AHIP MODULE 2 ACTUAL EXAM 2024-2025 COMPLETE 80
QUESTIONS AND CORRECT DETAILED ANSWERS WITH
RATIONALES|ALREADY GRADED A+
Mr. Lopez has heard that he can sign up for a product called "Medicare Advantage" but is not sure about
what type of plan designs are available through this program. What should you tell him about the types
of health plans that are available through the Medicare Advantage program? - ANSWER-a. They are
Medicare health plans such as HMOs, PPOs, PFFS, and MSAs. Correct
Mr. Wells is trying to understand the difference between Original Medicare and Medicare Advantage.
What would be a correct description? - ANSWER-b. Medicare Advantage is a way of covering all the
Original Medicare benefits through private health insurance companies. Correct
Mrs. Radford asks whether there are any special eligibility requirements for Medicare Advantage. What
should you tell her? - ANSWER-d. Mrs. Radford must be entitled to Part A and enrolled in Part B to enroll
in Medicare Advantage. Correct
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? - ANSWER-a. He is not
eligible to enroll in a Medicare Advantage plan until he re-enrolls in Medicare Part B. Correct
Mrs. Billings enrolled in the ABC Medicare Advantage (MA) plan several years ago. Her doctor recently
confirmed a diagnosis of end-stage renal disease (ESRD). What options does Mrs. Billings have in regard
to her MA plan during the next open enrollment season? - ANSWER-d. She may remain in her ABC MA
plan or enroll in a Special Needs Plan (SNP) for individuals suffering from ESRD if one is available in her
area. Correct
Daniel is a middle-income Medicare beneficiary. He has chronic bronchitis, putting him at severe risk for
pneumonia. Otherwise, he has no problems functioning. Which type of SNP is likely to be most
appropriate for him? - ANSWER-b. C-SNP Correct
Mr. Kumar is considering a Medicare Advantage HMO and has questions about his ability to access
providers. What should you tell him? - ANSWER-a. In most Medicare Advantage HMOs, Mr. Kumar must
obtain his services only from providers who have a contractual relationship with the plan (except in an
emergency). Correct
,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? - ANSWER-d. 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. 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? - ANSWER-b. SNPs have special programs for enrollees with chronic
conditions, like Mr. Sinclair, and they provide prescription drug coverage that could be very helpful as
well. Correct
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? - ANSWER-c. SNPs limit enrollment to certain sub-populations of beneficiaries.
Given his current situation, he is unlikely to qualify and would not be able to enroll in the SNP. Correct
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 like his current HMO plan requires him
to do. What should you tell him? - ANSWER-a. 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.
Correct
Mrs. Lee is discussing with you the possibility of enrolling in a Private Fee-for-Service (PFFS) plan. As part
of that discussion, what should you be sure to tell her? - ANSWER-b. PFFS plans may choose to offer Part
D benefits but are not required to do so. Correct
Mr. McTaggert notes that a Private Fee-for-Service (PFFS) plan available in his area has an attractive
premium. He wants to know what makes them different from an HMO or a PPO. What should you tell
him? - ANSWER-d. Enrollees in a PFFS plan can obtain care from any provider in the U.S. who accepts
Original Medicare, as long as the provider has a reasonable opportunity to access the plan's terms and
conditions and agrees to accept them. Correct
Dr. Elizabeth Brennan does not contract with the PFFS plan but accepts the plan's terms and conditions
for payment. Mary Rodgers sees Dr. Brennan for treatment. How much may Dr. Brennan charge? -
, ANSWER-b. Dr. Brennan can charge Mary Rogers no more than the cost sharing specified in the PFFS
plan's terms and condition of payment which may include balance billing up to 15 percent of the
Medicare rate. Correct
Mrs. Lyons is in good health, uses a single prescription, and lives independently in her own home. She is
attracted by the idea of maintaining control over a Medical Savings Account (MSA), but is not sure if the
plan associated with the account will fit her needs. What specific piece of information about a Medicare
MSA plan would it be important for her to know, prior to enrolling in such a plan? - ANSWER-a. All MSAs
cover Part A and Part B benefits, but not Part D prescription drug benefits, which could be obtained by
also enrolling in a separate prescription drug plan. Correct
Which of the following statement is correct about Medicare Savings Account (MSA) Plans? I.
MSAs may have not have a network or may have a full or partial network of providers.
II. MSA plans must cover preventive services that have no cost sharing before the enrollee has met
the deductible.
III. An individual who is eligible for health care benefits through the Veteran's Administration may
enroll in an MSA.
IV. Non-network providers must accept the same amount that Original Medicare would pay them
as payment in full. - ANSWER-b. I, II, and IV only Correct
Mr. Davies is turning 65 next month. He would like to enroll in a Medicare health plan, but does not
want to be limited in terms of where he obtains his care. What should you tell him about how a
Medicare Cost Plan might fit his needs? - ANSWER-c. Cost plan enrollees can choose to receive Medicare
covered services under the plan's benefits by going to plan network providers and paying plan cost
sharing, or may receive services from non-network providers and pay cost-sharing due under Original
Medicare. Correct
For which of the following individuals would a Cost Plan be most appropriate? - ANSWER-b. Ms. Baker
who is enrolled in Medicare Part B and is willing to continue paying Part B premiums plus any plan
premiums. Correct
Which statement best describes PACE plans? - ANSWER-d. It includes comprehensive medical and social
service delivery systems using an interdisciplinary team approach in an adult day health center,
supplemented by in-home and referral services. Correct
QUESTIONS AND CORRECT DETAILED ANSWERS WITH
RATIONALES|ALREADY GRADED A+
Mr. Lopez has heard that he can sign up for a product called "Medicare Advantage" but is not sure about
what type of plan designs are available through this program. What should you tell him about the types
of health plans that are available through the Medicare Advantage program? - ANSWER-a. They are
Medicare health plans such as HMOs, PPOs, PFFS, and MSAs. Correct
Mr. Wells is trying to understand the difference between Original Medicare and Medicare Advantage.
