AHIP Module 2
1. Daniel is a middle-earnings Medicare beneficiary. He has persistent bronchitis, setting
him at intense hazard for pneumonia. Otherwise, he has no problems functioning. Which
kind of SNP is probably to be most appropriate for him? - ANS-b. C-SNP Correct
2. Dr. Elizabeth Brennan does now not agreement with the PFFS plan but accepts the
plan's terms and conditions for fee. Mary Rodgers sees Dr. Brennan for remedy. How
plenty might also Dr. Brennan fee? - ANS-b. Dr. Brennan can rate Mary Rogers no extra
than the cost sharing precise inside the PFFS plan's phrases and circumstance of
payment which may additionally encompass balance billing up to 15 percentage of the
Medicare charge. Correct
3. For which of the following individuals might a Cost Plan be most appropriate? - ANS-b.
Ms. Baker who is enrolled in Medicare Part B and is willing to continue paying Part B
premiums plus any plan charges. Correct
4. Mr. Castillo, a naturalized citizen, previously enrolled in Medicare Part B however has
currently stopped paying his Part B premium. Mr. Castillo continues to be covered with
the aid of Part A. He would really like to join a Medicare Advantage (MA) plan and
continues to be protected by way of Part A. What have to you tell him? - ANS-a. He is
not eligible to join a Medicare Advantage plan till he re-enrolls in Medicare Part B.
Correct
5. Mr. Davies is turning sixty five next month. He would like to join a Medicare fitness plan,
but does not want to be restrained in terms of wherein he obtains his care. What need to
you tell him about how a Medicare Cost Plan might match his wishes? - ANS-c. Cost
plan enrollees can choose to receive Medicare covered services underneath the plan's
blessings by going to plot community companies and paying plan cost sharing, or may
additionally receive offerings from non-network carriers and pay value-sharing due
underneath Original Medicare. Correct
6. Mr. Gomez notes that a Private Fee-for-Service (PFFS) plan available in his area has an
attractive top class. He wants to recognise if he must use doctors in a network like his
present day HMO plan calls for him to do. What have to you inform him? - ANS-a. He
may additionally get hold of fitness care services from any doctor allowed to invoice
Medicare, as long as he shows the medical doctor the plan's identity card and the
medical doctor concurs to just accept the PFFS plan's price phrases and conditions,
which can include balance billing. Correct
7. Mr. Greco is in brilliant fitness, lives in his personal domestic, and has a huge income
from his investments. He has a pal enrolled in a Medicare Advantage Special Needs
Plan (SNP). His friend has noted that the SNP prices very low cost-sharing amounts and
Mr. Greco would like to join that plan. What have to you tell him? - ANS-c. SNPs restrict
enrollment to certain sub-populations of beneficiaries. Given his current scenario, he is
not going to qualify and might no longer be able to join in the SNP. Correct
1. Daniel is a middle-earnings Medicare beneficiary. He has persistent bronchitis, setting
him at intense hazard for pneumonia. Otherwise, he has no problems functioning. Which
kind of SNP is probably to be most appropriate for him? - ANS-b. C-SNP Correct
2. Dr. Elizabeth Brennan does now not agreement with the PFFS plan but accepts the
plan's terms and conditions for fee. Mary Rodgers sees Dr. Brennan for remedy. How
plenty might also Dr. Brennan fee? - ANS-b. Dr. Brennan can rate Mary Rogers no extra
than the cost sharing precise inside the PFFS plan's phrases and circumstance of
payment which may additionally encompass balance billing up to 15 percentage of the
Medicare charge. Correct
3. For which of the following individuals might a Cost Plan be most appropriate? - ANS-b.
Ms. Baker who is enrolled in Medicare Part B and is willing to continue paying Part B
premiums plus any plan charges. Correct
4. Mr. Castillo, a naturalized citizen, previously enrolled in Medicare Part B however has
currently stopped paying his Part B premium. Mr. Castillo continues to be covered with
the aid of Part A. He would really like to join a Medicare Advantage (MA) plan and
continues to be protected by way of Part A. What have to you tell him? - ANS-a. He is
not eligible to join a Medicare Advantage plan till he re-enrolls in Medicare Part B.
Correct
5. Mr. Davies is turning sixty five next month. He would like to join a Medicare fitness plan,
but does not want to be restrained in terms of wherein he obtains his care. What need to
you tell him about how a Medicare Cost Plan might match his wishes? - ANS-c. Cost
plan enrollees can choose to receive Medicare covered services underneath the plan's
blessings by going to plot community companies and paying plan cost sharing, or may
additionally receive offerings from non-network carriers and pay value-sharing due
underneath Original Medicare. Correct
6. Mr. Gomez notes that a Private Fee-for-Service (PFFS) plan available in his area has an
attractive top class. He wants to recognise if he must use doctors in a network like his
present day HMO plan calls for him to do. What have to you inform him? - ANS-a. He
may additionally get hold of fitness care services from any doctor allowed to invoice
Medicare, as long as he shows the medical doctor the plan's identity card and the
medical doctor concurs to just accept the PFFS plan's price phrases and conditions,
which can include balance billing. Correct
7. Mr. Greco is in brilliant fitness, lives in his personal domestic, and has a huge income
from his investments. He has a pal enrolled in a Medicare Advantage Special Needs
Plan (SNP). His friend has noted that the SNP prices very low cost-sharing amounts and
Mr. Greco would like to join that plan. What have to you tell him? - ANS-c. SNPs restrict
enrollment to certain sub-populations of beneficiaries. Given his current scenario, he is
not going to qualify and might no longer be able to join in the SNP. Correct
