AHIP 2024 MODULE 2 Quiz (20
Questions) – All Correct (100% Expert
Verified)
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? - ANSWER - 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? - ANSWER - 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? - ANSWER - 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? - ANSWER - 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? - ANSWER - 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? - ANSWER - Mrs. Chi may enroll in a MA
MSA plan and remain in her current standalone Part D prescription drug plan.
Questions) – All Correct (100% Expert
Verified)
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? - ANSWER - 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? - ANSWER - 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? - ANSWER - 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? - ANSWER - 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? - ANSWER - 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? - ANSWER - Mrs. Chi may enroll in a MA
MSA plan and remain in her current standalone Part D prescription drug plan.
