blessings, lowering
drug prices, and enhancing the sustainability of the Medicare software
7. Dolly Pardon is in absolutely right fitness, uses a unmarried prescription, and lives
independently in her personal domestic. She is attracted by the idea of keeping
manipulate over a Medical Savings Account (MSA) however isn't sure if the plan related
to the account will healthy her wishes. What unique piece of statistics about a Medicare
MSA plan wouldn't it be critical for her to recognise, previous to enrolling in this kind of
, plan? - ANS-MSA enrollees need to join in a stand-by myself prescription drug plan
(PDP) if they want prescription drug blessings.
8. Dr. DoLittle does not contract with the ABC PFFS plan but accepts the plan's phrases
and conditions for payment. Mary Rodgers sees Dr. DoLittle for remedy. How tons may
also Dr. DoLittle fee? - ANS-This physician can fee Mary Rogers no extra than the price
sharing specified in the PFFS plan's terms and condition of price which may additionally
encompass stability billing as much as 15%of the Medicare charge. Because Dr. DoLittle
accepts the plan's terms and conditions for charge, she is allowed to rate this quantity.
9. Drew Looksatme is 64, retiring soon, and considering enrollment in his
employer-sponsored retiree group health plan that consists of drug coverage with
nominal copays. He heard approximately a neighbor's MA-PD plan that you constitute
and due to the fact he is taking severa prescribed drugs, he's thinking about signing up
for it. What need to you tell him? - ANS-The sort of Medicare Advantage plans offered
range via employers. Therefore, beneficiaries must evaluate their corporation's retiree
plan with different available plan options.
10. Dua Lippa cares for her frail aged mom, Maria, who lives in North Carolina. She is
worried that without additional help, her mom will need to enter a nursing home. Ms.
Lippa asks you if there is any Medicare plan that could permit her mother to remain
inside the community instead of going right into a nursing domestic. How have to you
advocate Ms. Lippa? - ANS-There are Programs of All-Inclusive Care for the Elderly
(PACE) for frail elderly beneficiaries certified as needing a nursing domestic level of care
however are capable of live competently in the community on the time of enrolment.
11. Eleanor Rigby is enrolled in a Medicare Advantage plan that consists of prescription drug
plan (PDP) coverage. She is traveling and wishes to fill two of the prescriptions that she
has misplaced. How might you suggest her? - ANS-She may additionally fill prescriptions
for included drugs at non-community pharmacies, however likely at a better fee than paid
at an in-community pharmacy.
12. George Clonie has just became sixty five and is entitled to Part A however has not
enrolled in Part B due to the fact he has insurance through an corporation plan. If he
desires to sign up in a Medicare Advantage plan, what is going to he should do? -
ANS-To be eligible to enroll in a Medicare Advantage plan, a beneficiary have to be
entitled to Part A and enrolled in Part B.
13. Gramcicle is enrolled in a value plan for her Medicare blessings. She has recently lost
creditable insurance previously available via her husband's employer. She is interested
by enrolling in a Medicare Part D prescription drug plan (PDP). - ANS-She is enrolled in
a Cost plan. This offers her with alternatives as to how she secures Part D blessings.
Beneficiaries enrolled in a Cost plan may also gain Part D blessings via their plan (if
supplied) or via a stand-on my own (PDP).
14. Hank's Fish Store, Inc. Is a small employer with just 15 employees placed in Florida.
Hankie, the store owner, has provided remarkable health advantages to the shop's body
of workers. William, considered one of the store's long-time personnel, will soon be
accomplishing age sixty five and eligible for Medicare. William is in exact health. He
intends to remain an lively complete-time worker, operating several years after turning
into eligible for Medicare. What kind(s) of retiree fitness benefit will Hank's Fish Store be
1. A beneficiary lately lost her enterprise group fitness and drug insurance and now she
desires to join in a PPO that does not consist of drug insurance. What should you inform
her about obtaining drug insurance? - ANS-She can enroll in a PPO with out drug
coverage. However, If a beneficiary enrolls in a MA plan that is an HMO or PPO plan that
doesn't consist of Part D coverage, the beneficiary cannot be a part of a standalone
Prescription Drug Plan (PDP).
2. A purchaser enjoys a cozy retirement income. He currently had surgical procedure and
anticipated that he would have sure services and items blanketed via the plan with
minimal out-of-pocket prices due to the fact his MA-PD coverage has been excellent.
However, while he acquired the invoice, he become surprised to peer huge prices in
extra of his maximum out-of-pocket restrict that blanketed a few offerings and gadgets
he thought might be completely covered. He known as you to invite what he could do?
What ought to you inform him? - ANS-Medicare Advantage (MA) plan enrollees have a
right to gain a evaluation (enchantment) to positive selections about fitness care price,
coverage of services, or prescription drug insurance. Medicare fitness plans must offer
enrollees with a written description of the appeals process.
