AHIP Module 2 QUESTIONS AND
ANSWERS 2023
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?
Correct Answer: c. 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? Correct Answer: a. 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? Correct Answer: b. 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? Correct 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? Correct Answer:
a. 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? Correct Answer: a. 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? Correct Answer: d. 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? Correct 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. 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? Correct 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? Correct Answer: b. 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? Correct Answer: b. 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? Correct Answer: c. PFFS
plans may choose to offer Part D benefits but are not required to do so. Correct
ANSWERS 2023
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?
Correct Answer: c. 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? Correct Answer: a. 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? Correct Answer: b. 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? Correct 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? Correct Answer:
a. 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? Correct Answer: a. 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? Correct Answer: d. 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? Correct 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. 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? Correct 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? Correct Answer: b. 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? Correct Answer: b. 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? Correct Answer: c. PFFS
plans may choose to offer Part D benefits but are not required to do so. Correct