What would be a correct description? - ANSWER-b. Medicare Advantage is a way of covering all the
Original Medicare benefits through private health insurance companies. Correct
Mrs. Radford asks whether there are any special eligibility requirements for Medicare Advantage. What
should you tell her? - ANSWER-d. Mrs. Radford must be entitled to Part A and enrolled in Part B to enroll
in Medicare Advantage. Correct
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? - ANSWER-a. He is not
eligible to enroll in a Medicare Advantage plan until he re-enrolls in Medicare Part B. Correct
Mrs. Billings enrolled in the ABC Medicare Advantage (MA) plan several years ago. Her doctor recently
confirmed a diagnosis of end-stage renal disease (ESRD). What options does Mrs. Billings have in regard
to her MA plan during the next open enrollment season? - ANSWER-d. She may remain in her ABC MA
plan or enroll in a Special Needs Plan (SNP) for individuals suffering from ESRD if one is available in her
area. Correct
Daniel is a middle-income Medicare beneficiary. He has chronic bronchitis, putting him at severe risk for
pneumonia. Otherwise, he has no problems functioning. Which type of SNP is likely to be most
appropriate for him? - ANSWER-b. C-SNP Correct
Mr. Kumar is considering a Medicare Advantage HMO and has questions about his ability to access
providers. What should you tell him? - ANSWER-a. In most Medicare Advantage HMOs, Mr. Kumar must
obtain his services only from providers who have a contractual relationship with the plan (except in an
emergency). Correct
,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? - ANSWER-d. 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. 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? - ANSWER-b. SNPs have special programs for enrollees with chronic
conditions, like Mr. Sinclair, and they provide prescription drug coverage that could be very helpful as
well. Correct
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? - ANSWER-c. SNPs limit enrollment to certain sub-populations of beneficiaries.
Given his current situation, he is unlikely to qualify and would not be able to enroll in the SNP. Correct
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 like his current HMO plan requires him
to do. What should you tell him? - ANSWER-a. 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.
Correct
Mrs. Lee is discussing with you the possibility of enrolling in a Private Fee-for-Service (PFFS) plan. As part
of that discussion, what should you be sure to tell her? - ANSWER-b. PFFS plans may choose to offer Part
D benefits but are not required to do so. Correct
Mr. McTaggert notes that a Private Fee-for-Service (PFFS) plan available in his area has an attractive
premium. He wants to know what makes them different from an HMO or a PPO. What should you tell
him? - ANSWER-d. Enrollees in a PFFS plan can obtain care from any provider in the U.S. who accepts
Original Medicare, as long as the provider has a reasonable opportunity to access the plan's terms and
conditions and agrees to accept them. Correct
Dr. Elizabeth Brennan does not contract with the PFFS plan but accepts the plan's terms and conditions
for payment. Mary Rodgers sees Dr. Brennan for treatment. How much may Dr. Brennan charge? -
, ANSWER-b. Dr. Brennan can charge Mary Rogers no more than the cost sharing specified in the PFFS
plan's terms and condition of payment which may include balance billing up to 15 percent of the
Medicare rate. Correct
Mrs. Lyons is in good health, uses a single prescription, and lives independently in her own home. She is
attracted by the idea of maintaining control over a Medical Savings Account (MSA), but is not sure if the
plan associated with the account will fit her needs. What specific piece of information about a Medicare
MSA plan would it be important for her to know, prior to enrolling in such a plan? - ANSWER-a. All MSAs
cover Part A and Part B benefits, but not Part D prescription drug benefits, which could be obtained by
also enrolling in a separate prescription drug plan. Correct
Which of the following statement is correct about Medicare Savings Account (MSA) Plans? I.
MSAs may have not have a network or may have a full or partial network of providers.
II. MSA plans must cover preventive services that have no cost sharing before the enrollee has met
the deductible.
III. An individual who is eligible for health care benefits through the Veteran's Administration may
enroll in an MSA.
IV. Non-network providers must accept the same amount that Original Medicare would pay them
as payment in full. - ANSWER-b. I, II, and IV only Correct
Mr. Davies is turning 65 next month. He would like to enroll in a Medicare health plan, but does not
want to be limited in terms of where he obtains his care. What should you tell him about how a
Medicare Cost Plan might fit his needs? - ANSWER-c. Cost plan enrollees can choose to receive Medicare
covered services under the plan's benefits by going to plan network providers and paying plan cost
sharing, or may receive services from non-network providers and pay cost-sharing due under Original
Medicare. Correct
For which of the following individuals would a Cost Plan be most appropriate? - ANSWER-b. Ms. Baker
who is enrolled in Medicare Part B and is willing to continue paying Part B premiums plus any plan
premiums. Correct
Which statement best describes PACE plans? - ANSWER-d. It includes comprehensive medical and social
service delivery systems using an interdisciplinary team approach in an adult day health center,
supplemented by in-home and referral services. Correct