3. A purchaser is enrolled in her kingdom's Medicaid program further to Medicare. What
should she be aware of whilst considering enrollment in a Medicare Advantage (MA)
plan? - ANS-The consumer is a twin-eligible. Dual-eligible beneficiaries might also enroll
in any sort of MA plan except a MA Medical Savings Account (MSA) plan.
4. A capacity consumer calls and asks whether there are any special eligibility necessities
for Medicare Advantage. What have to you tell her? - ANS-To be eligible to enroll in
Medicare Advantage, an individual need to be entitled (no longer enrolled) to Part A and
enrolled in Part B.
5. A potential customer has heard that he can join up for a product referred to as "Medicare
Advantage" but is not certain approximately what sort of plan designs are to be had via
this program. What must you inform him approximately the sorts of fitness plans which
can be available through the Medicare Advantage application? - ANS-There are
coordinated care Medicare Advantage plans that include HMOs and PPOs. There are
also Private-Fee-for-Service (PFFS), Medicare Savings Account (MSA), and Special
Needs Plans (SNPs)
6. Benefits of Medicare Prescription Payment Plan - ANS-Expanding blessings, lowering
drug prices, and enhancing the sustainability of the Medicare software
7. Dolly Pardon is in absolutely right fitness, uses a unmarried prescription, and lives
independently in her personal domestic. She is attracted by the idea of keeping
manipulate over a Medical Savings Account (MSA) however isn't sure if the plan related
to the account will healthy her wishes. What unique piece of statistics about a Medicare
MSA plan wouldn't it be critical for her to recognise, previous to enrolling in this kind of
, plan? - ANS-MSA enrollees need to join in a stand-by myself prescription drug plan
(PDP) if they want prescription drug blessings.
8. Dr. DoLittle does not contract with the ABC PFFS plan but accepts the plan's phrases
and conditions for payment. Mary Rodgers sees Dr. DoLittle for remedy. How tons may
also Dr. DoLittle fee? - ANS-This physician can fee Mary Rogers no extra than the price
sharing specified in the PFFS plan's terms and condition of price which may additionally
encompass stability billing as much as 15%of the Medicare charge. Because Dr. DoLittle
accepts the plan's terms and conditions for charge, she is allowed to rate this quantity.
9. Drew Looksatme is 64, retiring soon, and considering enrollment in his
employer-sponsored retiree group health plan that consists of drug coverage with
nominal copays. He heard approximately a neighbor's MA-PD plan that you constitute
and due to the fact he is taking severa prescribed drugs, he's thinking about signing up
for it. What need to you tell him? - ANS-The sort of Medicare Advantage plans offered
range via employers. Therefore, beneficiaries must evaluate their corporation's retiree
plan with different available plan options.
10. Dua Lippa cares for her frail aged mom, Maria, who lives in North Carolina. She is
worried that without additional help, her mom will need to enter a nursing home. Ms.
Lippa asks you if there is any Medicare plan that could permit her mother to remain
inside the community instead of going right into a nursing domestic. How have to you
advocate Ms. Lippa? - ANS-There are Programs of All-Inclusive Care for the Elderly
(PACE) for frail elderly beneficiaries certified as needing a nursing domestic level of care
however are capable of live competently in the community on the time of enrolment.
11. Eleanor Rigby is enrolled in a Medicare Advantage plan that consists of prescription drug
plan (PDP) coverage. She is traveling and wishes to fill two of the prescriptions that she
has misplaced. How might you suggest her? - ANS-She may additionally fill prescriptions
for included drugs at non-community pharmacies, however likely at a better fee than paid
at an in-community pharmacy.
12. George Clonie has just became sixty five and is entitled to Part A however has not
enrolled in Part B due to the fact he has insurance through an corporation plan. If he
desires to sign up in a Medicare Advantage plan, what is going to he should do? -
ANS-To be eligible to enroll in a Medicare Advantage plan, a beneficiary have to be
entitled to Part A and enrolled in Part B.
13. Gramcicle is enrolled in a value plan for her Medicare blessings. She has recently lost
creditable insurance previously available via her husband's employer. She is interested
by enrolling in a Medicare Part D prescription drug plan (PDP). - ANS-She is enrolled in
a Cost plan. This offers her with alternatives as to how she secures Part D blessings.
Beneficiaries enrolled in a Cost plan may also gain Part D blessings via their plan (if
supplied) or via a stand-on my own (PDP).
14. Hank's Fish Store, Inc. Is a small employer with just 15 employees placed in Florida.
Hankie, the store owner, has provided remarkable health advantages to the shop's body
of workers. William, considered one of the store's long-time personnel, will soon be
accomplishing age sixty five and eligible for Medicare. William is in exact health. He
intends to remain an lively complete-time worker, operating several years after turning
into eligible for Medicare. What kind(s) of retiree fitness benefit will Hank's Fish Store be
